Improved non-calcified plaque delineation on coronary CT angiography by sonogram-affirmed iterative reconstruction with different filter strength and relationship with BMI
Purpose: To prospectively compare non-calcified plaque delineation and image quality of coronary computed tomography angiography (CCTA) obtained with sinogram-affirmed iterative reconstruction (IR) with different filter strengths and filtered back projection (FBP).
Total Body Irradiation (TBI) is given
to prepare (condition) the patient’s body for bone marrow or stem cell transplant.
It is a special radio therapeutic technique
that delivers to a patient’s whole body, a
uniform dose within (+/-)10% of the
prescribed dose.
ASRT at 2015 RSNA Annual Meeting CT scanning Face Transplant Surgical PlanningFrank Rybicki
Frank Rybicki lecture at the 2015 Annual Meeting of the Radiological Society of North America (RSNA). This lecture was invited by the American Society of Radiologic Technologists (ASRT) and features amazing technologists from my past position in Boston Massachusetts, at Brigham and Women's Hospital. Many of these slides were generous provided by Bo Pomahac, MD, brilliant surgeon, caring physician, and wonderful friend. I have removed the images of Bo's patients. We have permission to publish them, but I wanted to play it safe to avoid any possible complaints
Total Body Irradiation (TBI) is given
to prepare (condition) the patient’s body for bone marrow or stem cell transplant.
It is a special radio therapeutic technique
that delivers to a patient’s whole body, a
uniform dose within (+/-)10% of the
prescribed dose.
ASRT at 2015 RSNA Annual Meeting CT scanning Face Transplant Surgical PlanningFrank Rybicki
Frank Rybicki lecture at the 2015 Annual Meeting of the Radiological Society of North America (RSNA). This lecture was invited by the American Society of Radiologic Technologists (ASRT) and features amazing technologists from my past position in Boston Massachusetts, at Brigham and Women's Hospital. Many of these slides were generous provided by Bo Pomahac, MD, brilliant surgeon, caring physician, and wonderful friend. I have removed the images of Bo's patients. We have permission to publish them, but I wanted to play it safe to avoid any possible complaints
A presentation regarding a analysis of the marketplace for stents and also how Abbott could enter the market with their new stent technology in order to acquire the most amount of customers.
Preliminary Evaluation of Clinical and Angiographic
Outcomes with Biodegradable Polymer Coated
Sirolimus-Eluting Stent in De Novo Coronary Artery Disease: Results of the MANIPAL-FLEX Study
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
What is New in Cardiac CT? In Search of the Comprehensive and Conclusive Hear...Apollo Hospitals
Coronary CT Angiography (CT) with its noninvasive cross sectional information has seen remarkable growth in recent years. With the introduction of the new generation scanners, like the 320-slice CT, it has risen to a whole new level. Percent diameter stenosis determined with the use of 320-slice CT shows good correlation with Invasive catheter angiogram (ICA) without significant underestimation or overestimation. Plaque composition on CT regardless of lesion severity has emerged as a strong predictor of major cardiac events. The percentage stenosis mismatch between CT and ICA can be explained by the 2 dimensional nature of ICA and its interpretive inconsistencies. In the upcoming years, we need to evolve from focusing on lumen stenosis to a comprehensive assessment of CAD and its impact on patient outcome.
A presentation regarding a analysis of the marketplace for stents and also how Abbott could enter the market with their new stent technology in order to acquire the most amount of customers.
Preliminary Evaluation of Clinical and Angiographic
Outcomes with Biodegradable Polymer Coated
Sirolimus-Eluting Stent in De Novo Coronary Artery Disease: Results of the MANIPAL-FLEX Study
24° CORSO RESIDENZIALE DI AGGIORNAMENTO
con il patrocinio dell’Associazione Italiana di Radioterapia Oncologica (AIRO)
Moderna Radioterapia, Nuove Tecnologie e Ipofrazionamento della Dose
21 marzo 2014: Trattamenti stereo-RT e radiochirurgici come opzioni standard di trattamento: stato dell’arte in base a linee guida internazionali
Similar to Improved non-calcified plaque delineation on coronary CT angiography by sonogram-affirmed iterative reconstruction with different filter strength and relationship with BMI
What is New in Cardiac CT? In Search of the Comprehensive and Conclusive Hear...Apollo Hospitals
Coronary CT Angiography (CT) with its noninvasive cross sectional information has seen remarkable growth in recent years. With the introduction of the new generation scanners, like the 320-slice CT, it has risen to a whole new level. Percent diameter stenosis determined with the use of 320-slice CT shows good correlation with Invasive catheter angiogram (ICA) without significant underestimation or overestimation. Plaque composition on CT regardless of lesion severity has emerged as a strong predictor of major cardiac events. The percentage stenosis mismatch between CT and ICA can be explained by the 2 dimensional nature of ICA and its interpretive inconsistencies. In the upcoming years, we need to evolve from focusing on lumen stenosis to a comprehensive assessment of CAD and its impact on patient outcome.
