El 17 de octubre de 2014, la Fundación Ramón Areces celebró una nueva conferencia del ciclo 'Envejecimiento, Sociedad y Salud: envejecimiento y enfermedad', que organiza en colaboración con el Centro de Estudios del Envejecimiento. En esta ocasión, el doctor Valentín Fuster, director del Centro Nacional de Investigaciones Cardiovasculares Carlos III- CNIC, habló sobre 'Enfermedad subclínica de corazón y cerebro: el reto de la década'. En esta entrevista previa a su intervención, deja claro que nunca es tarde para cuidarse y que la clave no está tanto en el corazón, sino en el cerebro, donde se toman las decisiones para llevar hábitos de vida saludables.
Polypill for primary and secondary preventions of cardiovascularBhaswat Chakraborty
This document discusses cardiovascular diseases (CVDs) and strategies for primary and secondary prevention. It summarizes that CVDs are caused by risk factors like hypertension, diabetes, smoking, obesity, and high cholesterol. Modifying these risk factors can prevent CVDs. The document outlines that a polypill containing multiple drugs can provide primary prevention by lowering risk factors. Studies on Cadila Pharmaceuticals' polypill product Polycap found it reduced blood pressure and LDL cholesterol similarly to the individual drugs. Polycap was also found to have no drug interactions and preserve the bioavailability of components, establishing its potential for CVD prevention.
The document discusses three topics:
1) A pilot study of an extravascular implantable cardioverter-defibrillator (EV ICD) that showed feasibility of substernal lead placement and effective defibrillation and pacing. No major complications occurred.
2) A study finding that very low-density lipoprotein (VLDL) cholesterol, not triglycerides, explains about half the risk of myocardial infarction from apoB-containing lipoproteins.
3) A presentation by Dr. Sivanand Patel on cardiology topics including the EV ICD and implications of VLDL cholesterol and triglycerides.
Iron deficiency in Heart Failure - Trial evidencePraveen Nagula
1) Iron deficiency is a common but often unrecognized and undertreated comorbidity in patients with heart failure.
2) Iron deficiency is prevalent in around 76% of Indian patients with heart failure and is associated with increased morbidity and mortality as well as worse patient outcomes and quality of life.
3) Intravenous ferric carboxymaltose is recommended for treating iron deficiency in heart failure patients, as it is more effective than oral iron supplements which are poorly absorbed and do not adequately address the underlying causes of restricted iron availability.
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.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
There is a Primary Prevent Indication in Diabetes | Mubashar A ChoudryMubashar A Choudry MD
Dr. Mubashar A Choudry, MD, is proud to serve patients at Washington Vascular Specialists, the first outpatient vascular treatment center in the mid-Atlantic region, with locations in Takoma Park, Largo, and Frederick, Maryland. He is a specialist in cardiology medical field.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
Polypill for primary and secondary preventions of cardiovascularBhaswat Chakraborty
This document discusses cardiovascular diseases (CVDs) and strategies for primary and secondary prevention. It summarizes that CVDs are caused by risk factors like hypertension, diabetes, smoking, obesity, and high cholesterol. Modifying these risk factors can prevent CVDs. The document outlines that a polypill containing multiple drugs can provide primary prevention by lowering risk factors. Studies on Cadila Pharmaceuticals' polypill product Polycap found it reduced blood pressure and LDL cholesterol similarly to the individual drugs. Polycap was also found to have no drug interactions and preserve the bioavailability of components, establishing its potential for CVD prevention.
The document discusses three topics:
1) A pilot study of an extravascular implantable cardioverter-defibrillator (EV ICD) that showed feasibility of substernal lead placement and effective defibrillation and pacing. No major complications occurred.
2) A study finding that very low-density lipoprotein (VLDL) cholesterol, not triglycerides, explains about half the risk of myocardial infarction from apoB-containing lipoproteins.
3) A presentation by Dr. Sivanand Patel on cardiology topics including the EV ICD and implications of VLDL cholesterol and triglycerides.
Iron deficiency in Heart Failure - Trial evidencePraveen Nagula
1) Iron deficiency is a common but often unrecognized and undertreated comorbidity in patients with heart failure.
2) Iron deficiency is prevalent in around 76% of Indian patients with heart failure and is associated with increased morbidity and mortality as well as worse patient outcomes and quality of life.
3) Intravenous ferric carboxymaltose is recommended for treating iron deficiency in heart failure patients, as it is more effective than oral iron supplements which are poorly absorbed and do not adequately address the underlying causes of restricted iron availability.
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.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
There is a Primary Prevent Indication in Diabetes | Mubashar A ChoudryMubashar A Choudry MD
Dr. Mubashar A Choudry, MD, is proud to serve patients at Washington Vascular Specialists, the first outpatient vascular treatment center in the mid-Atlantic region, with locations in Takoma Park, Largo, and Frederick, Maryland. He is a specialist in cardiology medical field.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Guidelines and beyond new drug therapy for heart failure with reduced ejectio...ahvc0858
This document provides information on new guidelines and therapies for heart failure patients. It begins by outlining the challenges of managing heart failure patients and their high mortality rates. It then discusses the history of heart failure treatments from ACE inhibitors in the 1990s to newer drugs like ARNi's. The document defines the different types of heart failure - HFrEF, HFmrEF, and HFpEF - and their diagnostic criteria. It explains how neprilysin inhibition enhances natriuretic peptides while simultaneously suppressing the RAAS. Finally, it summarizes that the new drug LCZ696 combines neprilysin inhibition with an ARB to reduce mortality and hospitalization in heart failure patients beyond existing neurohormonal therapies
Modern therapy in diabetics with cad scintic dayOsama Almaraghi
This document provides information on modern therapy for diabetics with coronary artery disease. It discusses the following key points in 3 sentences:
Diabetes is a global epidemic that is increasing worldwide. Cardiovascular disease is the leading cause of death for diabetics, as they face comparable heart attack risks to those with a previous heart attack. The document reviews guidelines for glycemic, blood pressure, and lipid control to reduce cardiovascular risks and discusses various drug therapy options for treating diabetes in patients with cardiovascular disease.
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
Aspirin use for the primary prevention of cardiovascular disease and colorect...jegan mohan
This document summarizes recommendations from the U.S. Preventive Services Task Force (USPSTF) on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer. The USPSTF found that aspirin use for adults aged 50 to 69 years at increased cardiovascular risk provides moderate benefit in reducing heart attacks and strokes. It also reduces colorectal cancer risk after 5 to 10 years of use. However, aspirin also increases risks of gastrointestinal bleeding and hemorrhagic stroke. The balance of benefits and harms depends on age, risk level, and risk tolerance. An optimal daily dose appears to be 75-81 mg.
