The document discusses strategies for improving cardiovascular disease diagnosis and treatment in Ukraine. It argues that current approaches are insufficient as they focus on static examination of individual vascular segments rather than a dynamic, integrated analysis of the entire cardiovascular system. The article recommends predictive, preventive, and personalized medicine approaches using new technologies developed in Ukraine, such as ultrasound dopplerography, that allow comprehensive examination of vascular function and blood flow dynamics. Clinical trials of these innovative strategies showed improved treatment outcomes compared to conventional methods.
This document reviews methods for evaluating congestion in patients with acute heart failure. It proposes combining available measurements including bedside assessment, laboratory tests, and dynamic maneuvers into a scoring system to quantify the degree of congestion. Key elements are clinical signs and symptoms, along with biomarkers and hemodynamic measurements. This congestion score could help guide therapy to optimize volume status during and after hospitalization.
Cardiac emergencies in the first year of lifesxbenavides
This document discusses cardiac emergencies that may present in infants in the first year of life. It describes the most common cyanotic congenital heart lesions which cause central cyanosis, including Tetralogy of Fallot, Transposition of the Great Arteries, Tricuspid Atresia, Total Anomalous Pulmonary Venous Return, and Truncus Arteriosus. For each condition, it outlines the pathophysiology, typical presentation, physical exam findings, ECG and chest x-ray characteristics. It also discusses cyanosis, cyanotic heart disease, and the transition of cardiovascular physiology at birth.
Thermal Imaging for the Diagnosis of Early Vascular Dysfunctions: A Case Reportasclepiuspdfs
Diseases of blood vessels (referred in this article as vascular dysfunction) cause more morbidity and mortality, than combined impact of any other major non-communicable disease including cancer. We strongly feel that the development of a therapy system based on the management of disease of the vessel than management of the risk factors will yield better results and provide greater opportunity for individualized therapy. Detection of early vascular changes before clinical manifestations of endothelial dysfunction, hardening of the arteries, increased intima-media thickness, is of great importance for early identification of individuals with increased risk of accelerated atherosclerosis.
1) Cardiovascular risk factors were present in 67% of patients with central retinal artery occlusion (CRAO) and comprehensive testing identified at least one new risk factor in 78% of patients.
2) Ipsilateral carotid artery stenosis of at least 70% was found in 40% of patients, though it was only diagnosed in 3% prior to the CRAO event.
3) The study highlights the need for prompt and comprehensive diagnostic testing, including carotid ultrasound, for all CRAO patients given the high prevalence of previously undiagnosed vascular risk factors.
Study on viscosity induced contrast in ultrasound color flow imaging of carot...IJECEIAES
Efficient imaging of blood flow disturbances resulted from carotid atherosclerosis plays a vital role clinically to predict brain stroke risk. Carotid atherosclerosis and its development is closely linked with raised blood viscosity. Therefore, study of viscosity changing hemodynamic effect has importance and it might be useful for improved examination of carotid atherosclerosis incorporating the viscosity induced contrast in conventional ultrasound imaging. This work considered the design of realistic models of atherosclerotic carotid artery of different stages and solved to compute the hemodisturbances using computational fluid dynamics (CFD) by finite element method (FEM) to investigate viscosity changes effect. Ultrasound color flow image of velocities of blood have been constructed using phase shift information estimated with autocorrelation of Hilbert transformed simulated backscattered radiofrequency (RF) signals from moving blood particles. The simulated ultrasound images have been compared with CFD simulation images and identified a good match between them. The atherosclerosis stages of the models have been investigated from the estimated velocity data. It has been observed that the blood velocities increase noticeably in carotid atherosclerotic growths and velocity distribution changes with viscosity variations. It is also found importantly that the viscosity induced contrast associated to atherosclerosis is detectable in ultrasound color flow imaging. The findings of this work might be useful for better investigation of carotid atherosclerosis as well as prediction of its progression to reduce the stroke risk.
The document summarizes economic analyses that have found transradial procedures to be more cost-effective than transfemoral procedures. Several studies are highlighted, including a registry analysis finding lower total inpatient costs and shorter length of stay for transradial PCI. A meta-analysis found transradial procedures were associated with lower complication rates and costs. For STEMI patients, studies demonstrated transradial procedures were linked to shorter hospital stays. The conclusions state that transradial access can improve value by enhancing outcomes and reducing length of stay, creating value across clinical scenarios.
Pericardial Blood as a Trigger for POAF Affter Cardiac Surgery ~ Annals of Th...Paul Molloy
Background. Prevention strategies have long been
sought to reduce the incidence and burden of postoperative
atrial fibrillation (POAF) after heart surgery.
However, none has emerged as a dominant and widely
applicable prophylactic measure. The purpose of this
review is to consider the biological mechanisms by which
shed mediastinal blood leads to oxidation and inflammation
within the postoperative pericardial environment
and how this might trigger POAF in susceptible persons,
.....
Study ties use of dialysis catheters to greater infection risk in patientsdialysisinjuryhelpline
Dialysis catheters used to create a pathway to a patient's blood have been associated with a greater infection, cardiovascular problems, and mortality risk than other forms of procedures that access a patient's blood supply in dialysis treatment, a new study claims. See the Dialysis Injury Helpline at dialysisinjuryhelpline.com for comprehensive information pertaining to the serious adverse health consequences GranuFlo and NaturaLyte have been reported to cause.
This document reviews methods for evaluating congestion in patients with acute heart failure. It proposes combining available measurements including bedside assessment, laboratory tests, and dynamic maneuvers into a scoring system to quantify the degree of congestion. Key elements are clinical signs and symptoms, along with biomarkers and hemodynamic measurements. This congestion score could help guide therapy to optimize volume status during and after hospitalization.
Cardiac emergencies in the first year of lifesxbenavides
This document discusses cardiac emergencies that may present in infants in the first year of life. It describes the most common cyanotic congenital heart lesions which cause central cyanosis, including Tetralogy of Fallot, Transposition of the Great Arteries, Tricuspid Atresia, Total Anomalous Pulmonary Venous Return, and Truncus Arteriosus. For each condition, it outlines the pathophysiology, typical presentation, physical exam findings, ECG and chest x-ray characteristics. It also discusses cyanosis, cyanotic heart disease, and the transition of cardiovascular physiology at birth.
Thermal Imaging for the Diagnosis of Early Vascular Dysfunctions: A Case Reportasclepiuspdfs
Diseases of blood vessels (referred in this article as vascular dysfunction) cause more morbidity and mortality, than combined impact of any other major non-communicable disease including cancer. We strongly feel that the development of a therapy system based on the management of disease of the vessel than management of the risk factors will yield better results and provide greater opportunity for individualized therapy. Detection of early vascular changes before clinical manifestations of endothelial dysfunction, hardening of the arteries, increased intima-media thickness, is of great importance for early identification of individuals with increased risk of accelerated atherosclerosis.
1) Cardiovascular risk factors were present in 67% of patients with central retinal artery occlusion (CRAO) and comprehensive testing identified at least one new risk factor in 78% of patients.
2) Ipsilateral carotid artery stenosis of at least 70% was found in 40% of patients, though it was only diagnosed in 3% prior to the CRAO event.
3) The study highlights the need for prompt and comprehensive diagnostic testing, including carotid ultrasound, for all CRAO patients given the high prevalence of previously undiagnosed vascular risk factors.
Study on viscosity induced contrast in ultrasound color flow imaging of carot...IJECEIAES
Efficient imaging of blood flow disturbances resulted from carotid atherosclerosis plays a vital role clinically to predict brain stroke risk. Carotid atherosclerosis and its development is closely linked with raised blood viscosity. Therefore, study of viscosity changing hemodynamic effect has importance and it might be useful for improved examination of carotid atherosclerosis incorporating the viscosity induced contrast in conventional ultrasound imaging. This work considered the design of realistic models of atherosclerotic carotid artery of different stages and solved to compute the hemodisturbances using computational fluid dynamics (CFD) by finite element method (FEM) to investigate viscosity changes effect. Ultrasound color flow image of velocities of blood have been constructed using phase shift information estimated with autocorrelation of Hilbert transformed simulated backscattered radiofrequency (RF) signals from moving blood particles. The simulated ultrasound images have been compared with CFD simulation images and identified a good match between them. The atherosclerosis stages of the models have been investigated from the estimated velocity data. It has been observed that the blood velocities increase noticeably in carotid atherosclerotic growths and velocity distribution changes with viscosity variations. It is also found importantly that the viscosity induced contrast associated to atherosclerosis is detectable in ultrasound color flow imaging. The findings of this work might be useful for better investigation of carotid atherosclerosis as well as prediction of its progression to reduce the stroke risk.