Unlike other modalities, MRI offers the capability to modulate both the emitted and received signals so that a multitude of tissue characteristics can be examined and differentiated without the need to change scanner hardware.
As a result, from a single imaging session, one could obtain a wealth of information regarding
cardiac function and morphology,
myocardial perfusion & viability,
hemodynamics,
large vessel anatomy.
CMR is now considered the gold standard for the assessment of regional and global systolic function, myocardial infarction (MI) and viability, and the assessment of congenital heart disease.
ThompsonEtal2013.pdfAccurate localization of incidental fi.docxherthalearmont
ThompsonEtal2013.pdf
Accurate localization of incidental findings on the computed
tomography attenuation correction image: the influence
of tube current variation
John Thompsona,c, Peter Hogga, Samantha Highamb and David Manninga,d
This observer performance study assessed lesion
detection in the computed tomography attenuation
correction image, as would be produced for myocardial
perfusion imaging over a tube current (mA) range. A static
anthropomorphic chest phantom containing simulated
pulmonary lesions was scanned using the four available
mA values (1, 1.5, 2 and 2.5) on a GE Infinia Hawkeye 4.
All other computed tomography acquisition parameters
remained constant throughout. Twenty-seven cases
showing zero to four lesions were produced for a
free-response receiver-operating characteristic method.
Image observations were completed using our novel
web-based ROCView software under controlled conditions.
The Jackknife alternative free-response receiver-operating
characteristic (JAFROC) figure of merit was used for
significance testing, wherein a difference in lesion
detection performance was considered significant
at P values less than 0.05. Twenty readers with varying
computed tomography experience (0–24 years) evaluated
108 images using an ordinal scale to score confidence.
The JAFROC analysis showed that there was no
statistically significant difference in performance between
mA values (P = 0.439) for this sample of observers.
In conclusion, no significant difference in lesion detection
performance was seen between the mA values. This
suggests that there is no value in using anything other
than the lowest mA value for the investigation of incidental
extracardiac findings. Nucl Med Commun 34:180–184 �c
2013 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Nuclear Medicine Communications 2013, 34:180–184
Keywords: computed tomography acquisition parameters,
dose optimization, free-response receiver-operating characteristic,
tube current
aUniversity of Salford, bPennine Acute Hospitals NHS Trust, Greater
Manchester, cUniversity Hospitals of Morecambe Bay NHS Foundation Trust,
Barrow-in-Furness and dLancaster University, Lancaster, UK
Correspondence to John Thompson, BSc (Hons), MSc, Nuclear Medicine
Department, Furness General Hospital, Dalton Lane, Barrow-in-Furness,
Cumbria LA14 4LF, UK
Tel: + 44 1229 870870 x54388; fax: + 44 1229 491036;
e-mail: [email protected]
Received 31 July 2012 Revised 28 September 2012
Accepted 29 October 2012
Introduction
Computed tomography (CT) has improved the sensitivity
and specificity of many nuclear medicine techniques
through the provision of additional anatomic information or
by providing a high-quality attenuation correction (AC)
map [1,2]. The use of AC is strongly recommended in some
patients undergoing certain procedures, most notably in
those undergoing myocardial perfusion imaging [3,4]. Within
this patient group there is also potential for the discove ...
