Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
Impact of access site on bleeding and ischemic events in patients with non-ST-segment elevation myocardial infarction treated with prasugrel at the time of percutaneous coronary intervention or as pretreatment at the time of diagnosis: the ACCOAST access substudy
This presentation is about procedure called TAVI (Transcatheter Aortic Valve Implantation ) as a new alternative treatment to surgical valve replacement for patient with symptomatic severe Aortic stenosis who can't undergo surgery ..
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
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!
1. TransRadial PCI: Advantages, Disadvantages,
and Uptake in the U.S. and Abroad
TransRadial Education & Training & Therapy
(TREATT) Thinktank
Duke FDA Meeting
Silver Spring, MD
June 2010
David R. Holmes, MD
Mayo Clinic
Rochester, MN
2. Presenter Disclosure Information
David R. Holmes, Jr., M.D.
“TransRadial PCI: Advantages, Disadvantages, and
Uptake in the U.S. and Abroad”
The following relationships exist related to this presentation:
None
3. Radial Approaches
Issues
• What are the advantages
• Does this approach deliver?
• What are the issues in delivering
it?
• What is arteria subclavia dextra
lusiria?
4. Transfemoral Approach
• Dominant strategy since Dr Melvin Judkins
• Large vessels
• Preformed catheters
• Avoided cutdowns (Brachial artery Sones)
• Could tolerate larger catheter size
• Could be repeated
• Percutaneous
• Anatomy straightforward
5. Transfemoral Approach
• Entry site critical
• Landmarks sometimes very problematic
• The Red Sea
• Space for unrecognized blood collections
• Hemostasis
• Peripheral arterial disease
6. Advantage and Disadvantages
of Transradial Approach to PCI
Advantages
• Reduced bleeding risk
• Reduced length of stay and costs
• Early ambulation
• Improved patient comfort
• Obviates discontinuation of oral anticoagulant therapy
• Same-day discharge possible
Disadvantages
• Learning curve
• Not routinely taught in fellowship programs
• Limits guide catheter size
• Possible greater radiation exposure to operator
• Long-term consequences to radial artery
(eg, for re-access or for use as bypass graft) unknown
Rao SV et al: J Am Coll Cardiol 55:2187, 2010
3047869-6
9. Radial vs Femoral Access
Systematic Review and Meta Analysis
• 23 randomized trials with 7,020 patients
undergoing angiography or PCI
• Endpoints:
• Major bleeding
• Death
• MI
• Procedural or fluoro time
Jolly SS et al, Am Heart J 157:132-40, 2009
10. Radial vs Femoral Access
Systematic Review and Meta Analysis
Endpoints (%) Radial Femoral OR P
Major bleeding 0.05 2.3 0.27 <0.001
Death 1.2 1.8 0.74 0.29
D, MI, Stroke, PCI 2.5 3.8 0.71 0.06
Unable to cross lesions 4.7 3.4 1.29 0.21
Jolly SS et al, Am Heart J 157:132-40, 2009
11. Radial vs Femoral Access
Systematic Review and Meta Analysis
Conclusions: Radial access reduced
major bleeding and there was a
corresponding trend for reduction in
ischemic events compared to femoral
access. Large randomized trials are
needed to confirm the benefit of radial
access on death an ischemic events.
Jolly SS et al, Am Heart J 157:132-40, 2009
13. Radial Approaches
Issues
• Physical set up – arm board
• Radial anomalies
• Learning curve
• LIMA
• Radiation exposure
14. Transradial approach
• How do you introduce it?
• Ergonomics and radiation exposure
• Ergonomics and Left-Right
• Prior CABG
• Hemodynamic support
• What is arteria subclavia dextra lusiria?
15.
16.
17.
18.
19.
20. Radial Artery Anomalies
• 1,540 consecutive patients undergoing first
transradial procedure – angio + PCI
• Retrograde radial angiography performed
Lo TS: Heart 95:410, 2009
21. Radial Artery Anomalies
Clinical characteristics
Mean age (yr) 63.6
M/F 70.6/29.4
PVD 8.8%
Sheath size
5F 50.6
6F 48.0
7F 1.4
RA 93%
Lo TS: Heart 95:410, 2009
30. Radial Artery Anomalies
Procedural failure 14.2 vs 0.9% P<0.001
anomaly vs not
High-radial bifurcation 4.6%
Radial loop 37.1%
Radial tortuosity 23.3%
Misc 12.9%
Lo TS: Heart 95:410, 2009
31. Advantage and Disadvantages
of Transradial Approach to PCI
Advantages
• Reduced bleeding risk
• Reduced length of stay and costs
• Early ambulation
• Improved patient comfort
• Obviates discontinuation of oral anticoagulant therapy
• Same-day discharge possible
Disadvantages
• Learning curve
• Not routinely taught in fellowship programs
• Limits guide catheter size
• Possible greater radiation exposure to operator
• Long-term consequences to radial artery
(eg, for re-access or for use as bypass graft) unknown
Rao SV et al: J Am Coll Cardiol 55:2187, 2010
3047869-31
32. Radial Approaches
Issues
• What are the advantages
• Does this approach deliver?
