This study evaluated shock index (SI), defined as heart rate divided by systolic blood pressure, as a predictor of morbidity and mortality in pediatric trauma patients. The study used data from the 2010 National Trauma Data Bank and found that an elevated age-adjusted SI was strongly associated with mortality, need for blood transfusion, ventilation, procedures, and ICU stay. Compared to hypotension alone, elevated SI had improved sensitivity for predicting negative outcomes while maintaining high specificity. The findings support using SI as a simple tool to identify pediatric trauma patients at risk of shock-related complications.
A 2 year multidomain intervention of diet, exercise, cognitive training, and ...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
A 2 year multidomain intervention of diet, exercise, cognitive training, and ...Nutricia
A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Is clinician gestalt undervalued in chest pain assessment in EDkellyam18
This presentation discusses the role of clinician gestalt in assessment of emergency department chest pain patients. Is it accurate? How does it compare with risk scores? What are its weaknesses? Can we teach it?
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
Depression and Heart Disease - A Cross Cultural ViewAbdon Nanhay
INTRODUCTION
Depression is considered one of the most disabling diseases by year 2020, according to the World Health Organization
(WHO) statements. Epidemiological evidences indicate depression as an independent psychosocial risk factor for the
morbidity and mortality of heart disease around the world . Although the precise pathophysiological pathways linking
these disorders remain unknown, it seems that depression plays a key role in the development of heart disease, since it
contributes to the overactive of the hypothalamic-pituitary-adrenocortical axis, platelet activation, and decreased heart rate
variability.
In 1995, the WHO concluded the largest international multicentric survey on Psychological Problems in General Health Care (PPGHC). The PPGHC searched for the form, frequency, course and outcome of psychological problems commonly seen in
primary care facilities . This research had the collaboration of 15 centers from 14 countries: Ankara (Turkey), Athens
(Greece), Bangalore (India), Berlin and Mainz (Germany), Ibadan (Nigeria), Manchester (United Kingdom), Nagasaki
(Japan), Paris (France), Rio de Janeiro (Brazil), Santiago del Chile (Chile), Seattle (USA), Shangai (China) and Verona
(Italy) . It was a cross-sectional study of two stages: first-stage, a total of 25916 consecutive attenders were screened
for psychological distress, by using the 12-item General Health Questionnaire (GHQ-12); Patients screened were
sampled from the GHQ-12 score strata for the second-stage: the psychiatric interview, using the Composite International
Diagnostic Interview – Primary Health Care version (CIDI-PHC). It was applied to 5447 eligible persons for psychiatric
assessment of depressive disorders, anxiety disorders, somatization disorders, neurasthenia and alcohol problems,
according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) and the Diagnostic and
Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnostic criteria. The responders were also
interviewed about the presence of seven chronic medical conditions: hypertension, diabetes, arthritis, heart disease,
bronchitis/emphysema, stomach disorder and common parasitic disease.
During the PPGHC project, general practitioners seeing clients at the first-stage, were inquired to answer an encounter
form for each patient. It consisted of some sections: reason for contact, level of overall health, physical health status,
psychological health status and treatment prescribed. In almost all centers, there was a low rate of mental disorders
recognized by doctors, including depressive disorders, comparing to CIDI-PHC data findings.
The relationship between depression and heart disease is well documented. Some works compare symptoms of depression
with heart disease; others used a variety of scales and instruments for psychiatric morbidity measurement, to study that
connection. In the present study, the standardized psychiatric diagnosis for depression, generated from the CIDI-PHC, will be compared with the self-reported diagnosis of heart disease across cultures.
Copyright 2016 American Medical Association. All rights reserv.docxmelvinjrobinson2199
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
Geriatric Oncology
1. Relationship between aging and cancer
2. Constructs of frailty and multimorbidity
3. Evidence for geriatric assessment in older adults living with cancer
Is clinician gestalt undervalued in chest pain assessment in EDkellyam18
This presentation discusses the role of clinician gestalt in assessment of emergency department chest pain patients. Is it accurate? How does it compare with risk scores? What are its weaknesses? Can we teach it?