ISMRM 2003 Poster: Spatial Resolution Effects on Permeability-Surface Area Es...Mike Aref
This project attempts to use the optimal parameters for histopathological determination of tumor type and grade and translate them for use with dynamic contrast
enhanced (DCE) MRI. We test the hypothesis that poor spatial resolution used in clinical DCE MRI results in partial volume effects that yield inaccurate physiological
parameters, which results in erroneous diagnostic information. Preliminary data shows that correlation between tumor PS and tumor type and grade done at clinical imager
resolutions are inaccurate. PS estimated from higher resolution DCE MRI obtained by direct imaging or reduced encoding techniques may provide more diagnostically
relevant information.
Similar to Improved non-calcified plaque delineation on coronary CT angiography by sonogram-affirmed iterative reconstruction with different filter strength and relationship with BMI (20)
The World Hypertension League: where now and where to in salt reductionPaul Schoenhagen
Abstract: High dietary salt is a leading risk for death and disability largely by causing increased blood pressure. Other associated health risks include gastric and renal cell cancers, osteoporosis, renal stones, and increased disease activity in multiple sclerosis, headache, increased body fat and Meniere’s disease. The World Hypertension League (WHL) has prioritized advocacy for salt reduction. WHL resources and actions include a non-governmental organization policy statement, dietary salt fact sheet, development of standardized nomenclature, call for quality research, collaboration in a weekly salt science update, development of a process to set recommended dietary salt research standards and regular literature reviews, development of adoptable power point slide sets to support WHL positions and resources, and critic of weak research studies on dietary salt. The WHL plans to continue to work with multiple governmental and non-governmental organizations to promote dietary salt reduction towards the World Health Organization (WHO) recommendations.
Developing a national salt reduction strategy for MongoliaPaul Schoenhagen
Background: The increase in prevalence of risk factors such as hypertension has contributed to an incremental rise in non-communicable diseases (NCDs) in Mongolia over recent decades, such that they now account for 80% of all deaths in the country. Salt reduction is one of the most cost-effective interventions to reduce the burden of NCDs.
Methods: In 2011, the Ministry of Health (MOH) instigated the development of a national salt reduction strategy for Mongolia. As part of a 2-week national consultation and training program on salt reduction, it established an inter-sectoral working party and organized a series of bilateral meetings and visits to factories. Actions arising included a baseline survey of population salt consumption patterns and the implementation of a series of pilot salt reduction initiatives.
Results: The results of the baseline assessment revealed that average daily intake of salt, based on 24 hour urine samples from a representative national sample (n=1,027), was 11.06±5.99 g in 2011, more than double the World Health Organization (WHO) five grams recommendation. Moreover, while most participants knew that salt was bad for health, few were taking efforts to reduce intake, and many were consuming highly salty meals and tea; salt in tea alone was estimated to contribute 30% of daily salt intake. A pilot Pinch Salt intervention to reduce salt consumption of factory workers was undertaken in Ulaanbaatar (UB) city between 2012 and 2013, and was associated with a reduction of 2.8 g of salt intake. Ongoing food industry initiatives have led to significant reductions in salt levels in bread, and companies producing processed meat have indicated a willingness to reduce salt. Relevant stakeholders have also supported the campaign by participating in annual World Salt Awareness Week events. The activities to date have demonstrated the potential for action and there is now a need scale these up to a national level to ensure that Mongolia is in a strong position to achieve a 30% reduction in population salt intake by 2025. The main goal of the Mongolian national salt reduction strategy is to create a social, economic and legal environment that supports salt reduction, including by influencing food supply, increasing partnerships between government and relevant stakeholders, and creating an enabling environment to support improved consumer choices. The strategy will be implemented from 2015 to 2025, with an interim review of progress in 2020.
Conclusions: Given that Mongolia has one of the highest rates of stroke in the world, which is strongly associated with population-wide blood pressure (BP) levels, the addition of a population-based stroke surveillance program would provide a reliable direct assessment of the impact of these salt reduction initiatives on the health of the Mongolian people. The results from this research would likely be widely generalizable to other populations experiencing similar lifestyle transitional changes.
K
Sodium content in processed foods in Argentina: compliance with the national lawPaul Schoenhagen
Background: Despite the body of evidence that documents the unfavorable effects of excessive sodium
consumption on blood pressure and cardiovascular health, public health efforts to decrease sodium consumption
have been limited to a few countries. Argentina is the first country in Latin America to regulate sodium content of
processed foods by means of a national law. The objective of this cross-sectional quantitative study is to provide a
baseline comparison against the reduction targets set by the national law before its entry into force.