The document summarizes economic analyses that have found transradial procedures to be more cost-effective than transfemoral procedures. Several studies are highlighted, including a registry analysis finding lower total inpatient costs and shorter length of stay for transradial PCI. A meta-analysis found transradial procedures were associated with lower complication rates and costs. For STEMI patients, studies demonstrated transradial procedures were linked to shorter hospital stays. The conclusions state that transradial access can improve value by enhancing outcomes and reducing length of stay, creating value across clinical scenarios.
Pericardial Blood as a Trigger for POAF Affter Cardiac Surgery ~ Annals of Th...Paul Molloy
Background. Prevention strategies have long been
sought to reduce the incidence and burden of postoperative
atrial fibrillation (POAF) after heart surgery.
However, none has emerged as a dominant and widely
applicable prophylactic measure. The purpose of this
review is to consider the biological mechanisms by which
shed mediastinal blood leads to oxidation and inflammation
within the postoperative pericardial environment
and how this might trigger POAF in susceptible persons,
.....
Study ties use of dialysis catheters to greater infection risk in patientsdialysisinjuryhelpline
Dialysis catheters used to create a pathway to a patient's blood have been associated with a greater infection, cardiovascular problems, and mortality risk than other forms of procedures that access a patient's blood supply in dialysis treatment, a new study claims. See the Dialysis Injury Helpline at dialysisinjuryhelpline.com for comprehensive information pertaining to the serious adverse health consequences GranuFlo and NaturaLyte have been reported to cause.
Takayasu arteritis is a rare large vessel vasculitis that predominantly involves the aorta and its major branches. It was first described in 1908 by Mikito Takayasu and has various names including pulseless disease. It most commonly affects the subclavian and carotid arteries in women under 50 years old. Diagnosis is based on imaging and clinical criteria as there are no definitive diagnostic tests. Treatment involves steroids and steroid-sparing immunosuppressants, with TNF inhibitors being widely used biologic therapies. Ongoing management focuses on preventing arterial progression and complications like hypertension.
Polyarteritis nodasa and microscopic polyangitisMarwa Besar
This document discusses Polyarteritis Nodosa (PAN) and Microscopic Polyangiitis (MPA). PAN is a necrotizing vasculitis predominantly affecting medium-sized arteries that spares small vessels. It is typically ANCA-negative. MPA is a pauci-immune necrotizing vasculitis involving small vessels and sometimes medium arteries, associated with ANCA positivity. Both diseases can affect multiple organ systems and have variable clinical manifestations. Differentiation is based on vessel size involvement and ANCA status according to the Chapel Hill consensus criteria.
Presentatie Prof. dr. Büller en Prof. dr. ReitsmaCVON
The influence of statins on the role of blood coagulation in the maintenance of a healthy macro- and microvasculature and in the prevention of recurrent thrombosis.
Since the first heart transplant, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have
significantly improved survival. In this first of two articles, a perspective of the current realities of cardiac transplantation is shown, as well as the challenges to sustain services worldwide, and some of the new developments, both resently available and just beyond the horizon. Topics that will be covered in this first part include the donor and recipient demographics, as well as recent advances in transplantation immunology, allograft vasculopathy, and immune tolerance.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
The document provides a history and overview of heart failure epidemiology. It discusses how heart failure was described anciently but not well understood until William Harvey's description of circulation in 1628. Later advances like echocardiography improved diagnosis. Studies estimate heart failure prevalence is 1-2% overall, rising to over 4% among those over 70, with coronary artery disease and hypertension as major risk factors. Incidence also rises with age, doubling each decade after age 45. More men than women are affected. Rates are higher in black populations. Heart failure accounts for over 5% of hospital admissions and 1% of healthcare spending.
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Intraoperative aortic dissection during cardiac surgery is infrequent, complicating surgical intervention in 0.04 - 1% of cases. Dissections can occur anywhere, most often as a result of direct mechanical damage at the location of the side clamp, site of cannulation of the aorta, or at the site of proximal anastomosis and may manifest as hematoma, bleeding at the cannulation site or bleeding from the proximal anastomoses or aortic suture lines. Delayed diagnosis and treatment can lead to extremely (23-41%) high mortality rate.
Furosemide with matched hydration using the RenalGuard System was found to decrease the incidence of contrast-induced acute kidney injury (CI-AKI) compared to control treatments in patients undergoing interventional procedures. The RenalGuard System delivers intravenous fluids matched to urine output with hydration, furosemide, and continuous monitoring to maintain urine output over 300 ml/hr. A meta-analysis found the RenalGuard System reduced CI-AKI and need for renal replacement therapy with no increase in adverse events. However, more randomized trials are still needed to further evaluate the safety of the RenalGuard System.
Renal Artery Revascularization: where we arePAIRS WEB
This document discusses renal artery stenosis (RAS), which is narrowing of the renal arteries that can be caused by conditions like atherosclerosis or fibromuscular dysplasia. The two most common causes are atherosclerotic renal artery stenosis and fibromuscular dysplasia. RAS can lead to hypertension, renal impairment, and ischemic nephropathy. While renal artery stenting was often used as treatment, recent clinical trials found no clear added benefits of stenting over medical management alone for atherosclerotic cases. Stenting may still benefit cases of fibromuscular dysplasia or treatment-resistant high blood pressure. The best approach for RAS continues to be evaluated based on ongoing research.
Coronary artery ectasia (CAE) is an inappropriate dilatation of the coronary arteries. It has an unknown etiology but may be due to genetic or inflammatory factors. CAE is detected in 3-8% of angiograms and can be diffuse or localized. It can cause angina due to turbulent blood flow. Diagnosis is typically made using angiography, CT, or MRI imaging. Treatment involves aspirin due to risk of thrombosis, with surgical revascularization for significant coronary artery disease.
Dual antiplatelet therapy duration based on ischemic and bleeding risks after...NAJEEB ULLAH SOFI
The PRECISE-DAPT score is a 5-item bleeding risk prediction model developed to estimate the bleeding risk in patients who receive dual antiplatelet therapy (DAPT) after stent implantation
The categorization of patients based on the PRECISE-DAPT score was shown to be useful to inform decision-making for duration of DAPT in stented patients
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
This document summarizes treatment options for renal artery stenosis, including surgical, interventional, and medical approaches. The main treatment modalities discussed are percutaneous transluminal angioplasty with stent placement, which has become the standard therapy, and surgical revascularization for more complex cases. The summary highlights that technical success rates for stenting are high but durability is poor with high restenosis rates, while hypertension and renal function responses are inferior to surgical revascularization for diffuse atherosclerosis where mortality risks are significant.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Acute upper limb ischeamia (AULI) is a surgical emergency is a surgical emergency that is infrequently reported thus resulting in fewer literature/guidelines for its management. We are reporting a case of an elderly malay gentleman who is a chronic smoker that presented with sudden onset severe right upper limb pain. On examination of his right upper limb showed features of Rutherford Grade 1 of acute limb ischeamia. We proceeded with Computed tomography angiogram (CTA) and noted there was a short segment thrombosis of right brachial artery just before the branching into radial and ulnar artery which is the most frequent site. Electrocardiography (ECG) and Echocardiography is suggestive of recent ischeamic heart disease. We would like to advocate that Surgical management is the main stay of treatment modality however due recent cardiac event and the clinical staging, we managed him conservatively. Patient was discharged well with oral novel oral anti-coagulant (NOAC). This review intends to share our experience in managing this patient in a district hospital and hope it will provide a brief idea with regards to acute upper limb ischeamia.
philadelphia cpa considering bankruptcy, give us a call. We can help solve your accounting problems and alleviate your anxiety.For More Information, Visit:http://www.yelp.com/biz/tax-help-philly-jenkintown
This document discusses strategies for a company to establish its identity in the vitamin water category and communicate its message as a tool for intelligent living. It outlines target demographics, proposed media strategies including magazines and point of purchase, and a budget breakdown with goals for online advertising, print advertising, corporate citizenship programs, lifestyle interactions, and point of purchase advertising. The budget totals $50 million with targets for return on investment and category growth.
Leaflet of the Comenius Project - Czech RepublicRejzlBohuslav
A leaflet to promote the activities of the project Let's meet under the Spots was published by the Czech secondary school, Gymnázium bratří Čapků a První české soukromé střední odborné učiliště s.r.o.