This document is the title page and table of contents for the book "ABC OF ANTITHROMBOTIC THERAPY" edited by Gregory Y H Lip and Andrew D Blann. It lists the contributors to the book and provides a brief overview of the chapters included, which cover topics such as venous thromboembolism, atrial fibrillation, peripheral vascular disease, anticoagulation monitoring and special circumstances like pregnancy and cancer. The book aims to provide a practical guide to antithrombotic therapy for physicians and other healthcare professionals.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
The document discusses advances and ongoing disparities in heart failure treatment for African Americans. It summarizes the key findings of the landmark AHEFT trial from 2004, which found that the combination of isosorbide dinitrate and hydralazine reduced mortality and hospitalization rates in African Americans with heart failure compared to placebo. However, the document notes that a decade later, many African American heart failure patients are still not receiving guideline-directed medical therapies. It argues that future clinical trials of novel heart failure drugs need to incorporate background therapies across all demographic groups to truly advance health equity in heart failure care for African Americans through a paradigm shift, rather than just a paradigm drift.
This study compared the 7-year risk of heart attack in people with and without type 2 diabetes. It found:
1) The risk of heart attack over 7 years was much higher in people with prior heart attack (18.8% without diabetes, 45% with diabetes) compared to those without (3.5% without diabetes, 20.2% with diabetes).
2) People with diabetes but no prior heart attack had a similar risk of death from heart disease as people without diabetes but with a prior heart attack.
3) These findings suggest that people with diabetes should be treated as aggressively for cardiovascular risk factors as nondiabetic people with established heart disease.
SGLT-2 inhibitors have shown promising cardiovascular and renal benefits:
1) Trials have found SGLT-2 inhibitors reduce the risk of cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, as well as reducing heart failure hospitalizations in those with diabetes and cardiovascular risk factors.
2) Studies also show SGLT-2 inhibitors improve outcomes for patients with heart failure with reduced ejection fraction, reducing rates of heart failure hospitalization and mortality regardless of diabetes status or background heart failure therapies.
3) SGLT-2 inhibitors were also found to reduce the risk of renal death or progression to end-stage kidney disease in patients with type 2 diabetes and macroalbuminuria.
Cardiac risk evaluation: searching for the vulnerable patient FELIX NUNURA
The document discusses screening patients for cardiovascular risk factors and disease. It outlines various risk assessment tools like the Framingham Risk Score and SCORE that estimate risk based on factors like age, cholesterol levels, blood pressure, smoking status. It discusses limitations of risk factor-based screening and emphasizes the importance of directly measuring subclinical disease using tests like coronary artery calcium scoring and carotid intima-media thickness to identify vulnerable patients. The document advocates screening for and treating the underlying atherosclerotic disease rather than just risk factors to improve prevention outcomes.
JNC 8 guidelines are criticized for not being truly evidence-based. Most recommendations received a grade of evidence of D or E. The guidelines raise red flags for potential biases due to financial conflicts of interest among panel members. Recommending higher blood pressure targets may increase stroke risk for vulnerable groups. The guidelines are accused of not considering all available evidence and prioritizing improved statistics over patient outcomes.
Cardiac Stress Test vs CT Coronary Angiogram: Which is better?ahvc0858
Cardiac stress tests and CT coronary angiography are effective options for evaluating heart disease, with certain advantages and limitations for each. A cardiac stress test such as a treadmill exercise stress test or stress echocardiogram can detect ischemia by provoking the heart during exercise or pharmacologically, but may have lower sensitivity and specificity than imaging tests. A CT coronary angiogram provides detailed images of the coronary arteries but exposes patients to radiation. The optimal test depends on the individual patient's characteristics, risk factors, and the specific question being answered.
International Society of Hypertension 2020 guidlinesJAFAR ALSAID
The document outlines key points from a presentation on hypertension given by Dr. Jafar Alsaid at the Iraqi Hypertension Conference in November 2021. It discusses the global burden of hypertension, challenges in low-income countries, definitions and classifications of hypertension, measuring blood pressure, common risk factors, target organ damage, lifestyle modifications, pharmacological treatments, and the importance of patient education.
This patient is a 37-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a family history of coronary artery disease. Examination found elevated blood pressure and LDL, as well as signs of sympathetic overactivity.
Given the patient's sympathetic overactivity, diabetes, hypertension, and family history of CAD, treatment with a beta-blocker and high-intensity statin is recommended. Metoprolol is preferred as it has a short half-life, is excreted through the liver, and does not accumulate in renal impairment. Intensifying the statin dose is also needed given the patient's multiple risk factors to achieve a target LDL lower than 100 mg/dL.
Sex after acute myocardial infarctio(Heart attack).
There are fears of having another heart attack or dying during sex. One woman even had to convince her husband that she wasn't going to die in bed. But women also expressed a motivation to return to sex as a way to get back to their normal life and not be stigmatized as a heart patient. We heard that a lot.This presentation solves so many such doubts spread in society.
The document summarizes the recommendations of the 2014 JNC 8 guidelines for treatment of hypertension. It discusses:
1) The JNC 8 recommendation to initiate pharmacologic treatment for those aged 60 and older with a systolic blood pressure of 150 mm Hg or higher, and to treat to a goal of under 150 mm Hg.
2) Evidence from trials supporting this recommendation showing reduced risks of stroke, heart failure, and coronary heart disease with treatment to a goal of under 150 mm Hg.
3) Arguments against recommending treatment to lower goals not proven in clinical trials, such as unnecessary exposure to medication side effects and polypharmacy in the elderly.
Chronic obstructive pulmonary disease (COPD) is defined by several medical organizations and involves persistent airflow limitation that is usually progressive. Key indicators for considering COPD include dyspnea, chronic cough, sputum production, exposure to risk factors like smoking, and family history. COPD is assessed based on symptoms, degree of airflow limitation via spirometry, risk of exacerbations, and comorbidities. Exacerbations, which involve worsening of respiratory symptoms, are usually caused by infections and can be mild, moderate, or severe requiring hospitalization. COPD is a major cause of death and disability worldwide.
Managing CV risk in Inflammatory Arthritis (Focusing on Gout)Sidney Erwin Manahan
Presentation made during the 1st Inter-Hospital Rheumatology Fellows' Case Discussion on 9 June 2018 at the Speaker Feliciano Belmonte Auditorium, 7/F East Avenue Medical Center. Presentation highlights the needs to recognize gout as one of the rheumatic conditions that put patients at risk for developing CV disease.
Cardiovascular Pathophysiology In the Setting of Spinal Cord InjuryInsideScientific
Dr. Christopher West shares his research that investigates the cardiovascular and autonomic changes that occur following spinal cord injury as well as the efficacy of neuro-therapeutic interventions.
Dr. West’s group uses small and large in vivo animal models to understand how the circuitry that controls the cardiovascular system changes following injury and what the downstream impact of these changes are for heart and blood vessel function. They also use these models to test the efficacy of novel therapies in the both the acute and chronic setting following injury. In the clinical and athletic spinal cord injury population, his group has conducted a number of mechanistic and applied studies to, 1) improve the understanding of how best to hemodynamically manage acutely injured patients, and 2) enhance the capacity of the cardiovascular system to enable an improved exercise response.