Methods: Data were collected in February 2014 in a leading supermarket chain located in Buenos Aires.
Nutrient data from package labels were analysed for 1,320 products within 14 food groups during the study
period. To compare sodium concentration levels with the established maximum levels we matched the
collected food groups with the food groups included in the law resulting in a total of 292 products. Data
analysis was conducted using SPSS version 20 software.
Results: Food groups with the highest median sodium content were sauces and spreads (866.7 mg/100 g),
meat and meat products (750 mg/100 g) and snack foods (644 mg/100 g). Categories with the highest sodium
content were appetizers (1,415 mg/100 g), sausages (1,050 mg/100 g) and ready-made meals (940.7 mg/100 g).
We also found large variability within products from the same food categories. Products included in the
national law correspond to 22.1% (n=292) of the surveyed foods. From the 18 food groups, 15 showed
median sodium values below the established targets. Products exceeding the established maximum levels
correspond to 15.1% (n=44) of the products included in the analysis.
Conclusions: This study is the first analysis of food labels to determine sodium concentrations of processed
foods in Argentina and to provide a baseline against the national law standards. Upon the completion of
this analysis, maximum levels have been achieved by most of the food groups included in the law. Thus, the
introduction of further reductions for the existing maximum levels and the establishment of sodium targets for
all relevant product categories not included in the law should be considered as the next steps in the process.
Salt reduction and hypertension in China: a concise state-of-the-art reviewPaul Schoenhagen
Abstract: Hypertension (HTN) and its cardiovascular complications such as stroke and heart failure are a serious public health problem around the world. A growing number of studies confirm that salt plays an important role in the development of HTN. Increasing intake of salt leads to abnormal transport of sodium ions at the cellular level with activation of the sympathetic nervous system and renin-angiotensin-aldosterone system. Studies have shown that salt restriction can reduce blood pressure (BP) in patients with HTN, especially salt-sensitive HTN. Public health interventions to reduce salt intake, with the goal of decreasing adverse outcomes have been launched in numerous countries. In this review we will summarize the epidemiology of cardiovascular diseases and their risk factors, the relationship between salt and HTN, the effect of salt restriction on HTN and the current situation of prevention and treatment of HTN by salt reduction in China.
WHO’s supported interventions on salt intake reduction in the sub-Saharan Afr...Paul Schoenhagen
Abstract: Reduction of salt intake is an important and cost-effective way for reducing hypertension and the risk of cardiovascular diseases (CVDs). Current global salt intakes are estimated at around 10 g/day, well above the World Health Organization (WHO) recommended level of <5 g/day. The sub-Saharan Africa (SSA) region has a prevalence of hypertension of 46% among adults aged 25 and over and therefore strategies to reduce salt intake are necessary. This requires an understanding of salt intake behaviors in the population along with government commitment to increase awareness and take actions that would create an enabling environment. It is also important to have the food industry and other key stakeholders on board. A review of the developed WHO’s norms and guidelines, technical support provided to countries by WHO as well as country initiatives shows that countries in the African region are at different stages in the implementation of salt reduction interventions. For example, South Africa has enacted legislation to make the food industry reduce the salt content of a number of its products while Mauritius is requesting bakery owners to reduce salt in bread. A number of countries are currently undertaking studies to measure salt intake in the populations. Overall progress is slow as the region experiences a double burden of communicable and noncommunicable diseases, competing health priorities and limited resources for health.