Este documento habla sobre los primeros auxilios por intoxicación o envenenamiento. Explica que la atención inmediata a la víctima puede ganar tiempo mientras se busca ayuda médica. Las intoxicaciones pueden ser accidentales o por intento de suicidio e involucran la ingestión, inyección o inhalación de sustancias tóxicas. También define intoxicación como la reacción del organismo a sustancias lesivas y tóxicos como cualquier sustancia que en cierta concentración puede dañar a los seres vivos. Finalmente,
The document discusses the history of keyboard layouts, including QWERTY from 1873, Dvorak from 1936, and more recent variants like Colemak and Workman. It then explores the concept of using a genetic algorithm to evolve keyboard layouts or other designs through random mutations and selection of highest-scoring versions. The discussion considers whether something created through an algorithm can truly be called life or if it is just following its programming, and debates concepts like free will, perception of reality, and whether a creator such as God could have dreamed up the world.
Takayasu arteritis is a rare large vessel vasculitis that predominantly involves the aorta and its major branches. It was first described in 1908 by Mikito Takayasu and has various names including pulseless disease. It most commonly affects the subclavian and carotid arteries in women under 50 years old. Diagnosis is based on imaging and clinical criteria as there are no definitive diagnostic tests. Treatment involves steroids and steroid-sparing immunosuppressants, with TNF inhibitors being widely used biologic therapies. Ongoing management focuses on preventing arterial progression and complications like hypertension.
Polyarteritis nodasa and microscopic polyangitisMarwa Besar
This document discusses Polyarteritis Nodosa (PAN) and Microscopic Polyangiitis (MPA). PAN is a necrotizing vasculitis predominantly affecting medium-sized arteries that spares small vessels. It is typically ANCA-negative. MPA is a pauci-immune necrotizing vasculitis involving small vessels and sometimes medium arteries, associated with ANCA positivity. Both diseases can affect multiple organ systems and have variable clinical manifestations. Differentiation is based on vessel size involvement and ANCA status according to the Chapel Hill consensus criteria.
Presentatie Prof. dr. Büller en Prof. dr. ReitsmaCVON
The influence of statins on the role of blood coagulation in the maintenance of a healthy macro- and microvasculature and in the prevention of recurrent thrombosis.
Since the first heart transplant, refinement of donor and recipient selection methods, better donor heart management, and advances in immunosuppression have
significantly improved survival. In this first of two articles, a perspective of the current realities of cardiac transplantation is shown, as well as the challenges to sustain services worldwide, and some of the new developments, both resently available and just beyond the horizon. Topics that will be covered in this first part include the donor and recipient demographics, as well as recent advances in transplantation immunology, allograft vasculopathy, and immune tolerance.
Diagnosis of Early Risks, Management of Risks, and Reduction of Vascular Dise...asclepiuspdfs
In a recent issue of the Journal of Circulation, American Heart Association has published a scientific statement, related to the excess heart disease and acute vascular events in South Asians living in the USA. The same group of experts, also have published a complementary article in Circulation titled, “call to action: Cardiovascular disease (CVD) in Asian Americans.”I being a South Asian immigrant living in the USA, have always wondered as to why we do not have the same benefits as the other resident Americans in terms of the advantages of living in a highly advanced country? According to a study done in 2013, cardiovascular mortality has declined and diabetes mortality has increased in high-income countries. The study done in 26 industrialized nations, estimated the potential role of trends in population, for body mass index, systolic blood pressure, serum total cholesterol, and smoking, the modifiable risk factors identified as the promoters of CVD, and acute vascular events, by the Framingham Heart Study (FHS) group.
The document provides a history and overview of heart failure epidemiology. It discusses how heart failure was described anciently but not well understood until William Harvey's description of circulation in 1628. Later advances like echocardiography improved diagnosis. Studies estimate heart failure prevalence is 1-2% overall, rising to over 4% among those over 70, with coronary artery disease and hypertension as major risk factors. Incidence also rises with age, doubling each decade after age 45. More men than women are affected. Rates are higher in black populations. Heart failure accounts for over 5% of hospital admissions and 1% of healthcare spending.
This study prospectively examined cardiac arrhythmias in 90 patients undergoing cardiac surgery at a hospital in Romania between January and June 2017. The study found that postoperative atrial fibrillation was more common in older patients (above 60 years old) with enlarged left atriums. Patients who developed arrhythmias tended to have lower ejection fractions, higher creatinine levels, and more postoperative hemodynamic and renal complications compared to patients without arrhythmias. Risk factors for developing arrhythmias after cardiac surgery included older age, enlarged left atrium, lower arterial oxygen saturation, lower potassium levels, and need for higher doses of inotropic drugs.
Intraoperative aortic dissection during cardiac surgery is infrequent, complicating surgical intervention in 0.04 - 1% of cases. Dissections can occur anywhere, most often as a result of direct mechanical damage at the location of the side clamp, site of cannulation of the aorta, or at the site of proximal anastomosis and may manifest as hematoma, bleeding at the cannulation site or bleeding from the proximal anastomoses or aortic suture lines. Delayed diagnosis and treatment can lead to extremely (23-41%) high mortality rate.
Furosemide with matched hydration using the RenalGuard System was found to decrease the incidence of contrast-induced acute kidney injury (CI-AKI) compared to control treatments in patients undergoing interventional procedures. The RenalGuard System delivers intravenous fluids matched to urine output with hydration, furosemide, and continuous monitoring to maintain urine output over 300 ml/hr. A meta-analysis found the RenalGuard System reduced CI-AKI and need for renal replacement therapy with no increase in adverse events. However, more randomized trials are still needed to further evaluate the safety of the RenalGuard System.
Renal Artery Revascularization: where we arePAIRS WEB
This document discusses renal artery stenosis (RAS), which is narrowing of the renal arteries that can be caused by conditions like atherosclerosis or fibromuscular dysplasia. The two most common causes are atherosclerotic renal artery stenosis and fibromuscular dysplasia. RAS can lead to hypertension, renal impairment, and ischemic nephropathy. While renal artery stenting was often used as treatment, recent clinical trials found no clear added benefits of stenting over medical management alone for atherosclerotic cases. Stenting may still benefit cases of fibromuscular dysplasia or treatment-resistant high blood pressure. The best approach for RAS continues to be evaluated based on ongoing research.
Coronary artery ectasia (CAE) is an inappropriate dilatation of the coronary arteries. It has an unknown etiology but may be due to genetic or inflammatory factors. CAE is detected in 3-8% of angiograms and can be diffuse or localized. It can cause angina due to turbulent blood flow. Diagnosis is typically made using angiography, CT, or MRI imaging. Treatment involves aspirin due to risk of thrombosis, with surgical revascularization for significant coronary artery disease.
Dual antiplatelet therapy duration based on ischemic and bleeding risks after...NAJEEB ULLAH SOFI
The PRECISE-DAPT score is a 5-item bleeding risk prediction model developed to estimate the bleeding risk in patients who receive dual antiplatelet therapy (DAPT) after stent implantation
The categorization of patients based on the PRECISE-DAPT score was shown to be useful to inform decision-making for duration of DAPT in stented patients
This document discusses sudden cardiac death and proposes a new research hypothesis for drug design strategies. It summarizes current understanding of sudden cardiac death pathology from medical literature, which finds various etiologies including ventricular arrhythmias, coronary artery disease, and genetic channelopathies in about 20% of cases. The authors propose developing new diagnostic tests that can evaluate the heart's biochemical and metabolic status under normal and stressed conditions locally in the heart tissue, rather than just plasma, to help prevent unexpected cardiac events and better understand sudden cardiac death pathology. This could involve applying diagnostic strategies from other medical disciplines to cardiology.
This document summarizes treatment options for renal artery stenosis, including surgical, interventional, and medical approaches. The main treatment modalities discussed are percutaneous transluminal angioplasty with stent placement, which has become the standard therapy, and surgical revascularization for more complex cases. The summary highlights that technical success rates for stenting are high but durability is poor with high restenosis rates, while hypertension and renal function responses are inferior to surgical revascularization for diffuse atherosclerosis where mortality risks are significant.
Left Ventricular Apical Ballooning, Catecholamine Toxicity, and Cardiomyopathyasclepiuspdfs
Case reports and clinical experiences have implicated catecholamine. Excess likely contributes to the pathophysiologic process as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Cardiac dysfunction has also been described in many other diseases; there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after catecholamine surge and discuss the evidence surrounding cardiac dysfunction.