This webinar introduces the major cardiovascular changes that have been characterized following spinal cord injury in animal models and the clinical population. Chris shares some exciting results from recent studies in which his group has tested the efficacy of novel therapies to improve cardiovascular function. Finally, he provides his outlook for the future of the field.
The document summarizes the key topics from a 2013 convention on the integration of health. It discusses: 1) cardiovascular disease as a top global killer, focusing on heart and brain; 2) risk factors like lifestyle and aging that contribute to CVD; and 3) approaches to prevention through science, health education, and promoting healthy communities. The goal is to integrate knowledge on CVD causes and solutions to improve population health outcomes.
Modern therapy in diabetics with cad scintic dayOsama Almaraghi
This document provides information on modern therapy for diabetics with coronary artery disease. It discusses the following key points in 3 sentences:
Diabetes is a global epidemic that is increasing worldwide. Cardiovascular disease is the leading cause of death for diabetics, as they face comparable heart attack risks to those with a previous heart attack. The document reviews guidelines for glycemic, blood pressure, and lipid control to reduce cardiovascular risks and discusses various drug therapy options for treating diabetes in patients with cardiovascular disease.
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
Diabetes and heart two sides of the same coinSunil Wadhwa
This ppt presented in a CME of doctors in March 2017 discusses-if all Diabetics should be treated aggressively for prevention of coronary artery disease & SHOULD IT BE PRESUMED AS IF THEY ARE ALREADY PATIENTS OF CAD?
This presentation is updated till March 2017
Primary Prevention of Cardiovascular Disease: The Role of Aspirin and StatinsCTSI at UCSF
Presented by Michael Pignone, MD, MPH, at UCSF's symposium "The Role of Risk Stratification and Biomarkers in Prevention of Cardiovascular Disease" in Jan 2012.
Aspirin use for the primary prevention of cardiovascular disease and colorect...jegan mohan
This document summarizes recommendations from the U.S. Preventive Services Task Force (USPSTF) on aspirin use for the primary prevention of cardiovascular disease and colorectal cancer. The USPSTF found that aspirin use for adults aged 50 to 69 years at increased cardiovascular risk provides moderate benefit in reducing heart attacks and strokes. It also reduces colorectal cancer risk after 5 to 10 years of use. However, aspirin also increases risks of gastrointestinal bleeding and hemorrhagic stroke. The balance of benefits and harms depends on age, risk level, and risk tolerance. An optimal daily dose appears to be 75-81 mg.
This document is the title page and table of contents for the book "ABC OF ANTITHROMBOTIC THERAPY" edited by Gregory Y H Lip and Andrew D Blann. It lists the contributors to the book and provides a brief overview of the chapters included, which cover topics such as venous thromboembolism, atrial fibrillation, peripheral vascular disease, anticoagulation monitoring and special circumstances like pregnancy and cancer. The book aims to provide a practical guide to antithrombotic therapy for physicians and other healthcare professionals.
Fatty Acids and their role in Cardiometabolic HealthArindam Pande
This document discusses fatty acids and their role in cardiometabolic health. It summarizes that the conventional view of the diet-heart hypothesis, which links saturated fat and cholesterol to heart disease, may be an oversimplification. Different fatty acids, including saturated fatty acids found in dairy, can have varying metabolic effects. Replacing saturated fats with polyunsaturated fats may lower heart disease risk, but replacing them with carbohydrates does not. Ongoing research is exploring the cardiovascular impacts of omega-3 supplements and specific plant oils. In conclusion, the type of fat consumed is important for heart health, not just total fat intake, and dietary patterns rather than single nutrients should be the focus.
The document discusses advances and ongoing disparities in heart failure treatment for African Americans. It summarizes the key findings of the landmark AHEFT trial from 2004, which found that the combination of isosorbide dinitrate and hydralazine reduced mortality and hospitalization rates in African Americans with heart failure compared to placebo. However, the document notes that a decade later, many African American heart failure patients are still not receiving guideline-directed medical therapies. It argues that future clinical trials of novel heart failure drugs need to incorporate background therapies across all demographic groups to truly advance health equity in heart failure care for African Americans through a paradigm shift, rather than just a paradigm drift.
This study compared the 7-year risk of heart attack in people with and without type 2 diabetes. It found:
1) The risk of heart attack over 7 years was much higher in people with prior heart attack (18.8% without diabetes, 45% with diabetes) compared to those without (3.5% without diabetes, 20.2% with diabetes).
2) People with diabetes but no prior heart attack had a similar risk of death from heart disease as people without diabetes but with a prior heart attack.
3) These findings suggest that people with diabetes should be treated as aggressively for cardiovascular risk factors as nondiabetic people with established heart disease.
SGLT-2 inhibitors have shown promising cardiovascular and renal benefits:
1) Trials have found SGLT-2 inhibitors reduce the risk of cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, as well as reducing heart failure hospitalizations in those with diabetes and cardiovascular risk factors.
2) Studies also show SGLT-2 inhibitors improve outcomes for patients with heart failure with reduced ejection fraction, reducing rates of heart failure hospitalization and mortality regardless of diabetes status or background heart failure therapies.
3) SGLT-2 inhibitors were also found to reduce the risk of renal death or progression to end-stage kidney disease in patients with type 2 diabetes and macroalbuminuria.
Cardiac risk evaluation: searching for the vulnerable patient FELIX NUNURA
The document discusses screening patients for cardiovascular risk factors and disease. It outlines various risk assessment tools like the Framingham Risk Score and SCORE that estimate risk based on factors like age, cholesterol levels, blood pressure, smoking status. It discusses limitations of risk factor-based screening and emphasizes the importance of directly measuring subclinical disease using tests like coronary artery calcium scoring and carotid intima-media thickness to identify vulnerable patients. The document advocates screening for and treating the underlying atherosclerotic disease rather than just risk factors to improve prevention outcomes.
JNC 8 guidelines are criticized for not being truly evidence-based. Most recommendations received a grade of evidence of D or E. The guidelines raise red flags for potential biases due to financial conflicts of interest among panel members. Recommending higher blood pressure targets may increase stroke risk for vulnerable groups. The guidelines are accused of not considering all available evidence and prioritizing improved statistics over patient outcomes.
Cardiac Stress Test vs CT Coronary Angiogram: Which is better?ahvc0858
Cardiac stress tests and CT coronary angiography are effective options for evaluating heart disease, with certain advantages and limitations for each. A cardiac stress test such as a treadmill exercise stress test or stress echocardiogram can detect ischemia by provoking the heart during exercise or pharmacologically, but may have lower sensitivity and specificity than imaging tests. A CT coronary angiogram provides detailed images of the coronary arteries but exposes patients to radiation. The optimal test depends on the individual patient's characteristics, risk factors, and the specific question being answered.