Keywords: Africa; salt intake; sodium; non-communicable diseases (NCDs); cardiovascular
An overview of salt intake reduction efforts in the Gulf Cooperation Council ...Paul Schoenhagen
Globally, morbidity and mortality from non-communicable diseases (NCDs) are increasing steadily and at an alarming rate. High blood pressure is a major risk factor for cardiovascular disease (CVD) and salt reduction is an effective measure to decrease mortality rates. In the Eastern Mediterranean region, current salt intake is high, with an average intake of >12 g per person per day. Reducing the intake of salt has been identified as a priority intervention to reduce NCDs. Countries of the Gulf Cooperation Council (GCC) are showing a willingness to comply with the World Health Organization (WHO) recommendations and an eagerness to reduce the burden of NCDs. However, they face some challenges, including lack of political commitment, lack of experience, and shortage of qualified human resources. Salt intake reduction efforts
Salt intake reduction efforts: advances and challengesPaul Schoenhagen
The articles in this special issue of Cardiovascular Diagnosis and Therapy describe the efforts to reduce salt intake in different parts of the world, including South America, Africa, the Middle East, the Far East (China and Mongolia) and Australia, in addition to an overview of the work of the World Hypertension League in this domain. Sharing experiences from diverse regions and countries, these data will contribute to better understanding the challenges and opportunities encountered by the groups working in the field.
A new polymer-free drug-eluting stent with nanocarriers eluting sirolimus fro...Paul Schoenhagen
Background: Permanent polymers in first generation drug-eluting stent (DES) have been imputed to be a possible cause of persistent inflammation, remodeling, malapposition and late stent thrombosis. We aim to describe the in vivo experimental result of a new polymer-free DES eluting sirolimus from stent-plus-balloon (Focus np stent, Envision Scientific) compared with a bare-metal stent (BMS) (Amazonia CroCo, Minvasys) and with a biolimus A9 eluting stent (Biomatrix, Biosensors).
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
Hemodynamic assessment of partial mechanical circulatory support: data derive...Paul Schoenhagen
Partial mechanical circulatory support represents a new concept for the treatment of advanced heart failure. The Circulite Synergy Micro Pump®, where the inflow cannula is connected to the left atrium and the outflow cannula to the right subclavian artery, was one of the first devices to introduce this concept to the clinic. Using computational fluid dynamics (CFD) simulations, hemodynamics in the aortic tree was visualized and quantified from computed tomography angiographic (CTA) images in two patients. A realistic computational model was created by integrating flow information from the native heart and from the Circulite device. Diastolic flow augmentation in the descending aorta but competing/antagonizing flow patterns in the proximal innominate artery was observed. Velocity time curves in the ascending aorta correlated well with those in the left common carotid, the left subclavian and the descending aorta but poorly with the one in the innominate. Our results demonstrate that CFD may be useful in providing a better understanding of the main flow patterns in mechanical circulatory support devices.
Spontaneous coronary artery dissection (SCAD) is an infrequent and often missed diagnosis among patients presenting with acute coronary syndrome (ACS). Unfortunately, SCAD can result in significant morbidities such as myocardial ischemia and infarction, ventricular arrhythmias and sudden cardiac death. Lack of angiographic recognition from clinicians is a major factor of under-diagnosis. With the advent of new imaging modalities, particularly with intracoronary imaging, there has been improved diagnosis of SCAD. The aim of this paper is to review the epidemiology, etiology, presentation, diagnosis and management of SCAD.
microRNA-based diagnostics and therapy in cardiovascular disease—Summing up t...Paul Schoenhagen
Circulating microRNAs (miRNAs) are discussed as potential disease-specific biomarkers in cardiovascular disease. Their diagnostic value has been examined in numerous studies and animal models with respect to coronary artery disease (CAD) and myocardial infarction (MI) and the prognostic abilities of circulating miRNAs in risk stratification of future disease have been evaluated. Various miRNAs are described to complement protein-based biomarkers or classical risk factors in the diagnosis of CAD or MI and even represent potential new biomarkers in the discrimination of unstable angina pectoris (UAP). Signatures consisting of sets of multiple miRNAs seem to improve the predictive power compared to single miRNAs. Furthermore, the emerging field of miRNA-based therapeutics has reached cardiovascular research. The first promising in vitro results are raising hope for future clinical application. However, methods and material used for RNA isolation, miRNA detection and normalization steps still lack ways of standardization and need to be considered carefully. This article reviews the current knowledge of miRNAs in cardiovascular disease focusing on CAD and MI and will provide an overview regarding the use of circulating miRNAs as biomarkers and potential therapeutic targets in the field of CAD.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Carotid intima-media thickness (CIMT) and carotid plaques in young Nepalese p...Paul Schoenhagen
Abstract
Background: Carotid intima-media thickness (CIMT) and carotid plaques are non-invasive surrogate markers of early evaluation of coronary artery disease (CAD) and sub clinical atherosclerosis. The objective of the study was to evaluate CIMT and carotid plaques in less than 45 years old Nepalese patients with angiographically proven CAD.