Compliance of pharmacological treatment for non-ST-elevation acute coronary syndromes with contemporary guidelines: influence on outcomes
Authors: Hélder Dores, Carlos Aguiar, Jorge Ferreira, Jorge Mimoso, Sílvia Monteiro, Filipe Seixo, José Ferreira Santos, On behalf of Portuguese Registry on Acute Coronary Syndromes (ProACS) Investigators
Depression and Heart Disease - A Cross Cultural ViewAbdon Nanhay
INTRODUCTION
Depression is considered one of the most disabling diseases by year 2020, according to the World Health Organization
(WHO) statements. Epidemiological evidences indicate depression as an independent psychosocial risk factor for the
morbidity and mortality of heart disease around the world . Although the precise pathophysiological pathways linking
these disorders remain unknown, it seems that depression plays a key role in the development of heart disease, since it
contributes to the overactive of the hypothalamic-pituitary-adrenocortical axis, platelet activation, and decreased heart rate
variability.
In 1995, the WHO concluded the largest international multicentric survey on Psychological Problems in General Health Care (PPGHC). The PPGHC searched for the form, frequency, course and outcome of psychological problems commonly seen in
primary care facilities . This research had the collaboration of 15 centers from 14 countries: Ankara (Turkey), Athens
(Greece), Bangalore (India), Berlin and Mainz (Germany), Ibadan (Nigeria), Manchester (United Kingdom), Nagasaki
(Japan), Paris (France), Rio de Janeiro (Brazil), Santiago del Chile (Chile), Seattle (USA), Shangai (China) and Verona
(Italy) . It was a cross-sectional study of two stages: first-stage, a total of 25916 consecutive attenders were screened
for psychological distress, by using the 12-item General Health Questionnaire (GHQ-12); Patients screened were
sampled from the GHQ-12 score strata for the second-stage: the psychiatric interview, using the Composite International
Diagnostic Interview – Primary Health Care version (CIDI-PHC). It was applied to 5447 eligible persons for psychiatric
assessment of depressive disorders, anxiety disorders, somatization disorders, neurasthenia and alcohol problems,
according to the International Statistical Classification of Diseases, 10th Revision (ICD-10) and the Diagnostic and
Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnostic criteria. The responders were also
interviewed about the presence of seven chronic medical conditions: hypertension, diabetes, arthritis, heart disease,
bronchitis/emphysema, stomach disorder and common parasitic disease.
During the PPGHC project, general practitioners seeing clients at the first-stage, were inquired to answer an encounter
form for each patient. It consisted of some sections: reason for contact, level of overall health, physical health status,
psychological health status and treatment prescribed. In almost all centers, there was a low rate of mental disorders
recognized by doctors, including depressive disorders, comparing to CIDI-PHC data findings.
The relationship between depression and heart disease is well documented. Some works compare symptoms of depression
with heart disease; others used a variety of scales and instruments for psychiatric morbidity measurement, to study that
connection. In the present study, the standardized psychiatric diagnosis for depression, generated from the CIDI-PHC, will be compared with the self-reported diagnosis of heart disease across cultures.
Copyright 2016 American Medical Association. All rights reserv.docxmelvinjrobinson2199
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
Copyright 2016 American Medical Association. All rights reserv.docxbobbywlane695641
Copyright 2016 American Medical Association. All rights reserved.