International Society of Hypertension 2020 guidlinesJAFAR ALSAID
The document outlines key points from a presentation on hypertension given by Dr. Jafar Alsaid at the Iraqi Hypertension Conference in November 2021. It discusses the global burden of hypertension, challenges in low-income countries, definitions and classifications of hypertension, measuring blood pressure, common risk factors, target organ damage, lifestyle modifications, pharmacological treatments, and the importance of patient education.
This patient is a 37-year-old man with type 2 diabetes, hypertension, dyslipidemia, and a family history of coronary artery disease. Examination found elevated blood pressure and LDL, as well as signs of sympathetic overactivity.
Given the patient's sympathetic overactivity, diabetes, hypertension, and family history of CAD, treatment with a beta-blocker and high-intensity statin is recommended. Metoprolol is preferred as it has a short half-life, is excreted through the liver, and does not accumulate in renal impairment. Intensifying the statin dose is also needed given the patient's multiple risk factors to achieve a target LDL lower than 100 mg/dL.
Sex after acute myocardial infarctio(Heart attack).
There are fears of having another heart attack or dying during sex. One woman even had to convince her husband that she wasn't going to die in bed. But women also expressed a motivation to return to sex as a way to get back to their normal life and not be stigmatized as a heart patient. We heard that a lot.This presentation solves so many such doubts spread in society.
The document summarizes the recommendations of the 2014 JNC 8 guidelines for treatment of hypertension. It discusses:
1) The JNC 8 recommendation to initiate pharmacologic treatment for those aged 60 and older with a systolic blood pressure of 150 mm Hg or higher, and to treat to a goal of under 150 mm Hg.
2) Evidence from trials supporting this recommendation showing reduced risks of stroke, heart failure, and coronary heart disease with treatment to a goal of under 150 mm Hg.
3) Arguments against recommending treatment to lower goals not proven in clinical trials, such as unnecessary exposure to medication side effects and polypharmacy in the elderly.
Chronic obstructive pulmonary disease (COPD) is defined by several medical organizations and involves persistent airflow limitation that is usually progressive. Key indicators for considering COPD include dyspnea, chronic cough, sputum production, exposure to risk factors like smoking, and family history. COPD is assessed based on symptoms, degree of airflow limitation via spirometry, risk of exacerbations, and comorbidities. Exacerbations, which involve worsening of respiratory symptoms, are usually caused by infections and can be mild, moderate, or severe requiring hospitalization. COPD is a major cause of death and disability worldwide.
Managing CV risk in Inflammatory Arthritis (Focusing on Gout)Sidney Erwin Manahan
Presentation made during the 1st Inter-Hospital Rheumatology Fellows' Case Discussion on 9 June 2018 at the Speaker Feliciano Belmonte Auditorium, 7/F East Avenue Medical Center. Presentation highlights the needs to recognize gout as one of the rheumatic conditions that put patients at risk for developing CV disease.
Cardiovascular Pathophysiology In the Setting of Spinal Cord InjuryInsideScientific
Dr. Christopher West shares his research that investigates the cardiovascular and autonomic changes that occur following spinal cord injury as well as the efficacy of neuro-therapeutic interventions.
Dr. West’s group uses small and large in vivo animal models to understand how the circuitry that controls the cardiovascular system changes following injury and what the downstream impact of these changes are for heart and blood vessel function. They also use these models to test the efficacy of novel therapies in the both the acute and chronic setting following injury. In the clinical and athletic spinal cord injury population, his group has conducted a number of mechanistic and applied studies to, 1) improve the understanding of how best to hemodynamically manage acutely injured patients, and 2) enhance the capacity of the cardiovascular system to enable an improved exercise response.
This webinar introduces the major cardiovascular changes that have been characterized following spinal cord injury in animal models and the clinical population. Chris shares some exciting results from recent studies in which his group has tested the efficacy of novel therapies to improve cardiovascular function. Finally, he provides his outlook for the future of the field.
The document summarizes the key topics from a 2013 convention on the integration of health. It discusses: 1) cardiovascular disease as a top global killer, focusing on heart and brain; 2) risk factors like lifestyle and aging that contribute to CVD; and 3) approaches to prevention through science, health education, and promoting healthy communities. The goal is to integrate knowledge on CVD causes and solutions to improve population health outcomes.
The document summarizes key points from the 18th International Conference on Co-morbidities and Adverse Drug Reactions in HIV. It discusses findings related to bone health, cardiovascular health, and physical activity levels in people living with HIV. Regarding bone health, studies showed bone mineral density loss with tenofovir-containing antiretroviral therapy and PrEP. Loss was also seen with glucocorticoid use. For cardiovascular health, studies suggested lower risk of atherosclerotic events with NNRTI-based initial ART and possible lower risk with atazanavir. Physical activity levels were associated with comorbidity risk, with higher risk at lower activity levels.
Metabolic syndrome (MetS) predicts cardiovascular and cerebrovascular events over 20 years of follow-up. A study of 529 asymptomatic patients with MetS at baseline found they experienced 199 cardiovascular adverse events, compared to 120 events for 278 healthy controls, with an odds ratio of 2.3. Multivariate analysis identified MetS, BMI, C-reactive protein levels, and preclinical atherosclerosis as independent predictors of cardiovascular events over the 20 year period. Subclinical atherosclerosis was more prevalent in patients with MetS compared to controls. MetS significantly increased the risk of total cardiovascular, cerebrovascular, myocardial infarction and angina events over the long term follow-up period.
Men in the lower third of muscular strength had higher rates of mortality than those in the middle or upper thirds. A study of over 3,000 women with breast cancer found that low muscle mass and quality were associated with higher mortality. Older age is a major risk factor for poor outcomes from influenza, COVID-19, and critical illness due to the impacts of aging on muscle loss and frailty. Fortetropin has been shown to increase muscle mass and strength in humans and prevent disuse muscle atrophy in dogs after surgery.
The document discusses changing views on aging and increasing life expectancy. Traditionally, aging was seen as a biological process of decline, but research now shows it is more malleable. As lifespans increase, aging is now routine rather than a rarity. Studies also find we are programmed for survival, not death, and aging results from accumulated damage over time. This challenges the view that aging inevitably leads to loss of health and greater costs for societies. The document advocates research and interventions to promote healthy aging and maximize later life.
This document summarizes osteoporosis, including its definition, prevalence, risk factors, pathogenesis, diagnosis, and treatment options. It discusses how osteoporosis is a widespread condition characterized by compromised bone strength and increased fracture risk. Diagnostic tools like DXA scans and emerging methods like multi-detector CT are used to assess bone mineral density and structure. Treatment involves lifestyle changes as well as pharmacotherapy like bisphosphonates, calcitonin, PTH, and emerging drugs. Overall the document provides a comprehensive overview of osteoporosis from causes and diagnosis to current and novel treatment approaches.