Methods: A total of 54 patients with angiographically documented CAD at less than 45 years of age were enrolled. CAD was confirmed by coronary angiography. Demographic profile was obtained. High resolution B-mode ultrasound was used to detect the CIMT and carotid plaques.
Results: The study population included 44 males and 10 females, with a mean ± SD age of 38.4±4.3 years (range, 25-44 years). Cardiovascular risks factors included smoking in 81%, Hypertension in 52%, diabetes in 19% and alcohol consumption in 78% of patients. Lipid profile (mean ± SD) was normal except for elevated triglyceride (TG) levels of 204±130.8 mg/dL. By angiography, 64.8% had single vessel disease, 26% had double vessel disease and 9.2% had triple vessel disease. Ultrasound detected either thickened CIMT or presence of plaques in 46 (85.2%) cases (group-A) and 8 (14.8%) had negative (normal) carotid study (group-B). Among the 46 patients with positive findings 63% had carotid plaques and 37% had thickened CIMT only. The majority (69%) of the carotid plaques were detected at the carotid bulbs. In total population, carotid plaque was detected in 53.7% of cases. There was no statistical significant difference of age, body mass index (BMI) and lipid level between group-A and group-B.
Conclusions: Increased CIMT and carotid plaques are detected in majority of the young Nepalese patients with angiographically documented CAD. The majority of carotid plaques are detected at the carotid bulbs. Routine carotid ultrasound study in young individuals with CAD risk factors appears worthwhile.
Impact of statins and beta-blocker therapy on mortality after coronary artery...Paul Schoenhagen
Abstract
Background: We conducted a retrospective cohort study of patients after first-time isolated coronary artery bypass graft surgery (CABG) and assessed the impact of a discharge regimen including beta-blockers and statin therapy and their relationship to long-term all cause mortality and major adverse cardiovascular events (MACE).
Methods: We identified patients age >18 years, undergoing first time isolated CABG from 1993 to 2005. Patients were identified using the Cardiovascular Information Registry (CVIR). We collected follow-up information at 30, 60, 90 days and yearly follow-up. The registry is approved for use in research by the institutional review broad.
Results: We identified 5,205 patients who underwent single isolated CABG between January 1993 and December 2005. The mean age was 64.5±9.7 years and over 70% were male. There was a significant difference in the low density lipoproteins (LDL) concentration between those with or without statin medications (134±41.9 mg/dL) (no statin) vs. 126±44.8 mg/dL (with statin), P=0.001. A discharge regimen with statin therapy was associated with and overall reduction in 30 day, 1 year and long-term mortality. In addition, overall the triple ischemic endpoint of death, myocardial infarction (MI) and stroke was also significantly lower in the statin vs. no-statin group. In addition, statin and beta-blockers exerted synergistic effect on overall mortality outcomes short-term and in the long-term. We note that the predictors of overall death include no therapy with statin therapy and age [hazard ratios (HR) 1.1, 95% CI: 1.04-1.078, P<0.001] and presence of renal failure (HR 2.0, P=0.005). The estimated 11-year Kaplan Meier curves for mortality between the two groups starts to diverge immediately post discharge after single isolated CABG and continue to diverge through out the follow-up period.
Conclusions: A post-discharge regimen of statins independently reduces overall and 1 year mortality. These results confirm those of earlier studies within a contemporary surgical population and support the current clinical guidelines.
Cardiac imaging in prosthetic paravalvular leaksPaul Schoenhagen
Abstract: Prosthetic paravalvular leaks (PVL) is an uncommon but serious complication after surgical valve replacement. Although surgery has been the traditional treatment of choice in hemodynamically significant PVL, percutaneous transcatheter closure is emerging as a novel and less invasive option for patients with high operative risk. Cardiac imaging, especially two- and three-dimensional transoesophageal echocardiography, plays an essential role in the diagnosis, guidance of intervention and subsequently in the evaluation of the outcomes of the procedure. The aim of this manuscript is to review the role of cardiac imaging techniques in the interventional management of patients with symptomatic PVL.
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
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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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
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