Intensive vs Standard Blood Pressure Control
and Cardiovascular Disease Outcomes in Adults Aged ≥75 Years
A Randomized Clinical Trial
Jeff D. Williamson, MD, MHS; Mark A. Supiano, MD; William B. Applegate, MD, MPH; Dan R. Berlowitz, MD; Ruth C. Campbell, MD, MSPH;
Glenn M. Chertow, MD; Larry J. Fine, MD; William E. Haley, MD; Amret T. Hawfield, MD; Joachim H. Ix, MD, MAS; Dalane W. Kitzman, MD;
John B. Kostis, MD; Marie A. Krousel-Wood, MD; Lenore J. Launer, PhD; Suzanne Oparil, MD; Carlos J. Rodriguez, MD, MPH;
Christianne L. Roumie, MD, MPH; Ronald I. Shorr, MD, MS; Kaycee M. Sink, MD, MAS; Virginia G. Wadley, PhD; Paul K. Whelton, MD;
Jeffrey Whittle, MD; Nancy F. Woolard; Jackson T. Wright Jr, MD, PhD; Nicholas M. Pajewski, PhD; for the SPRINT Research Group
IMPORTANCE The appropriate treatment target for systolic blood pressure (SBP) in older
patients with hypertension remains uncertain.
OBJECTIVE To evaluate the effects of intensive (<120 mm Hg) compared with standard
(<140 mm Hg) SBP targets in persons aged 75 years or older with hypertension
but without diabetes.
DESIGN, SETTING, AND PARTICIPANTS A multicenter, randomized clinical trial of patients aged
75 years or older who participated in the Systolic Blood Pressure Intervention Trial (SPRINT).
Recruitment began on October 20, 2010, and follow-up ended on August 20, 2015.
INTERVENTIONS Participants were randomized to an SBP target of less than 120 mm Hg
(intensive treatment group, n = 1317) or an SBP target of less than 140 mm Hg (standard
treatment group, n = 1319).
MAIN OUTCOMES AND MEASURES The primary cardiovascular disease outcome was a
composite of nonfatal myocardial infarction, acute coronary syndrome not resulting in a
myocardial infarction, nonfatal stroke, nonfatal acute decompensated heart failure, and death
from cardiovascular causes. All-cause mortality was a secondary outcome.
RESULTS Among 2636 participants (mean age, 79.9 years; 37.9% women), 2510 (95.2%)
provided complete follow-up data. At a median follow-up of 3.14 years, there was a
significantly lower rate of the primary composite outcome (102 events in the intensive
treatment group vs 148 events in the standard treatment group; hazard ratio [HR], 0.66
[95% CI, 0.51-0.85]) and all-cause mortality (73 deaths vs 107 deaths, respectively; HR, 0.67
[95% CI, 0.49-0.91]). The overall rate of serious adverse events was not different between
treatment groups (48.4% in the intensive treatment group vs 48.3% in the standard
treatment group; HR, 0.99 [95% CI, 0.89-1.11]). Absolute rates of hypotension were 2.4% in
the intensive treatment group vs 1.4% in the standard treatment group (HR, 1.71 [95% CI,
0.97-3.09]), 3.0% vs 2.4%, respectively, for syncope (HR, 1.23 [95% CI, 0.76-2.00]), 4.0% vs
2.7% for electrolyte abnormalities (HR, 1.51 [95% CI, 0.99-2.33]), 5.5% vs 4.0% for acute
kidney injury (HR, 1.41 [95% CI, 0.98-2.04]), and 4.9% vs 5.5% for inj.
Exploring the Relationship between the Platelet Indices and Psychosocial Morb...CrimsonPublishersGGS
Exploring the Relationship between the Platelet Indices and Psychosocial Morbidity in Elderly Patients at a Rural Medical College Hospital by Sunil Kumar in Geriatrics studies Journal
Central Adiposity and Mortality after First-Ever Acute Ischemic StrokeErwin Chiquete, MD, PhD
Erwin Chiquete a José L. Ruiz-Sandoval c Luis Murillo-Bonilla e
Carolina León-Jiménez g Bertha Ruiz-Madrigal d, f Erika Martínez-López d, f
Sonia Román d, f Arturo Panduro d, f Alma Ramos b Carlos Cantú-Brito
Background: The waist-to-height ratio (WHtR) may be a better
adiposity measure than the body mass index (BMI). We
evaluated the prognostic performance of WHtR in patients
with acute ischemic stroke (AIS). Methods: First, we compared
WHtR and BMI as adiposity measures in 712 healthy
adults by tetrapolar bioimpedance analysis. Thereafter,
baseline WHtR was analyzed as predictor of 12-month allcause
mortality in 821 Mexican mestizo adults with first-ever
AIS by a Cox proportional hazards model adjusted for baseline
predictors. Results: In healthy individuals, WHtR correlated
higher than BMI with total fat mass and showed a higher
accuracy in identifying a high percentage of body fat (p <
0.01). In AIS patients a U-shaped relationship was observed
between baseline WHtR and mortality (fatality rate 29.1%).