Association Study of Single Nucleotide Polymorphism of PTH Gene in Osteopor...Alia Iqniebi
This study investigated associations between single nucleotide polymorphisms (SNPs) in the parathyroid hormone (PTH) gene and osteoporosis in post-menopausal Saudi women. The study genotyped 4 PTH SNPs in 100 osteoporosis patients and 100 controls. Results found the TT genotype of rs6254 and the CT genotype of rs1459015 were associated with increased osteoporosis risk. The CT genotype of rs10500783 was also associated with higher osteoporosis risk, while the T allele of rs10500783 and rs1459015 were associated with increased risk. No associations were found for rs10500784. This suggests certain PTH gene variants may influence osteop
One year mortality rate after hip fracture in the western region of saudi ara...Prof. Hesham N. Mustafa
Background:
The mortality rate of elderly patients who sustain a hip fracture is high compared to the general population. Identifying risk factors can help predict patients at risk of hip fracture to reduce the mortality rate. No studies have shown the mortality rate of patients with hip fractures in the western region of Saudi Arabia. Therefore, this study aimed to identify the risk factors associated with the mortality of patients with hip fractures admitted to the King Abdulaziz Hospital and compare the results with other studies.
Methods:
The mortality rate (within 1 yr or less) in 177 patients over the age of 60 yr who were admitted to the university hospital between July, 2007, and September, 2012, with hip fractures was retrospectively studied. The patients were assessed with regard to gender, age, type of hip fracture, and type of surgical intervention.
Results:
The overall mortality rate 1 yr after hip fracture was 12.43%, and the mean age was 77.77 yr old. The risk factors most associated with mortality were as follows: advanced age (71 to 80 and 81 to 90 yr old), male, peritrochanteric (extracapsular) fracture, and operative fixation with dynamic hip screw.
Conclusions:
The mortality rate of patients with hip fractures within 1 yr has a high-risk potential, especially for male patients over 71 yr of age with peritrochanteric (extracapsular) fractures. Surgical treatment with dynamic hip screw also was shown to be a risk factor between the different treatment options.
Level of Evidence:
Level IV.
Overview of the Health Benefits of Vitamin C by Prof Margreet VissersKiwifruit Symposium
Prof Margreet Vissers, Research Professor at University of Otago, New Zealand: http://www.kiwifruitsymposium.org/presentations/overview-of-the-many-health-benefits-of-vitamin-c/
Presented at 1st International Symposium on Kiwifruit and Health.
Vitamin C is essential for life, and humans obtain this nutrient exclusively through the diet. It functions inside the cells in our bodies, where it plays an important role in supporting many essential processes. One kiwifruit a day gives the daily requirement of vitamin C.
Clinico-Demographic Profile of Traumatic Spinal Injury in a Tertiary HospitalLemuelJohnTonogan
As of today, there has been a limited number of studies about the demographic profile of traumatic spinal injuries in our locality and our country. The objective of this study is to determine the clinico-demographic profile of patients with traumatic spinal injury admitted in our institution for the past 10 years. A chart review of 73 patients who satisfied the inclusion criteria with traumatic spinal injuries were reviewed. Traumatic spinal injury in the locality mostly affects ages 46-60 years with a mean age of 53.5. Males were most commonly affected, married and unemployed secondary to fall and motor vehicular accidents. The cervical spine is the most commonly affected area, resulting to an incomplete paraplegia with ASIA D score in most cases. These patients were mostly managed conservatively and improved upon discharge. Strict implementation of traffic rules and fall prevention should be emphasized by the government and the locality, and also increase the awareness of patients at risk for traumatic spinal injuries and its debilitating consequences.
This document summarizes a presentation on recent developments in treating scleroderma interstitial lung disease. It discusses that ILD affects the lung interstitium and causes decreased oxygen transfer and stiff lungs. ILD risk is higher in patients with autoantibodies like anti-Scl-70. New data shows that long-term lung function loss predicts benefit from anti-fibrotic drugs. The Senscis trial found that nintedanib slowed lung function decline in SSc-ILD patients. Hematopoietic stem cell transplant trials like ASTIS and SCOT showed reduced mortality compared to controls, but transplant-related mortality remains a concern. A new Scleroderma Lung Study trial will test pirfen
Emerging evidence indicates that impaired cellular energy metabolism is the defining characteristic of nearly all cancers regardless of cellular or tissue origin. In contrast to normal cells, which derive most of their usable energy from oxidative phosphorylation, most cancer cells become heavily dependent on substrate level phosphorylation to meet energy demands. Evidence is reviewed supporting a general hypothesis that genomic instability and essentially all hallmarks of cancer, including aerobic glycolysis (Warburg effect), can be linked to impaired mitochondrial function and energy metabolism. A view of cancer as primarily a metabolic disease will impact approaches to cancer management and prevention
This document contains a bibliography divided into sections on basic science, oncology, prognosis, burden of illness, and HIV. It lists over 100 references for studies that have used bioelectrical impedance analysis to study body composition, fluid status, and the relationship between impedance measurements and health outcomes in various patient populations.
Healthy Longevity Promotion as a scientific and social taskMoshe Kenigshtein
This document discusses the promotion of healthy longevity as both a scientific and social task. It argues that extending healthy longevity is feasible based on emerging anti-aging therapies and interventions targeting the basic processes of aging. Promoting longevity is also deemed desirable given ethical arguments that longevity is correlated with well-being and human development. The document calls for action to further research on aging and aging-related diseases in order to improve health and longevity, which could provide substantial healthcare savings and economic returns.
Healthy Longevity Promotion as a scientific and social taskMoshe Kenigshtein
This document discusses the promotion of healthy longevity as both a scientific and social task. It argues that extending healthy longevity is feasible based on emerging anti-aging therapies and interventions targeting the basic processes of aging. Promoting longevity is also deemed desirable given ethical arguments that longevity is correlated with well-being and human development. The document calls for action to further research on aging and aging-related diseases in order to improve health and longevity, which could provide substantial healthcare savings and economic returns.
Similar to Dr. Valentín Fuster - Enfermedad subclínica de corazón y cerebro (20)
Jordi Torren - Coordinador del proyecto ESVAC. Agencia Europea de Medicamento...Fundación Ramón Areces
El martes 5 de junio del 2018 organizamos una Jornada en la Fundación Ramón Areces, en la cual se habló sobre el consumo de antibióticos y transmisión de resistencia entre humanos y animales.
Dominique L. Monnet Director del programa ARHAI (Antimicrobial Resistance an...Fundación Ramón Areces
El martes 5 de junio del 2018 organizamos una Jornada en la Fundación Ramón Areces, en la cual se habló sobre el consumo de antibióticos y transmisión de resistencia entre humanos y animales.
El jueves 24 de mayo del 2018 organizamos una Conferencia con Antonio Cabrales en la Fundación Ramón Areces. Una conferencia en la cual el tema fue: Estilo negociador y confianza, ¿hay diferencias entre hombres y mujeres?