Acute upper limb ischeamia (AULI) is a surgical emergency is a surgical emergency that is infrequently reported thus resulting in fewer literature/guidelines for its management. We are reporting a case of an elderly malay gentleman who is a chronic smoker that presented with sudden onset severe right upper limb pain. On examination of his right upper limb showed features of Rutherford Grade 1 of acute limb ischeamia. We proceeded with Computed tomography angiogram (CTA) and noted there was a short segment thrombosis of right brachial artery just before the branching into radial and ulnar artery which is the most frequent site. Electrocardiography (ECG) and Echocardiography is suggestive of recent ischeamic heart disease. We would like to advocate that Surgical management is the main stay of treatment modality however due recent cardiac event and the clinical staging, we managed him conservatively. Patient was discharged well with oral novel oral anti-coagulant (NOAC). This review intends to share our experience in managing this patient in a district hospital and hope it will provide a brief idea with regards to acute upper limb ischeamia.
philadelphia cpa considering bankruptcy, give us a call. We can help solve your accounting problems and alleviate your anxiety.For More Information, Visit:http://www.yelp.com/biz/tax-help-philly-jenkintown
This document discusses strategies for a company to establish its identity in the vitamin water category and communicate its message as a tool for intelligent living. It outlines target demographics, proposed media strategies including magazines and point of purchase, and a budget breakdown with goals for online advertising, print advertising, corporate citizenship programs, lifestyle interactions, and point of purchase advertising. The budget totals $50 million with targets for return on investment and category growth.
Leaflet of the Comenius Project - Czech RepublicRejzlBohuslav
A leaflet to promote the activities of the project Let's meet under the Spots was published by the Czech secondary school, Gymnázium bratří Čapků a První české soukromé střední odborné učiliště s.r.o.
Este documento habla sobre los primeros auxilios por intoxicación o envenenamiento. Explica que la atención inmediata a la víctima puede ganar tiempo mientras se busca ayuda médica. Las intoxicaciones pueden ser accidentales o por intento de suicidio e involucran la ingestión, inyección o inhalación de sustancias tóxicas. También define intoxicación como la reacción del organismo a sustancias lesivas y tóxicos como cualquier sustancia que en cierta concentración puede dañar a los seres vivos. Finalmente,
The document discusses the history of keyboard layouts, including QWERTY from 1873, Dvorak from 1936, and more recent variants like Colemak and Workman. It then explores the concept of using a genetic algorithm to evolve keyboard layouts or other designs through random mutations and selection of highest-scoring versions. The discussion considers whether something created through an algorithm can truly be called life or if it is just following its programming, and debates concepts like free will, perception of reality, and whether a creator such as God could have dreamed up the world.
Linked in page slide share - final-20160506eswadmin
ESW is an IT services company that started in Grande Prairie, Alberta in 1998 and has since expanded to include offices in Calgary and Edmonton. They offer a wide range of IT services including service desk support, network implementation, server implementation, and cloud technology services. ESW values their employees and clients, treating employees as co-workers rather than staff. They offer benefits and training from the first day of employment. ESW aims to leverage technology to benefit their clients and provide a positive experience for both clients and employees.
The Challenges of Urbanisation in IndiaRajesh K.Wdr
India's urban population is projected to grow rapidly in the coming decades, posing major challenges if not properly managed. While urbanization has occurred more slowly in India than other developing countries, the pace is accelerating. By 2025, another 300 million people will be added to Indian cities. This unprecedented growth will stress infrastructure like housing, transportation, and utilities if India does not address issues of inclusive development, governance, financing, planning, capacity building, and affordable housing. Reforms are needed to empower local governments and boost funding to develop long-term plans and professional management capable of supporting prosperous urbanization.
Manometria is a medical test that measures pressure in different parts of the body. It involves inserting a thin tube called a catheter into an artery or other vessel and connecting it to a manometer, which is a device that measures pressure. The manometer then provides readings of pressure at various points that can help doctors diagnose issues related to blood pressure, urinary problems, and other conditions.
Cookies are small text files stored on a user's device that are used to identify users and customize their experience. Session data is stored on the server to identify users across page requests during a browser session, using a session ID sent back and forth via cookies or URL rewriting. This document discusses how cookies and sessions work, how to set them in JSP, and some common session functions like registering and accessing session variables.
Este documento resume las guías para el tratamiento adyuvante y neoadyuvante del cáncer de tiroides. Indica que el rastreo posoperatorio con yodo radiactivo no se requiere para pacientes menores de 45 años con tumores menores a 2 cm sin extensión a la tiroides o metástasis. También describe las complicaciones agudas y crónicas del tratamiento con yodo radiactivo, así como el uso de la hormona tiroidea para suprimir la TSH y reducir las recurrencias. Finalmente, explica que los niveles de t
The document contains a series of multiple choice questions with numeric point values ranging from 100 to 1,000,000. The questions cover topics like geography, history, entertainment, science and more. Each question is followed by 4 possible answer choices labelled A-D.
Este documento describe la colangitis, una inflamación de la vía biliar. Se discuten las causas, síntomas, diagnóstico y tratamiento de la colangitis aguda y crónica. La colangitis aguda se produce por obstrucción biliar e infección, mientras que la colangitis crónica incluye la colangitis esclerosante primaria, que causa estrecheces fibrosas en los conductos biliares. El diagnóstico se basa en exámenes de laboratorio, ultrasonido, colangiopancreatografía retrógra
The document is from the American Heart Association's Advanced Cardiovascular Life Support Provider Manual published in Barcelona, Spain in 1980-1088. It discusses cardiac arrhythmias, cardiovascular arrest, fibrillation, torsades, and a clinical case study. Key terms mentioned include H's and T's.
Este documento resume la incidencia, prevalencia, mortalidad y complicaciones de la diabetes en México. Describe las características clínicas de las crisis hiperglucémicas agudas como la cetoacidosis diabética y la hiperglucemia hiperosmolar, incluyendo su fisiopatología, factores precipitantes, diagnóstico, tratamiento con fluidoterapia, insulina y electrolitos, así como el manejo de las hipoglucemias.
This document provides instructions for setting up a MySQL database connection from Java using JDBC. It describes creating a package and Java class to connect to a MySQL database hosted on localhost. It also explains how to use Navicat to create a new database called "CharacterSet" and a table within it to store and retrieve data from the MySQL database using the Java application.
1. The document discusses Chronic Cerebrospinal Venous Insufficiency (CCSVI), a condition linked to multiple sclerosis (MS) where veins draining the brain and spinal cord are narrowed or blocked.
2. It provides details on diagnosing and treating CCSVI using procedures like Doppler ultrasound, MRI, venography, and venous angioplasty to widen blocked veins.
3. While the relationship between CCSVI and MS is still being studied, the document reports that over 600 MS patients treated for CCSVI experienced reduced fatigue, improved quality of life, psychological state, and physical condition based on evaluation scales.
This meta-analysis compared the effectiveness of surgical procedures for portal hypertension, including selective or nonselective shunts, devascularization, and combined shunt and devascularization. It found that shunt procedures were more effective at reducing rebleeding compared to devascularization alone, but also carried a higher risk of encephalopathy. Combined shunt and devascularization was more effective at reducing portal vein pressure and rebleeding than devascularization alone. There were no significant differences in outcomes between selective and nonselective shunts. The analysis was based on data from randomized controlled trials involving over 1000 patients with portal hypertension.
1) The document discusses several studies that examine new pharmacological strategies and surgery for treating atherosclerotic conditions. It summarizes findings that calcium deposits play a role in atherosclerosis and can be quantified.
2) One study found that a combination therapy of EDTA, tetracycline, and supplements (ComET) led to decreases in coronary artery calcium scores for 57% of patients with coronary artery disease, implying regression of calcified plaque.
3) The TACT trial found that chelation therapy with EDTA reduced cardiovascular events by 18% overall and by 41% for patients with diabetes, showing potential benefit of removing heavy metals through chelation.
Inter society consensus for the management of peripheral arterial disease (tasc)Jonathan Campos
This document summarizes the key findings of the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). It discusses the prevalence of peripheral arterial disease (PAD), finding that PAD affects approximately 3-10% of the general population but is asymptomatic in around 75% of cases. The ratio of asymptomatic to symptomatic PAD is estimated to be between 3:1 and 4:1. Symptomatic PAD presents mainly as intermittent claudication. The document also outlines the grading system used to rate the strength of recommendations.
Invasive hemodynamic monitoring using a pulmonary artery catheter can help guide treatment for complex patients by providing detailed cardiac information. While use of these catheters is declining somewhat, the data they provide on issues like cardiogenic shock and pulmonary pressures can still be useful for diagnosis and management. For a complex patient, this information could be used to individualize a treatment plan involving medications, devices, or other therapies. However, there are also risks to consider from potential complications of catheter insertion or use.