• What are the issues in delivering
it?
• What is arteria subclavia dextra
lusiria?
36. Transradial Access
Site of Bleeding Complications
CVA
100 2.9 GI
RP
12.5
80 5.9
Hematoma
6.3
60 0.8
%
40 73.4
59
20
0
TIMI major TIMI minor
Rao SV et al: J Am Coll Cardiol 55:2187, 2010
3047869-36
37. Transradial Access
Association Between Vascular Access Site
for PCI and Outcomes
1.31 (0.87-1.96)
(0.87-
Procedure failure
Access site crossover
0.74 (0.42-1.30)
(0.42- 3.82 (2.83-5.15)
(2.83-
Death
0.71 (0.49-1.01)
(0.49-
Death, stroke, or MI
0.27 (0.16-0.45)
(0.16-
Major bleeding
Transradial better 1.0 Transfemoral better
Rao SV et al: J Am Coll Cardiol 55:2187, 2010
3047869-37
38. Transradial Access
Association Between Vascular Access Site
for PCI and Outcomes
1.31 (0.87-1.96)
(0.87-
Procedure failure
Access site crossover
0.74 (0.42-1.30)
(0.42- 3.82 (2.83-5.15)
(2.83-
Death
0.71 (0.49-1.01)
(0.49-
Death, stroke, or MI
0.27 (0.16-0.45)
(0.16-
Major bleeding
Transradial better 1.0 Transfemoral better
Rao SV et al: J Am Coll Cardiol 55:2187, 2010
3047869-38
39. M.O.R.T.A.L. Study
• British Columbia Cardiac Registry study
• 38,872 procedures in 32,822 patients
undergoing PCI
• Purpose: evaluate the association of arterial
access site (radial or femoral) with
transfusion and mortality
Chase AJ et al, Heart 94:1019-1025, 2008
41. M.O.R.T.A.L. Study
Unadjusted Outcome
Transfusion Status Radial vs Femoral
0.25 0.05
0.20 0.04 Femoral
Transfused
Mortality
Mortality
0.15 0.03
0.10 0.02 Radial
0.05 Not transfused 0.01
0.00 0.00
0 100 200 300 400 0 100 200 300 400
Days Days
Chase AJ et al: Heart 94:1019, 2008
3047177-41
42. M.O.R.T.A.L. Study
Conclusions
In a registry of all comers to PCI,
transradial access was associated
with a halving of the transfusion
rate and a reduction in 30-day and
1-year mortality.
Chase AJ et al, Heart 94:1019-1025, 2008
43. Radial Intervention
• RCT of 1005 patients undergoing PCI with
bolus abciximab and uncomplicated
transradial PCI
• Randomization to:
• Same day home discharge no infusion
• Standard 12-hour infusion
• Primary endpoint:
• 30-day D
• MI
• Urgent revasc.
• Major bleeding
• Access site complications
Bertrand OF et al, Circ 114:2636-43, 2006
44. Radial Intervention
Conclusion – Our data
suggest that same-day
1.0 home discharge after
Proportion of patients
uncomplicated transradial
0.8 coronary stenting and
without event
bolus only of abciximab is
0.6 not clinically inferior, in a
wide spectrum of patients,
0.4 Same-day home discharge
Same- to the standard overnight
and single bolus hospitalization and a bolus
0.2 Overnight hospitalization followed by a 12-hour
and bolus + infusion infusion. This novel
0.0 approach offers a safe
0 5 10 15 20 25 30 strategy for same-day
Days to event home discharge after
uncomplicated coronary
intervention.
Bertrand OF et al: Circ 114:2636, 2006
3047025-44
45. Outpatient Discharge Candidates
A Conservative Approach
Clinical Anatomic + Procedural
• Stable AP • SVD
• Asymptomatic + • 1 lesion in MVD
ischemia
• Single stent
• Normal EF
• Uncomplicated
• Pre-loaded with procedure
thienopyridine
SCAI Expert Consensus Document
46. Radial Approaches
Benefits Disadvantages
• Improved patient • Catheter size
safety
• Hemodynamic
• Patient comfort – support
preference
• Operator radiation
• Simplified post
procedure care • Access to LIMA
• Decreased LOS • Training