Teresa Puig - Institut de Ciència de Materials de Barcelona, ICMAB-CSIC, Espa...Fundación Ramón Areces
El lunes y martes 21 y 22 de mayo del 2018 realizamos un Simposio Internacional en la Fundación Ramón Areces, tratando el tema de la superconductividad y presión: una relación fructífera en el camino hacia la superconductividad a temperatura ambiente.
Elena Bascones - Instituto de Ciencia de Materiales de Madrid (ICMM-CSIC), Es...Fundación Ramón Areces
El lunes y martes 21 y 22 de mayo del 2018 realizamos un Simposio Internacional en la Fundación Ramón Areces, tratando el tema de la superconductividad y presión: una relación fructífera en el camino hacia la superconductividad a temperatura ambiente.
El jueves 17 de mayo del 2018 se organizó una Mesa Redonda en la Fundación Ramón Areces, en la cual se habló sobre las subidas de tipos en la era Trump y la nueva globalización.
El jueves 17 de mayo del 2018 se organizó una Mesa Redonda en la Fundación Ramón Areces, en la cual se habló sobre las subidas de tipos en la era Trump y la nueva globalización.
El miércoles 16 de mayo del 2018 celebramos una Jornada en la Fundación Ramón Areces, en la cual se habló sobre las nuevas fronteras de investigación sobre la distribución comercial y el comportamiento del consumidor.
El miércoles 16 de mayo del 2018 celebramos una Jornada en la Fundación Ramón Areces, en la cual se habló sobre las nuevas fronteras de investigación sobre la distribución comercial y el comportamiento del consumidor.
Juan Carlos López-Gutiérrez - Unidad de Anomalías Vasculares, Hospital Unive...Fundación Ramón Areces
El jueves y viernes 10 y 11 de mayo del 2018 realizamos en la Fundación Ramón Areces un Simposio Internacional, en el cual se trató el tema del mosaicismo somático en malformaciones vasculares.
Víctor Martínez-Glez. - Instituto de Genética Médica y Molecular (INGEMM). I...Fundación Ramón Areces
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Rudolf Happle - Dermatología, University of Freiburg Medical Center, Freiburg...Fundación Ramón Areces
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Rafael Doménech - Responsable de Análisis Macroeconómico, BBVA Research. Fundación Ramón Areces
El martes 8 de mayo de 2018 realizamos una conferencia en la Fundación Ramón Areces, en la cual se habló sobre el futuro de las pensiones: una visión global.
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Nicholas Barr - Profesor de Economía Pública, London School of Economics. Fundación Ramón Areces
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El viernes 27 de abril del 2018 se celebró en la Fundación Ramón Areces una Jornada sobre física , en la cual se trataron diversos temas como: Los materiales mecanocalóricos, magnetísmo, biofísica, la energía oscura y instrumentación astronómica.
El viernes 20 de abril organizamos una Jornada sobre la ciencia en el corazón de Europa, en colaboración con Científicos Españoles en Bélgica (CEBE) y realizada en la Fundación Ramón Areces.
Marta Olivares - Investigadora Postdoctoral en Université catholique de Louva...Fundación Ramón Areces
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El viernes 20 de abril organizamos una Jornada sobre la ciencia en el corazón de Europa, en colaboración con Científicos Españoles en Bélgica (CEBE) y realizada en la Fundación Ramón Areces.
CLASSIFICATION OF H1 ANTIHISTAMINICS-
FIRST GENERATION ANTIHISTAMINICS-
1)HIGHLY SEDATIVE-DIPHENHYDRAMINE,DIMENHYDRINATE,PROMETHAZINE,HYDROXYZINE 2)MODERATELY SEDATIVE- PHENARIMINE,CYPROHEPTADINE, MECLIZINE,CINNARIZINE
3)MILD SEDATIVE-CHLORPHENIRAMINE,DEXCHLORPHENIRAMINE
TRIPROLIDINE,CLEMASTINE
SECOND GENERATION ANTIHISTAMINICS-FEXOFENADINE,
LORATADINE,DESLORATADINE,CETIRIZINE,LEVOCETIRIZINE,
AZELASTINE,MIZOLASTINE,EBASTINE,RUPATADINE. Mechanism of action of 2nd generation antihistaminics-
These drugs competitively antagonize actions of
histamine at the H1 receptors.
Pharmacological actions-
Antagonism of histamine-The H1 antagonists effectively block histamine induced bronchoconstriction, contraction of intestinal and other smooth muscle and triple response especially wheal, flare and itch. Constriction of larger blood vessel by histamine is also antagonized.
2) Antiallergic actions-Many manifestations of immediate hypersensitivity (type I reactions)are suppressed. Urticaria, itching and angioedema are well controlled.3) CNS action-The older antihistamines produce variable degree of CNS depression.But in case of 2nd gen antihistaminics there is less CNS depressant property as these cross BBB to significantly lesser extent.
4) Anticholinergic action- many H1 blockers
in addition antagonize muscarinic actions of ACh. BUT IN 2ND gen histaminics there is Higher H1 selectivitiy : no anticholinergic side effects
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14...Donc Test
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
TEST BANK For Brunner and Suddarth's Textbook of Medical-Surgical Nursing, 14th Edition (Hinkle, 2017) Verified Chapter's 1 - 73 Complete.pdf
Storyboard on Skin- Innovative Learning (M-pharm) 2nd sem. (Cosmetics)MuskanShingari
Skin is the largest organ of the human body, serving crucial functions that include protection, sensation, regulation, and synthesis. Structurally, it consists of three main layers: the epidermis, dermis, and hypodermis (subcutaneous layer).
1. **Epidermis**: The outermost layer primarily composed of epithelial cells called keratinocytes. It provides a protective barrier against environmental factors, pathogens, and UV radiation.
2. **Dermis**: Located beneath the epidermis, the dermis contains connective tissue, blood vessels, hair follicles, and sweat glands. It plays a vital role in supporting and nourishing the epidermis, regulating body temperature, and housing sensory receptors for touch, pressure, temperature, and pain.
3. **Hypodermis**: Also known as the subcutaneous layer, it consists of fat and connective tissue that anchors the skin to underlying structures like muscles and bones. It provides insulation, cushioning, and energy storage.
Skin performs essential functions such as regulating body temperature through sweat production and blood flow control, synthesizing vitamin D when exposed to sunlight, and serving as a sensory interface with the external environment.
Maintaining skin health is crucial for overall well-being, involving proper hygiene, hydration, protection from sun exposure, and avoiding harmful substances. Skin conditions and diseases range from minor irritations to chronic disorders, emphasizing the importance of regular care and medical attention when needed.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
BBB and BCF
control the entry of compounds into the brain and
regulate brain homeostasis.
restricts access to brain cells of blood–borne compounds and
facilitates nutrients essential for normal metabolism to reach brain cells
This presentation gives information on the pharmacology of Prostaglandins, Thromboxanes and Leukotrienes i.e. Eicosanoids. Eicosanoids are signaling molecules derived from polyunsaturated fatty acids like arachidonic acid. They are involved in complex control over inflammation, immunity, and the central nervous system. Eicosanoids are synthesized through the enzymatic oxidation of fatty acids by cyclooxygenase and lipoxygenase enzymes. They have short half-lives and act locally through autocrine and paracrine signaling.