Introduction: There is growing evidence that Obstructive Sleep Apnea (OSA) is a risk factor for Pulmonary Embolism (PE). This
association represents a major public health burden.Aims and Objectives: To investigate Computed Tomography Obstruction Index (CTOI) and the Right Ventricular (RV) to Left Ventricular (LV) diameter ratio with OSA severity. Materials and Methods: 46 Patients with (PE) were evaluated for OSA. Pulmonary Artery Obstruction Index (PAOI) and RV/ LV diameter ratio was measured by pulmonary angiography. Pulmonary Embolism Severity Index (PESI) was determined. Epworth Sleepiness Scale (ESS) and Polysomnography (PSG) was performed for all patients. Based on the PAOI, patients divided into (< 15%, 15-50%, > 50%).
An Advanced Low-cost Blood Cancer Detection SystemChristo Ananth
Christo Ananth, K. Jasmine Mystica, M. Sridharan, S. Aaron James, T. Ananth Kumar, “An Advanced Low-cost Blood Cancer Detection System”, International Journal of Early Childhood Special Education, Volume 14, Issue 05, 2022,pp. 4115-4123.
Description:
Christo Ananth et al. discussed that Blood leukemia can be diagnosed with greater precision and specificity when red blood cells are separated from young white blood cells. The only way to tell if someone has a blood disorder is to take photographs of their skin, calculate, shade, and measure them. According to the World Health Organization, leukemia is the fifth leading cause of death in the world. Early detection and identification of infection are critical to the treatment's success and outcome. It is hoped that the researchers will be able to identify and test cells that are linked to leukemia in this study. This disease can be classified according to whether or not it has immature cells and the severity of persistent or intense leukemia. A more uniform distribution of data points can be achieved by using histogram levelling and straight difference extending with morphological methods such as region opening, region closing, disintegration, and expansion. Thus, the Proposed Method is more effective than other previous methods.
This study aims to establish new parameters to guide fluid resuscitation in shock therapy and reduce the risk of acute kidney injury (AKI). The study will measure intra-abdominal pressure, renal resistive index, sublingual microcirculation, and total body water in patients with shock and correlate these values with the occurrence of AKI and need for renal replacement therapy. The study is an observational clinical trial that has recruited 33 patients so far and expects final results in late 2018. It hypothesizes that integrating new regional measurements into fluid resuscitation guidance can lower AKI rates and renal replacement therapy needs compared to using only standard hemodynamic parameters.
This document discusses various imaging modalities for assessing the right heart, including echocardiography and cardiac magnetic resonance imaging (CMR). It provides details on:
1) The challenges of using echocardiography to evaluate right ventricular (RV) structure and function due to its complex geometry, though it is commonly used. Quantitative measures like fractional area change and tricuspid annular plane systolic excursion are recommended.
2) CMR is considered the clinical reference technique due to unlimited imaging planes, superior resolution, and ability to perform 3D volumetric rendering, making it ideal for serial exams.
3) Other modalities like multidetector computed tomography and radionuclide techniques play roles
This document provides an overview of sepsis. It begins with definitions of sepsis from Hippocrates to modern consensus definitions. The third consensus definitions from 2016 emphasize evidence of infection plus life-threatening organ dysfunction. The scale of the problem is discussed, with an estimated 19 million cases of sepsis worldwide annually. Landmark studies showing the importance of early goal-directed therapy and timely antibiotics are reviewed. The key role of emergency physicians is to assess for signs of sepsis, suspect sepsis, reassess with lactate and glucose levels, provide early fluids and appropriate antibiotics. Ongoing local studies on lactate levels and screening tools for sepsis identification in the emergency department are mentioned.
Week 7 Hematological SystemOften in the medical field, an empha.docxcockekeshia
Week 7: Hematological System
Often in the medical field, an emphasis is placed on the importance of the heart and the lungs. While these two organs are vital to the sustainability of life, the blood is what makes the cardiovascular and respiratory systems function—it’s the connection for the heart and lungs. For this reason, disorders of the hematological system can be potentially devastating for patients. Consider the case of Connie Prochnow. Connie was diagnosed with leukemia after seeking medical care for bruising, shortness of breath, and exhaustion. Her blood disorder resulted in alterations that impacted other body systems, including her respiratory system (UW Health, 2012). Since the heart and the lungs rely so heavily on the blood, it is important that hematological disorders are quickly identified and managed.
This week, as you focus on hematological disorders commonly presented to advanced practice nurses, you examine the pathophysiology of anemia. You also explore the impact of patient factors on anemic disorders.
Reference
Prochnow, C. (n.d.). Restoring hope: A cancer patient shares her story. Retrieved September 11, 2012, from http://www.uwhealth.org/uw-carbone-cancer-center/restoring-hope-a-cancer-patient-shares-her-story/20371
Learning Objectives
Students will:
· Analyze the pathophysiology of anemia
· Compare the pathophysiology of iron deficiency anemia to the pathophysiology of other types of anemia
· Evaluate the impact of patient factors on anemic disorders
· Understand and apply key terms, concepts, and principles related to alterations of the hematological system
Photo Credit: JPC-PROD/iStock/Getty Images Plus/Getty images
Learning Resources
Required Readings
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.
· Chapter 19, “Structure and Function of the Hematologic System”
This chapter examines components of the hematologic system, development of blood cells, mechanisms of hemostasis, and hematologic value changes in pediatrics and geriatrics. It also focuses on common blood tests for hematologic disorders.
· Chapter 20, “Alterations of Hematologic Function”
This chapter focuses on common alterations of hematologic function, including alterations of erythrocyte function, leukocyte function, lymphoid function, splenic function, platelets, and coagulation.
· Chapter 21, “Alterations of Hematologic Function in Children”
This chapter expands on alterations of hematologic function by presenting disorders that affect children, such as disorders of erythrocytes, coagulation, and platelets.
McPhee, S. J., & Hammer, G. D. (2010). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.
· Chapter 6, “Blood Disorders”
This chapter begins by exploring the anatomy and physiology of blood and the coagulation system. It then examines two types of anemia caused by red cell disorders.
This document provides an introduction to the Transfusion Medicine Module. It discusses the key topics that will be covered, including the history and evolution of transfusion medicine over the past two centuries. Major developments include Dr. James Blundell establishing transfusion medicine as a clinical discipline in the 1800s, Dr. Karl Landsteiner discovering blood groups in 1901, and Dr. Patrick Mollison prolonging blood storage times during World War II. The document outlines how transfusion medicine now encompasses diverse fields from blood donation and screening to hemostasis, immunotherapy, and cellular therapies. It provides an overview of the module's syllabus and readings.
Cardiorenal Syndrome Classification, Pathophysiology, Diagnosis, and Treatmen...pedro betancourt
This document provides a scientific statement on cardiorenal syndrome from the American Heart Association. It defines cardiorenal syndrome as disorders involving dysfunction of both the heart and kidneys, where acute or chronic dysfunction in one organ can induce dysfunction in the other. The statement describes the classification of cardiorenal syndrome into five subtypes based on the organ of initial injury and disease acuity. It discusses the pathophysiology, diagnostic strategies, and therapeutic options for cardiorenal syndrome. The goal is to provide guidance to cardiologists and nephrologists on the management of this important condition.
The document discusses laboratory evaluation of anemia through complete blood count (CBC) and red blood cell indices. CBC provides parameters like hemoglobin, red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red blood cell distribution width. MCV is used to classify anemias as microcytic, normocytic, or macrocytic and guide diagnoses. Additional tests of iron, B12, and folate status can identify underlying causes like deficiencies. A comprehensive evaluation including CBC, indices, and other tests is needed to make a definitive diagnosis and guide treatment of the anemia.
The document discusses laboratory evaluation of anemia through complete blood count (CBC) and red blood cell indices. CBC provides parameters like hemoglobin, red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red blood cell distribution width. MCV is used to classify anemias as microcytic, normocytic, or macrocytic and guide diagnoses. Additional tests of iron, folate, B12, reticulocytes, and other markers further evaluate the cause of anemia. A comprehensive analysis following this pathway can identify underlying pathological processes causing decreased red blood cell production or destruction.
The document discusses laboratory evaluation of anemia through complete blood count (CBC) and red blood cell indices. CBC provides parameters like hemoglobin, red blood cell count, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and red blood cell distribution width. MCV is used to classify anemias as microcytic, normocytic, or macrocytic and guide diagnoses. Additional tests of iron, B12, and folate status can identify underlying causes like deficiencies. A comprehensive evaluation including CBC, indices, and other tests is needed to make a definitive diagnosis and guide treatment of anemia.