On multivariate analysis, baseline WHtR ≤ 0.300 or >0.800 independently
predicted 12-month all-cause mortality (h
Number of Pages 4 (Double Spaced)Number of sources 8Writi.docxcherishwinsland
Number of Pages: 4 (Double Spaced)
Number of sources: 8
Writing Style: APA
Type of document: Coursework
Category: Healthcare
Order Instructions:
Comprehensive Article Review
Caverly, T.J., Fagerlin, A, & Wiener, R.S. (2018, January 22). Comparison of observed harms and expected mortality benefit for persons in the Veterans Health Affairs Lung Cancer Screening Demonstration Project. JAMA Internal Medicine.
1. What research questions are addressed in this study and what is their purpose (5 points)?
2. What type of research design was used (experimental, quasi-experimental, correlational) in this study and what led you to your decision (5 points)?
3. Are the instruments in this study valid and reliable, why or why not (10 points)?
4. Discuss the specific results of each of the ANCOVAs (analysis of covariance) done in this study. What was the purpose of"each" of the ANCOVAs? What was the covariate in each and why did they do an ANCOVA in each case (5 points)?
5. In the Tables, results are presented, Please explain the tables and summarize the results (15 points).
6. Explain, in simple language, any significant results of this study (25 points)?
7. Identify and discuss any threats to internal and/or external validity in this study (10 points).
8. If you could redesign this study correcting anything you have found wrong with the research, what would you correct and how would you do it (20 points)?
Opinion
EDITORIAL
Reducing Harms in Lung Cancer Screening
Bach to the Future
Michael ln cze, MD, MSEd: Rita F. Redberg, MD, MSc
TbeUS PreventativeServices Task Force cmrcntly recom mends si:;ree ning (grade Brecommendation)for lung canc er witha nnuallow-dose computed tomo graph}' for high-risk in dividuals ages55 to 80 years, defined as those having greate r
gLblefor LCS using the Bach risk tool,11 a vaJidatcd risk model usingsex,age, smokingduration, durationof abstinence from smoking and number of cigarettes smoked per day as inpu ts.
The asto undingly high ratesof false-pos itiveresults in the low
=Related attid e
than a 30 pack-year cumula tivesmoking historyand h av• ing quit with in the past 15 years.1 The evide nce to sup
est risk quintiles (eg, 2221false-positive resul ts per lung ca n cer death averted and a NNS of nearly 5600 in quintile1), as well as extremelylow ratesoflungcancerincidencein the low est-risk groups, confirm trends illustrated in previous stud
port thisrecommendation overwhelminglycomes rrom the Na
tional Lung CancerScreenfngTrial(NL ST). While3 other large randomized clinical trials failed to show any mortality ben efit tolung cancer screening (LCS), the NLST demonstrateda 20% reduction in lungcan ce r mortality,a lo ng with a 6.7% re duction in .ill-ca use mortality, when compared with an an nual chest radiograph, witb a number needed toscreen (NNS} of256to prevent I lung-cancerassociated death over3years.-2 5 Real-worldapplication ofLCS has been particularly .