As the world population is aging, Health tourism has become vitally important and will be increased day by day. Because
of the availability of quality health services and more favorable prices as well as to shorten the waiting list for medical
services regionally and internationally. There are some aspects of managing and doing marketing activities in order for
medical tourism to be feasible, in a region called as clustering in a region with main stakeholders groups includes Health
providers, Tourism cluster, etc. There are some related and affecting factors to be considered for the feasibility of medical
tourism within this study such as competitiveness, clustering, Entrepreneurship, SMEs. One of the growth phenomenon
is Health tourism in the city of Izmir and Turkey. The model of five competitive forces of Porter and The Diamond model
that is an economical model that shows the four main factors that affect the competitiveness of a nation and its industries
in this study. The short literature of medical tourism and regional clustering have been mentioned.
Selective alpha1 blockers are Prazosin, Terazosin, Doxazosin, Tamsulosin and Silodosin majorly used to treat BPH, also hypertension, PTSD, Raynaud's phenomenon, CHF
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Dr. Valentín Fuster - Enfermedad subclínica de corazón y cerebro
1. From Clinical &
Subclinical CVD
to Health Locally &
Worldwide
Round Trip of Motivation /
Funding
MM aa dd rr ii dd ,, O cc tt.. 1177,, 22001144 NNoo
DDiisscclloossuurreess
2. 1. A Transition From Disease to Health 2. Hear t – Brain Integration 3. Imaging / Omics / Regeneration / Style
Complex (5) CAD Valv. – CM
Sub-Clinical (4) Ar terial
Health (3) Political
1970 1990 2000 2010 2015
1990 2000 2010 2015 2020
3. 1. A Transition From Disease to Health 2. Hear t – Brain Integration
3. Imaging / Omics / Regeneration /
Complex (5) CAD Valv. – CM
Sub-Clinical (4) Ar terial
1970 Health 1990 (4) 2000 Political
2010 2015
1990 2000 2010 2015 2020
4. 1). Cardio-Cerebro Vascular Disease –
1
D Butler. Nature. 2011;477:261 (UN. NCD). At Present
R. Beaglehole et. al. Lancet 2008;372:1988 - > 30% Across, 2030
7. 4). Risk Factors, Motivation Missing
>1 Risk Factors
1. MI & Stroke
25% in 10 Yrs
75% in 30 Yrs
2. DBD / AD /
Cognitive
3. Aging
c
c
Framingham (2010) 5:
Interheart (2004) 2: Obesity, Sedentary(Diet)
8. 5). Deaths Attributable to Selected
Behavioral
Risk Factors in 2010
M Ezzati et. al. N Engl J Med 2013;369:954
SS Lim et. al. Lancet 2012;380:2224
9. 1. A Transition From Disease to Health 2. Hear t – Brain Integration 3. Imaging / Omics / Regeneration / Style
Complex (5) CAD Valv. – CM
Sub-Clinical (4) Ar terial
Health (3) Political
1970 1990 2000 2010 2015
1990 2000 2010 2015 2020
10. A Community Call
Population Ageing & Cost
The Lancet NCD Action (G Alleyne et. al.) Lancet. 2013;381:566
12. HRP - BioImage Study – Mobile Units
PI: Valentin Fuster, Co-PI: Erling Falk, Peter Muntendam - AHJ 2010;160:49
13. Plaque Burden (N=5808)
Carotid 3D-US, Coronary Calc ification
H Sillesen, P Muntendam, E Falk, V Fuster et.al JACC Imag. 2012;7:681.
14. Cross Interaction (n=5808)
Between Carotid Plaque Area &
CAC
IIMMTT vvss FFooccaall:: ++
IIlliioo--FFeemmoorraall:: ++++++
(n = 1480) (n = 1477) (n = 1479) (n = 1478)
Carotid Plaque Area Quartiles
V Fuster, U Baber, R Mehran, E Falk, et al, 2014 (Subm)
15. Three Year All-Cause MACE Rates (N=216)
by Carotid and Coronary Atherosclerosis
Reclassification: CAC 24% - cPB 18%
V Fuster, U Baber, R Mehran, E Falk, et al, 2014 (Subm)
16. PPEESSAA && AAWWHHSS HHRRPP >> 55yy,,
4400--544yy,, NN== 44,,006600 ,, FFUU 00,,33,,66 yy NN==5880088 FFUU 33yy
Omics (Framingham)
Telomeres (S.blot, qPCR, Fresh)
a) Predictive ?
b) Economics ?
c) Imaging & Life Style
Three Approaches
2).
18. Distribution Of The Systemic Extent
Of Subclinical Atherosclerosis
PESA (L Fernandez-Friera, V Fuster et. al.)
2014 (subm.)
19. 1. A Transition From Disease to Health 2. Hear t – Brain Integration 3. Imaging / Omics / Regeneration / Style
Complex (5) CAD Valv. – CM
Sub-Clinical (4) Ar terial
Health (3) Political
1970 1990 2000 2010 2015
1990 2000 2010 2015 2020
20. 3). Cortical Atrophy (Alzheimer’s),
White Matter & Lacunar Lesions
(DBD)
JC Kovacic, V Fuster et. al. Circulation. 2011;123:1900
MA Lim et. al. Clin Geriatr Med. 2009;25:191.
21. DBD / Alzheimer’s
White Matter and Lacunar Lesions (?)
Promoting Cardiovascular and
Cerebrovascular Health
V Fuster, S Bansilal. Stroke 2010; 41:1079
Highlight Dementia Risk to Reduce CVD
BM Mearns, V Fuster. Nature Rev Card 2010; 7:237
Cellular Senescence, Aging & Vascular Disease
( Part 2 of a 2-Part Review )
JC Kovacic, EG Nabel, V Fuster Circ 2011; 123: 1900
Complex Coronary Disease, Cerebrovascular
Disease and Degenerative Brain Disease
JC Kovacic, V Fuster et al. Ann. NY. Acad. Sc 2012; 1254: 99
23. DBD/AD - CVRFs, Lacunar Les., < Cognitive
MRI – Perfusion
1.V Novak, I Hajjar. Nat. Rev. Cardiol. 2010;7:686(HMS)
2. HW Querfurth, FM LaFerla. NEJM 2010; 362:329
3. WB White et al.Circ 2011;124:2312 (Farmington,Yale)
4. AHA/ASA, Stroke 2011; 42:2672
5. WHO - Dementia report 2012
6. JB Toledo et al. Brain July 10, 2013 – Autopsy (n=6000)
7. C Russo, RL Sacco et.al. Circ. 2013;128:1105
8. JR Kizer Circ 2013;128:1045
9. CARDIA (K Yaffe et al) Circ. 2014; 129 (In Press)
Ischemia affects 60 to 90% of patients with Alzheimer’s
24. Early Adult to Midlife
CV Risk Factors & Cognitive Function
Studies have linked midlife and late-life CV risk factors
(CVRFs) to cognitive function, yet little is known about
CVRF exposure in early adulthood and subsequent
cognitive function. In a prospective study of 3381 adults
(age, 18-30 years at baseline) with 25 years of follow-up,
we assessed cognitive function at year 25 (2010-2011)
with the Digit Symbol Substitution Test, Stroop Test, and
Rey Auditory Verbal Learning Test. Cumulative
exposure to CVRFs from early to middle adulthood was
associated with worse cognition in midlife.