Aim: To evaluate the effectiveness of simultaneous TAVI and coronary stenting in elderly and old patients with AVAS and CAD at high surgical risk.
Methods: The study comprised 121 patients who underwent TAVI. They were assigned to two groups: I–patients who underwent TAVI with simultaneous coronary stenting (n = 30); II–patients with AVAS without severe stenotic changes in the coronary arteries. They underwent only TAVI (n = 91). The in-hospital period and the mid-term results have been studied.
Results: The success of simultaneous TAVI and PCI was 100%. There were no intra- or perioperative deaths, acute myocardial infarction, acute brain stroke, or acute renal failure requiring dialysis. During the 6-month followup, one patient died from cancer. There were no other serious complications. The left bundle branch block occurred in 23.3% of cases and regurgitation (leakage) on the aortic valve in 6.6% of cases. Conclusion: Simultaneous TAVI and coronary stenting in elderly and old patients with severe aortic stenosis and CAD are feasible and safe. Within the first 30 days after the procedure, there were no significant differences in mortality and severe complication rates between the two groups.
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
chemistry investigatory project
The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
NAVIGATING THE HORIZONS OF TIME LAPSE EMBRYO MONITORING.pdfRahul Sen
Time-lapse embryo monitoring is an advanced imaging technique used in IVF to continuously observe embryo development. It captures high-resolution images at regular intervals, allowing embryologists to select the most viable embryos for transfer based on detailed growth patterns. This technology enhances embryo selection, potentially increasing pregnancy success rates.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
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.
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
2. namely cardiovascular diseases are an urgent medical
and social problem nowadays because of high rates of
morbidity, mortality and disability, indicating the low ef-
ficiency of applied methods for vascular diagnosis and
treatment [4-7,9,18,19].
For the last 10 years, only single works have described
studies of arteriovenous cerebral balance as a sign of
hydrodynamic and volumetric disbalance in the inter-
dependent arterial and venous links of the brain vascular
system [9,17,20]. During the last 2 decades, many scien-
tific investigations have been aimed at studying problems
of diagnostics and pathogenesis of cardiovascular dis-
eases; there are methods of in vivo noninvasive exami-
nation of the vascular system on macro- and micro-levels.
There is a tendency to create vascular pathology depart-
ments in medical establishments. Physicians pay more
attention to the combined vascular cardioneurological
pathology [4,5,8,14,17-19,21,22].
Current problems in diagnostics and treatments in
Ukraine: can a personalization of the approach be
possible?
Despite of considerable efforts of scientists, there is no ten-
dency to decrease morbidity and mortality indexes of car-
diovascular diseases today. In fact, the world has not
enough efficient technologies for preventive examination of
the cardiovascular system (CVS) [1-3,10-12,15,20,23-28].
They must not be for palliative adaptation to the sickly
state, but for restoration of the system to the level of auto-
regulation and self-control. Some important aspects in
evidence-based medicine have not been included in basic
and applied research. Let us name the most important:
1. Generally local structural examinations of separate
CVS segments prevail in CVD research. Local CVS
examination does not consider interconnections
between dynamics of segments and general dynamics
of the vascular system on various regional levels.
2. There is no systemic approach to the examination of
CVS as an entire system of vascular ‘hemo-supply’
with multiple intersystemic connections.
3. A role of arterial and venous dampers is ignored for
blood redistribution in various regional reservoirs.
4. The venous system is not examined enough as it is
considered to be in a shadow and less accessible for
life-time functional examination.
5. Current diagnostic and treatment measures are not
sensitive enough for early disorders in CVS
functioning.
6. One-sided CVS examination. There is a gap between
local medical examination and a global approach
under mathematical modeling of CVS according to
cybernetics because of the lack of local indicators for
the vascular system condition. One cannot make
global conclusions about the functioning of the entire
system basing on one CVS parameter. Such an
approach to the CVS investigation is too expensive,
thus causing ‘rejuvenation’ and progression of CVDs.
7. Lack of a single approach in vivo to blood as a
biological and biochemical non-Newton liquid causes
physicians to be mistaken about the properties of
blood—it is perceived as an ordinary liquid.
8. Usage of absolute values as a statement of incorrect
functioning of the system not taking into account
parameters of reactivity and adaptation of CVS in
conditions of internal homeostatic imbalance and
changes of environmental parameters (meteorological
factors), and neglecting integral parameters when
estimating CVS functioning causes a principally
wrong static (but not dynamic) approach in
analyzing the functioning of the dynamic blood
circulation system with many variable, in the certain
range, one moment hemodynamic indexes in various
CVS segments.
However, it is only a top of an iceberg called ‘pathology
of the vascular bed’ because today, the situation of ve-
nous stagnation in organs of the small pelvis, hyperten-
sion in pregnants, and vascular anomalies in new-born
is out-of-control, and the only thing applied to fight
hypertension is tonometry.
This shows that the generally accepted approaches pre-
determine small efficiency of diagnostic and therapeutic
procedures because of poor sensitivity of the applied
diagnostic methods for early disorders in CVS function-
ing and lack of effective technologies of these methods'
application.
Even in the theory, not to mention in practice, physi-
cians do not have a single integrated approach to the vas-
cular system. As for existing methods for diagnosing
circulatory system diseases, we can talk about the domin-
ance of static methods such as X-ray contrast angiography
and magnetic resonance imaging in angiomode [20].
Ability to detect atherosclerotic plaques and thromboem-
bolus applying the newest diagnostic methods provoked
the creation of new fields in medicine—angiosurgery and
cardiosurgery with allegedly radical approach—which found
the cause of and managed vascular decompensation. Eve-
rything seems to be acceptable, but why do some post-
operated patients often have temporary improvement and
relapses often occur?
The catamnesis shows deeper disorders in the whole
CVS as a complex system of interconnected tubes with
different caliber and specific features of their walls and
biophysical blood properties that can be called as a liquid
only in theory.
Any clinical result in medical practice is considered as
positive when a patient has stable positive angioneurological
Lushchyk et al. The EPMA Journal 2012, 3:12 Page 2 of 13
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3. dynamics during treatment and durable positive disease
catamnesis after treatment completion. In a global scale,
these criteria of treatment efficiency result in the reduc-
tion of morbidity indexes, death rate, and disability
caused by cardiovascular diseases.
Current new ideologies in the application of prin-
ciples of evidence-based medicine in the medical ma-
nagement of CVDs and the potential of modern
medical technique allow the realization of the predicti-
ve IT program of the individually oriented approaches
for early detection, prevention of vascular crises, and
treatment of CV pathology to be seen in a new light.
According to the CVS treatment tactics, the approaches
must not for palliative adaptation to a sick condition but
for restoration of the system to the level of autoregula-
tion and self-control.
Recommendations
Patients' recovery and decreased disability and mortality
are the primary objectives of medicine. In the last de-
cade, the business-marketing approach in medicine
offered by pharmaceutical and medical–technical indus-
tries has converted medical industry into a source of
super profits for pharmaceutical and medical–technical
globalized businesses by means of the formation of treat-
ment standards. The negative result of such strategy has
leveled the primary objective of the medicine and was
shown to be associated with the increase of morbidity,
death rate, and disability of CVD patients.
As a result, people lose treatment methods and doctors'
art elaborated for years as the standardized approach to
‘sales of medications’ and ‘robotization’ of organs does
not take into account the features of the pathogeny of the
integral system of the human organism and the course of
combination of diseases in a specific patient.
The current level of examination of the cardiovascular
system requires new analytical approaches for the preven-
tion of CVDs, insults and infarctions in people of diffe-
rent age, and diminishing of disability and mortality of
vascular critical states. In this connection, principles of
predictive, preventive, and personalized (PPP) medicine
become principally actual [15].
Ukrainian integrated medical technologies for CVS
examination
Lately, there are positive tendencies of medical cluster cre-
ation in Ukraine [9,22]. Combination of innovative projects
within the framework of scientific centers, clinics, and cen-
ters for the development of new medical technologies is
interesting enough and perspective [21,29]. Combining
efforts of the specialists' team for the creation of innovative
approaches for diagnostics and treatment of cardiovascular
diseases is an example of the cluster, which has been func-
tioning since 1996 and engaged in profound scientific
investigations and modeling of any vascular problems. The
innovative medical technologies developed by the cluster
enable considerably to reduce morbidity indexes of car-
diovascular pathologies in the population. Beginning with
a methodology of ultrasound dopplerography of arteries
and veins of the brain [30], they have created unique
developments in the field of angioneurology with the in-
vestigation of angioarchitectonics, arteriovenous balance,
microcirculation bed, and the formation of some logical
approaches to controlled changes in hemodynamics of
the regional reservoirs [25-28].