Serum Uric Acid and Outcome after Acute Ischemic Stroke: PREMIER StudyErwin Chiquete, MD, PhD
Background: Current evidence shows that uric acid is a potent
antioxidant whose serum concentration increases rapidly
after acute ischemic stroke (AIS). Nevertheless, the relationship
between serum uric acid (SUA) levels and AIS
outcome remains debatable. We aimed to describe the
prognostic significance of SUA in AIS. Methods: We studied
463 patients (52% men, mean age 68 years, 13% with glomerular
filtration rate <60 />2) at 30 days, or with
any outcome measure at 3, 6 or 12 months poststroke. After
adjustment for age, gender, stroke type and severity (NIHSS
<9),><24 h. Conclusions: A low SUA
concentration is modestly associated with a very good
short-term outcome. Our findings support the hypothesis
that SUA is more a marker of the magnitude of the cerebral
infarction than an independent predictor of stroke outcome.
Study Of Prevalence Of Malnutrition In HIV Positive Children And Its Correlat...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Are There Any Natural Remedies To Treat Syphilis.pdf
Jurnal 2 wawan
1. Shock Index as a Predictor of
Morbidity and Mortality in Pediatric
Trauma Patients
Dr. Rahman setiawan
2. Background
In pediatric patients with shock, early recognition and treatment save
Incaring for the emergent trauma patient,vital signs, such as heart rate (HR) and
systolic blood pressure (SBP), are easily obtainable and are considered quick and
reliable clinical indicators of shock
Tachycardia has been shown to predict increased mortality risk In pediatric shock
Low SBP in the ED has been found to be one of the more powerful predictors of in-
hospital mortality in pediatric trauma patients
In pediatric patients, the addition of delayed capillary refill to SBP measurement
improves early identification of mortality prone shock over hypotension and
tachycardia alone
3. Background
Shock index (SI), defined as HR divided by SBP, has emerged as a useful tool for
monitoring acute circulatory failure in adults.
When used for diagnosing early acute hypovolemia, SI can outperform
measurements of HR or SBP alone
In pediatric septic shock, an increasing SI is associated with a higher risk of
mortality
Early implementation of advanced life support in pediatric shock was associated
with improving SI
In pediatric trauma patients SI would be a predictor of the primary outcome
mortality, in addition to other defined negative outcomes
4. Methods
Cohort of patients to study SI using the National Trauma Data Bank (NTDB), version
7.2, admission year 2010
Inclusion criteria were traumatically injured patients younger than 15 years
Excluded patients transferred from another institution, patients dead on arrival,
patients with burn injuries, patients with missing data on presentation (HR, SBP,
GCS, and Injury Severity Score [ISS]), and patients with data that were considered
inconsistent with signs of life (HR <30beats /min and SBP<60mmHg)
. Shock index was calculated by dividing HR by SBP
5. Methods
SI was stratified by age (<12 months, 1 to <2 years, 2to<5years, 5to<12years
and12–14years)
For each age group , a cut off SI was calculated rom the highest normal value of HR
and the lowest normal value of SBP taken from the vital sign ranges in the
Advanced Trauma Life Support manual
a single variable (normal vs elevated) SI was created based on this age-specific cut
off value
MannWhitney U test and Student t test to identify differences in the 2 groups for
continuous variables.
Multivariate regression analysis was performed to assess factors predicting
mortality in pediatric trauma patients
6. Result
A total of 88,045 pediatric trauma patients were identified in the 2010 NTDB. After
applying our exclusion criteria, 28,741 patients remained eligible foranalysis
Median age for patients in our analytic data set was 9 years (IQR, 4–12 years), and
64.5% were male
Median GCS score of 15 (IQR, 15–15), median ISS of 5 (IQR, 4–9), and median SI of
0.86 (IQR,0.72–1.03
The overall mortality rate for all pediatric cases in the 2010 NTDB was 0.8%
(701/28,045
After applying our selection criteria, the mortality rate was 0.7% (190/28,741), and
1.7% (n = 504) had an elevated SI on presentation
9. Result
Tabel 3
We present the association between normal SI and elevated SI and our study
outcomes. Patients with elevated SI were more likely to require blood transfusion (P <
0.001), require assisted ventilation (P < 0.001), require an OR/IR procedure (P < 0.001),
and require an ICU stay (P < 0.001).