CARDIA (K Yaffe, et al.) Circulation 2014; 129 (In Press) – 4 Cities
25. Early Adult to Midlife
CV Risk Factors and Cognitive
Function
Adjusted For Age, Sex, Race And Education
CARDIA (K Yaffe, et al.) Circ 2014 (In Press) (Birmingham, Chicago, Minneapolis, Oakland)
26. 4). Frailty : The Hallmarks of
Aging
Non-specific
Extreme fatigue, unexplained weight loss, frequent infections.
Falls
So-called hot fall is related to a minor illness that reduces postural
balance below a crucial threshold necessary to maintain gait
integrity. Spontaneous falls occur in more severe frailty.
Delirium
Rapid onset of fluctuating confusion and impaired awareness.
Delirium is related to reduced integrity of brain function and is
independently associated with adverse outcomes.
Fluctuating disability
Fluctuating disability is day-to-day instability.
A Clegg et al., Lancet 2013; 381:752
27. Aging / Senescence
Oxidative Stress on Telomere
1
2
4
3
B Niemann et. al. JACC 2011; 57: 577.
R Madonna, R De Caterina et. al EHJ 2011;32:1190 (Houston &Chieti, Italy)
JC Kovacic, EG Nabel, V Fuster – Circ. 2011;123:1650
30. 1. A Transition From Disease to Health 2. Hear t – Brain Integration 3. Imaging / Omics / Regeneration / Style
Complex (5) CAD Valv. – CM
Sub-Clinical (4) Ar terial
Health (3) Political
1970 1990 2000 2010 2015
1990 2000 2010 2015 2020
32. 2). Promoting CV Health Worldwide
3x5 36
2011 June 27 2014
Circ. 2011;123:1671 a. Behavior Risk, b. Lack of Policy NCD,
12 RECOMMENDATIONS: c. No Intersectorial, d. Mixt Health Delivery
33. 3). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypll / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
36. A).TECHNOLOGY AND INFRASTRUCTURE
Dpt. of Atherothrombosis and Imaging
PRECLINICAL RESEARCH FACILITIES
CARDIOVASCULAR IMAGING RESEARCH LABORATORY
ANIMAL MODELS
41. 3). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypll / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
42. Childhood Obesity & Opportunity
1. Childhood Obesity: Increases Adult BP & Risk of Stroke
2. Childhood Obesity: Accounts For About 60% of Adult’s
The Finish Study (S Mayor) BMJ) 2012; 344:e3065
48. SPAIN - CHILDREN’S PROGRAM
Cardona, J Cardona July, 2011 uly 2013
Madrid, October 2011- Madrid, October 2013
49. Top 10 Advances in Hear t Disease and
Stroke
2013 AHA / ASA AHA
Dr V Ruster
newsroom.heart.org. Jan 2,
2014
50. 3). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypill / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
51. AMPATH Centers In Kenya
BP Control / Non MD / High
Technology
V Fuster, R Vedanthan, et al NHLBI / Kenya Model
52. 3). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypill / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
53. CARDONA INTEGRAL – “FIFTY-FIFTY”
SMOKING 0 11 2 -- -- 2
OVERWEIGHT 0 12 2 -- -- 2
SEDENTARISM 0 13 2 -- -- 2
HYPERTENSION 0 14 2† -- -- 2
TOTAL HABIT SCORE 8
SIX MONTHS
95% of the people have improved
in one or more of the habits or RF.
54. 3). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypill / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
55. CNIC-F/S*-FERRER POLYPILL, 2ary PREVENTION.
ASA, Statin, ACE-Inhibitor
FOCUS 1 & 2
Argentina
Brazil
Paraguay
Italy
Spain
FREEDOM
AETNA
EU 2020
Am. H J 2011;162:811
Semin.Thor.Cardiov.Surg 2011;23:24
JACC, 2014-In Press - Approved in 22 Countries
* Fuster-Sanz - Funding: European Community
56. 3). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypill / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
57. 4).From Families to Communities &
Cities
(a). AHA -THE HARLEM FAMILY APPROACH
(b). CNIC-THE SEVEN COMMUNITIES STUDY
(c). VF/MS-SHE -VILLAGE OF CARDONA
HEALTHY.
58. 4a). Science, Health, Education
Powered by / for Three Ages
A
Science / Health
2 . C
Polypill / DBD
B
Focus / Group
“Extended healthy lives” in part due to medical research
generates dramatic returns - Albert & Mary Lasker Found.- 2002
59. American Hear t AssociationStrategically
Focused Prevention Research Center
Family-Based Approach to the Prevention
of Cardiovascular Disease in a Minority
Community Integrating Systems-Biology
Icahn School of Medicine at Mount
Sinai
60. O
Start
Children
(3 Groups)
Caregivers
(3 Groups)
Start
PPP
P
PP
Teachers
O
I
I
IO
O
O
O O
O
OOO
O
KAH-BEA
Mol. GenomicsKAH-BEA S-KAH-BEA
1st Yr 2nd Yr 3rd Yr
4th Yr
BEWAT
Point of Care.
3D-US
Mol. Genomics
O
O
IP
II II
IP
Control/Interv.
PPPI
S-BEWAT
Point of Care
BEWAT
Point of Care
3D-US
Mol. Genomics
Intervention.
Intervention
Control
IIIP
P = Pilot 1st Year; S = Sustained; O = No Intervention; I = Intervention
PI = Peer Interv., II = Indiv. Interv.; PPPI = Peer-to-Peer Program Interv;
IIIP = Intensive Individual Intervention Program
KAH-BEA = Knowledge, Attitude, Habit -BMI, Exercise, Alimentation
BEWAT = BP, Exercise, Weight, Alimentation, Tobacco
61. 4b). The Seven Community Study
86
86
69
96
104
127
70
N=552
62. 4c). C A R D O N A A S A MODEL FOR THE
DEVELOPMENT OF HEALTHY VILLAGE / CITY
63. From Clinical &
Subclinical CVD
to Health Locally &
Worldwide
Round Trip of Motivation /
Funding
MM aa dd rr ii dd ,, O cc tt.. 1177,, 22001144 NNoo
DDiisscclloossuurreess
Editor's Notes
58
Adjusted by sex and age of children, group, socioeconomic status, age of parents, age and educational level of teachers . Ɨ Habits in physical activity. ǂ Standard error