The model of symbiosis of the scientific and practical
medical establishments allow for the improvement of
generally accepted technologies for diagnostics and treat-
ment of cardiovascular and cerebrovascular diseases in
3,424 patients for 16 years. A theory of vascular pipeline
with moving blood as non-Newtonian liquid lies in the
basis of these innovative studies [9,28-31]. The theory
allows estimating a structure and function of vascular
blood pipeline from positions of unity of arterial, venous,
and capillary links in different regional reservoirs. The
poly-vector approaches to the estimation of CVS func-
tioning enable to diagnose the state of arteriovenous ba-
lance, arteriolar–venular balance, and their displacement,
and estimate a key nosotropic factor in pathological re-
constructions of the vascular bed: atherosclerosis, arteritis,
aneurysm, sinuosity, tortuosity, hypoplasia, phlebectasia,
congenital anomalies of angioarchitectonical formation,
thrombosis, stenotic-occlusive pathology, etc.
Current diagnostic methods of CVS like CТ, МRТ in
angiomode, US scanning have static nature and mainly
they insufficiently estimate CVS functioning. ECG repre-
sents mainly the bioelectric state of myocardium and,
being a diagnostic method, it does not allow estimating
sufficient functioning of the heart as a pump for vascular
blood pipeline. EchoCG estimates the pumping function
of the myocardium only from a position of discharge
fraction not taking into account hemodynamic features
like plasticity, adaptogenity, and intravascular resistances
of the whole CVS. Therefore, all these methods give in-
sufficient information for analytical estimation of CVS
functioning in blood supply for organs and systems
[9,13,22,25-27,29-32].
The approach enables to detect the combination of basic
pathogenetic factors that initiate a cascade of pathological
alterations in the structure and function of the vascular
pipeline [10,33]. Indexes of sufficient and adequate blood
supply; blood pressure; renewal of balance between elasti-
city and tone of the vascular wall, and intravascular pres-
sure and distal resistance; a level of hydrodynamic conflict
between the vessel and surrounding tissues are the most
substantial criteria, which represent some positive dyna-
mics in the restoration of the blood supply for the organ.
Therefore, medicinal treatment included the exact analysis
Lushchyk et al. The EPMA Journal 2012, 3:12 Page 3 of 13
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4. of these hemodynamic parameters for the estimation of
treatment dynamics.
Analyzing the positive results of treatment and mark-
ing the stability of retaining the results for 6 months to
2 years, we gradually have created our own medical
technologies for personalized objectification of a vascu-
lar pathology for prophylaxis and prevention of critical
states. More detailed research of peculiar functioning of
the cardiovascular system as a complex vascular pipeline
in virtually healthy patients with minimum complaints
about worsening of their work ability and periodic dis-
comfort during weather changes suggested us an idea
concerning the necessity of revision and correction of
the generally accepted conception of segmental research
and treatment of the arterial pathology.
Such approach to complex CVS examination has
motivated the necessity of deeper study of the many-
sided aspects of the living pipeline functioning, namely,
the vascular wall functioning, changes of elasticity and
tonus in arterial and venous vessels, internal vascular
peripheral resistances, intravascular transversal and lon-
gitudinal pressures, and arteriovenous balance.
For completion of absolute understanding of the whole
cardiovascular system as an integral entity, an urgent
need in the microcirculatory research occurred because
microcirculation is a system of complicated interconnec-
tions of arteriolar and venular segments of capillaries
and the most distant CVS segment from the heart.
We got positive results of integrated treatment of dif-
ferently aged CVD patients applying the method of the
personalized intensive medicinal correction of the vascu-
lar pathology [13,25,30], which have showed an increase
of treatment efficiency of 2–5 times with reduction of
treatment period to 1–2 months.
The treatment effectiveness is the absence of vascu-
lar crises, meteoropathy signs and subjective discom-
fort, and work-ability renewal and remaining stable for
3–6 months accompanied by the stable state of blood
supply for the organism nearly without any daily back-
ground medicinal therapy during an intercourse period.
Strategic predictive, preventive, and personalized
approaches to the development and creation of analytical
evidence-based medical technologies for CVS
examination and correction
The organism is considered to be a controlled system, to
peculiarities of hydrohemodynamic laws in vivo for provid-
ing functioning of interdependent segments of the closed
CVS: heart → major arteries → peripheral arteries →
arterioles → capillaries → venules → peripheral veins →
major veins → heart that is why one-moment examination
of CVS requires quite new technological approaches with
the detection of polyvector characteristics of all levels and
concretization of an injured area and influence of the area
on the functioning of the whole system [9].
The experience of instrumental diagnosis of disorders
in cardiovascular system with ultrasound dopplerogra-
phy, ultrasound scanning and smart capillaroscopy, MRT
in angiomode, and effective clinical results of integrated
treatment of CVD patients at all ages gradually formed a
view about urgent need in the integrated approach to
diagnosis and correction of changes in CVS including
the following principles of evidence-based medicine:
predictive testing of the treatment scheme
effectiveness by means of individual acute medical
tests with possible correction with the help of
feed-back options;
an analytical approach to profound interpretation of
pathological or sanogenic changes in the vascular
system, but not just statement of absolute
parameters of blood flow;
prevention: fixing results by improving the function
of CVS into physiologically stable type, with the
restoration of the stable balance in the dynamic
system;
early preclinical diagnostics of vascular changes
enable to detect vascular pathological alterations at
the initial stages and to avoid CVS disbalance to the
critical level. This is a very important preventive
approach for the prophylaxis of stroke and heart
attack as displays of CVS decompensation at
different levels.
personalization: individual approach to the
simultaneous integrated CVS examination in a
particular patient; individual control of the effective
treatment, owing to monitoring by methods of the
evidence-based medicine.
We consider that the classic standardized approaches
to the treatment of a disease, but not a certain patient,
must become a thing of the past. Today's level of
evidence-based medicine allows and requires an indivi-
dual approach to every patient which, with particular doc-
tor's knowledge, enables to get some substantial positive
results in treatment and to stabilize the situation.
Thanks to the methodology for examination and cli-
nical interpretation of hemodynamic reconstructions
developed by our specialists, the ultrasound dopplero-
graphy has come up to a level of modern innovative
medical technology that enables considerably to improve
the state of the cardiovascular system functioning and
reasonably to correct it, taking into account detected
pathologies. Only an inexperienced doctor affords to
ignore the dopplerography results of the main and pe-
ripheral vessels [34]. It is necessary to analytically estimate
the results of separate local instrumental examinations
Lushchyk et al. The EPMA Journal 2012, 3:12 Page 4 of 13
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5. with their generalization within the limits of the single
vascular system of the organism and analysis of the syn-
chronous functioning of the different regional reservoirs.
The predictive approach to CVD diagnostics and treat-
ment consists the necessity of multivector investigation
of the vascular system as an integral pipeline
1. Arterial link
a) Linear circulation rate
b)Vascular lumen
c)Pressure
d)d Tonus
e) Elasticity of a vascular wall
f) Angioarchitectonics
2. Venous link
a) Linear circulation rate
b)Vascular lumen
c)Pressure
d)Tonus
e) Elasticity of a vascular wall
f) Angioarchitectonics
g)Sate of the valvular apparatus
3. Vascular balance
a)Arteriovenous balance
b)Arteriolar–venular balance
4. Microcirculation as the most sensitive link to early
signs of any vascular disorders. Very dynamic CVS
examination, which takes into account
interconnections between the segments, must reach
a principally new stage of intellectual processing
of results from different local instrumental
examinations with general conclusion within the
entire vascular system in the organism. Currently,
there is an urgent need for predictive struggle with
‘invasion’ of cardiovascular diseases
(Figures 1, 2, 3, 4).
An algorithm for PPP management of CVD patients
1) Detailed complex diagnostics of the vascular bed
enabled to detect nearly 5–8 pathological links in
CVS functioning in the sick organism on a stage of
early preclinical changes in the organism;
2) Multivector signs of synergy disbalance in the
vascular pipeline functioning require one-moment
purposeful influence of adequate medicinal remedies
individually selected under instrumental control
using technologies for prognostication of the end
result in the closest month and half-year period;
3) Instrumental monitoring of the dynamics of
hemodynamic parameter changes on the principles of
evidence-based medicine at intermediate critical
periods of sanogenic changes of the vascular bed and
timely reaction to pathological meteor tropic reactions,
which occur under influence of external factors;
4) The treatment is conducted with the purpose of
getting stabilized hemodynamic parameters of the
whole system of the vascular plumbing in all regional
reservoirs in order to achieve hydro- and
hemodynamic balance in the whole system of the
vascular plumbing.