10. Result
Tabel 3
Highlights the trend toward negative outcomes in patients with both elevated SI
who were discharged alive and those with a normal SI but ultimately died.
Compared with the population of patients discharged alive with an elevated SI, the
population of patients who died with a normal SI had an increase in all defined
negative outcomes except for blood transfusions (26.8% vs 41.4%, respectively).
11. Result
Tabel 4
Table 4 demonstrates the
multivariate regression analysis for
factors associated with mortality in
pediatric trauma patients. Elevated
SI was the strongest predictor for
mortality (odds ratio [OR], 22.0;
95% confidence interval
[95%CI],15.1–31.9) in pediatric
trauma patients.When stratified by
minor trauma (ISS <16) and mild
brain injury (GCS score
>12),elevated SI remained
significantly associated with
mortality (ORs,72.0[95%CI,11.5–
449.6]and62.0[95%CI,14.6–269.1],
respectively). Hypotension (OR, 12.6
[95% CI, 7.8–20.4]) and tachycardia
(OR, 2.6 [95% CI, 1.9–3.5]) were also
predictive of mortality when
included simultaneously in a
separate regression analysis
12. Result
Tabel 5
Table 5 demonstrates the diagnostic test characteristics for elevated SI for each of the outcomes. Elevated SI had a specificity of
98.4% or greater for all outcomes tested. In predicting mortality inpediatrictrauma patients, the positive likelihoodratio for
elevated SI was 15.8. The sensitivity and negative likelihood ratio performance for elevated SI was best for mortality at 25.3% and
0.76, respectively. When compared with hypotension alone, the sensitivity for elevated SI was improved significantly for all defined
negative outcomes.
13. Discussion
This study demonstrates that elevated SI is a useful tool for the prediction of negative
outcomes in pediatric trauma patients
Compared with patients with a normal SI,patients with an elevated SI for their age
group have higher mortality rate, blood transfusion requirement, ventilation
requirement, OR/IR procedure requirement, and ICU stay requirement.
Elevated SI more strongly predicts mortality in pediatric trauma patients than
tachycardia or hypotension alone and improves upon the poor sensitivity of pediatric
hypotension in negative outcome prediction
14. Discussion
Shock index has been widely reported as a more sensitive marker of hemodynamic
instability compared with traditional vital signs such asHR and SBP
Shock index is a known predictor of mortality and adverse outcomes in pediatric septic
shock
The results of our study demonstrate that elevated SI is an accurate and specific tool
for predicting negative outcomes in pediatric trauma patients
Although tachycardia and hypotension were also associated with mortality, elevated SI
was the strongest predictor for mortality in pediatric trauma patients
15. Discussion
Elevated SI has high negative predictive value for identifying true negative outcomes;
however, the low prevalence of those outcomes limits its usefulness in that manner
Our results support the use of elevated SI in predicting high risk of mortality
irrespective of ISS or GCS.
16.
17. • Population
• Traumatically injured patients younger than 15 yearsP
• Intervention
• Age-adjusted Shock IndexI
• Comparison
• Hypotension
C
• Outcome
• Primary : mortality.
• Secondary : blood transfusion, ventilation, any
procedures, and ICU stay
O
17
20. Yes, they aimed to further evaluate the
utility of age-adjusted Shock Index to predict negative
outcomes in pediatric trauma.
20
1. Was the research question clear? Was the need for the
study adequately substansiated?
21. Design : cohort
Data collection: cross sectionally from National Trauma Data Bank
(NTDB), version 7.2, admission year 2010, the largest collection of trauma
index cases, which is maintained by the American College of Surgeons
(Chicago, Ill)
Limitation: The NTDB is not a population-based data set and thus may
not be generalizable. They acknowledge the large amount of missing
data in their study may lead to selection bias, as noted by the
discrepancy between frequency of negative outcomes when comparing
the population with complete versus missing data.
21
2. What was the design of the study? How were the data collected (one
time (cross sectional) or repeated over time (longitudinal)? What were
the limitation data collection methods?
22. Their inclusion criteria were traumatically injured patients younger than
15 years.
They excluded patients transferred from another institution, patients
dead on arrival, patients with burn injuries, patients with missing data
on presentation (HR, SBP, GCS, and Injury Severity Score [ISS]), and
patients with data that were considered inconsistent with signs of life
(HR <30 beats/min and SBP <60 mm Hg).
This sample is not representative because the NTDB is not a population-
based data set
22
3. Describe the sample. How was the sample selected (eligibility
criteria)? How is the sample representative of the population?
23. Elevated SI had a specificity of 98.4% or greater for all outcomes tested.
In predicting mortality in pediatric trauma patients, the positive
likelihood ratio for elevated SI was 15.8. The sensitivity and negative
likelihood ratio performance for elevated SI was best for mortality at
25.3% and 0.76, respectively. When compared with hypotension alone,
the sensitivity for elevated SI was improved significantly for all defined
negative outcomes
23
4. Describe the variables of interest. If comparison study, on what
variables are group being compared? How were the groups similar?
How were the groups different?
24. No, their sample size was not large enough to perform any
sub-analysis among the different age groups.
Yes, they performed power analysis (Table 5)
24
5. Was the sample size large enough to detect a statistically
significant association or difference? Was a power analysis
performed?
25. Confounder factor that have been accounted: age, gender, mechanism
of injury, race, payment type, and trauma center level designation
Potential source of bias: there are no published normal SI values for
children and large amount of missing data
25 6. Were there any potential sources of bias? (Difference between
groups not accounted for in the analysis, drop-outs, discounting
outcomes, funding agency, etc)
26. SI was stratified by age a cutoff SI was calculated from the highest
normal value of HR and the lowest normal value of SBP a single
variable (normal vs elevated) SI was created based on this age-specific
cutoff value (Table 1).
There are no published normal SI values for children; thus, they
created the SI cutoff value used in their study to help identify patients
who have tachycardia but a normal low blood pressure.
26
7. Describe the reliability and validity of the measure. Were the
measures appropriate for the population or the variable being
studied?
27. Yes, they described analysis plan in detail. They used appropriate type of
data analyzed.
They performed Mann-Whitney U test and Student t test to identify
differences in the 2 groups for continuous variables. Multivariate
regression analysis was performed to assess factors predicting mortality
in pediatric trauma patients.
Data distribution unkwown
27 8. Were the analysis plans (statisticalmethods) described in detail?
How were the data distributed? Were the correlative and
comparative tests appropriate for the type of data analyzed and the
questions asked?
30. Elevated SI is an accurate and specific predictor of morbidity
and mortality in pediatric trauma patients and is superior to tachycardia
or hypotension alone for predicting mortality.
30
1. What were the findings?
32. Yes, the authors put their findings in the context of the
broader literature on this topic
In a prospective study evaluating the detection of early
hypovolemia, SI was a more accurate
Shock index is a known predictor of mortality and adverse outcomes
in pediatric septic shock
32
3. did author put their findings in the context of the
broader literature on this topic?
35. This study showed that elevated SI is more strongly predictive of mortality than
tachycardia or hypotension alone in pediatric trauma patients and is especially
useful in children who present with apparent minor injury.
35
1. What relevance do the findings have to practice?
36. Their results support the use of elevated SI as a readily available, simple
tool to improve early recognition of pediatric patients who are at risk of
shock and subsequent negative outcomes.
36
2. Discuss how the findings can be applied to practice