Up-to-date highly sensitive devices enable to work both
with arterial and venous segments at the same time, and
Figure 1 High trust and understanding of the heart portrait in dynamics by a patient. The methods of highly sensitive ECG allows the
diagnosis and monitoring of early ischemic changes in the myocardium with the correction of vascular blood flow.
Lushchyk et al. The EPMA Journal 2012, 3:12 Page 5 of 13
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6. specially developed software calculates what vital devia-
tions are in the patient from the state of arteriovenous bal-
ance towards unjustified arterial hyperemia or venous
stagnation of one or other degree [34]. Today, the method
is necessary not only for functional and ultrasound diag-
nosticians but also for many medical directions such as re-
animation, pediatrics, neonatology, neurology, psychiatry,
urology, gynecology and obstetrics, oncology, cardiology,
surgery, and neurorehabilitation.
On the base of our clinic, we apply authorial technolo-
gies of examination of arteries and veins in the human or-
ganism [30] and we have experienced unique diagnostics
and treatment with individual control of the state of vascu-
lar channel reconstructions in the organism at CVS dys-
function. Successful results of treatment (Figures 5, 6, 7, 8,
9, 10, 11, 12) of incurable states, such as apallic syndrome,
heavy forms of infantile cerebral paralysis, autism, and epi-
lepsy (www.inno-health.com.ua, www.istyna.kiev.ua, www.
itmed.com.ua), enabled us to consider background and re-
serve potential of vascular diagnostics in a new light and
to understand logic of pathological and physiological
reconstructions in the vascular channel. Indication and
verification of control parameters according to the princi-
ples of evidence-based medicine enabled to put aside
standard approach, to hold an ideology of individuality of
changes and variety of combination of pathological links at
CVDs, to change attitude toward diagnostics and treat-
ment of CVS as dynamic, but not static system in the
human organism.
We have obtained positive results of medicinal CVS
correction in every certain case and stable clinical results
of recovery and absence of repeated vascular crises du-
ring a long time (0.5–1 year), even without application
of corresponding medicinal remedies that testify to pos-
sible sanogenic reconstruction of the cardiovascular bed
when considering the logic of the process.
The personalized approach has showed the effectiveness
at different psychoneurological and cardioneurological
diseases (stroke, heart attack, aneurysms of the anterior
communicating artery for 12 years without the repeated
stroke catamnesis due to adequate predictive treatment,
comatose states with consciousness renewal in non-
perspective patients during half-year intensive treatment,
epilepsy with stable residual period after 8–15 months of
the vascular pathology correction, and autism with abso-
lute socialization of the child and successful catamnesis at
general school after 4 years of intensive purposeful vascu-
lar correction and multidisciplinary approach in neuro-
rehabilitation (Figures 5, 6, 7, 8, 9, 10, 11, 12).
Figure 2 Clinical interpretation of the functional state of brain
arteries and veins through ultrasound dopplerography. Only
methods of clinical interpretation of the functional state of arteries
and veins in the brain with the help of ultrasound dopplerography
can localize signs of the arteriovenous shunting and define its size
and risk of development of deficit in regional blood supply
[25-27,30].
Figure 3 An example of an examination of the arteriovenous
cerebral balance with ultrasound dopplerography [30]. If we do
not take into account the degree of violation of this balance,
treatment of any vascular pathology in the regional reservoir may be
not effective.
Figure 4 Equipment in obtaining images. Due to the obtained
images, we can estimate large amount of microcirculatory
parameters that enable to estimate the influence of rehabilitation on
all stages.
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7. In the treatment process, it was succeeded to avoid
critical moments due to purposeful medicinal cure of
CVD patients under instrumental control. Patients in
critical states (stroke, heart attack, comma, Epictetus,
and apallic syndrome) during the rehabilitation course
required permanent hemodynamic monitoring for the
timely indication of pathological paradoxical reactions of
the vascular system with the purpose of minimization of
the state worsening and prevention of new crises.
An analysis of the acquired results shows that the or-
ganism of patients with CVS dysfunction in the process
of the individually prescribed and controlled treatment
has passed to the fundamentally new way—stable ba-
lance of hemodynamic processes in different CVS seg-
ments involving sanogenic autoregulated mechanisms of
correction of adaptive CVS reconstructions. It appeared
that capillary circulation, which carries out the basic
function of the microcirculatory system (transcapillary
exchange), id est, metabolism between blood and tissues,
plays an important role in control of these processes.
That is why periodic control of the microcirculation state
Figure 5 Interchanging of various neurorehabilitation exercises. This takes into account a level of blood filling and the brain readiness to
loads. Born in 1989. Diagnosis: apallic syndrome, the stage of ‘high’ full consciousness, first degree of disability.
Figure 6 Microcirculatory image.
Figure 7 The six-year rehabilitation program is successfully
completed. Born in 1983. Diagnosis: multiple sclerosis,
1st degree of disability, tied down to the bed.
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8. Figure 8 The microcirculatory picture testifies about the
necessity of continuation of regular exercises.
Figure 9 A stage of preparation to some group activity in a
preschool establishment. This became possible due to the
circulation improvement and strengthening of cognitive functions.
Born in 2001. Diagnosis: autism, arrest of psycho-motor
development.
Figure 10 Microcirculatory image.
Figure 11 Psychokinetic therapy. This helps to restore sanogenic
reactions of the vascular system to psychological and physical
loadings, and to prepare the vascular system to the body
verticalization of the patient after long staying in bed. Born in 1977.
Diagnosis: apallic syndrome, stage of ‘large’ (full) consciousness, first
degree of disability.
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9. in the process of treatment can be as an arbiter of well-
being in the vascular macrosystem and in regional vascular
reservoirs.
Recommendations
1. The major condition of overcoming the CVDs
epidemics is a client-oriented (personalized) approach
to every patient in particular that is based on
principles of the evidence-based medicine. The logic of
preventive approach to early diagnostics and treatment
lays in deep knowledge of vascular pathology and laws
of hemodynamics and analytical approaches to
diagnostic potential of modern vascular technologies.
2. All investigations and monitoring of CVS functioning
must be based on principles of evidence, informatively,
specificity and high sensitiveness of modern
technologies to disorders of various parameters of the
vascular system in the process of pathological and
sanogenic adaptive reconstructions in CVS provoked
by a disease, processing different descriptions of vector
of all segments in CVS local and regional levels with
the specification on the damaged area and local
influence of the area on the whole system functioning.
3. Any treatment course ultimately requires the CVS
monitoring to analyze hemodynamic changes of
adaptive or pathological reorganization in the vascular
bed and the ability to predict any reactions of the
disbalanced CVS to various internal and external stimuli.
Predictive potential of the capillaroscopy for estimation
of the vascular diseases' risk
Substantiating a problem of the human organism's sen-
escence, Zalmanoff [35] considered that we should al-
ways observe the progressing decrease of the number of
open capillaries, a part of them transformed into a state
of shadows–non-functioning capillaries, for people of
40–45 years old [35]. This progressing drying out makes
the anatomic–physiologic base of senescence. People of
the elderly age have the velocity of blood flow that is
reduced to one-third because of relative atony of capil-
laries in these people; their partial occlusion causes in-
creasing resistance in the peripheral blood circulation. In
the very senescence, capillaries become weaker, are
winding, their diameter diminishes. Blood flow is slow-
ing down. The above-stated data say for the indissoluble
connection between heart functioning, chest volume, ar-
terial discharge and venous inflow to the heart and, of
course, between arterial and venous cerebral beds.
The term ‘capillary’ (from Latin capillaris, which means
hair) combines the most thin-walled vessels of microcircu-
latory canal of size 8–12 μ. All human tissues are pierced
by capillaries. As the capillary blood circulation makes the
main function of the microcirculatory system (transcapil-
lary exchange), that is metabolism between blood and tis-
sues, condition of the microcirculation can be as an
arbiter of welfare in the systemic hemodynamics and
reflects the preserved arteriovenous balance in the re-
gional vascular reservoirs.
Origin of any vascular pathology is associated primar-
ily with the circulation disorders in the smallest blood
vessels, the capillaries. Any reconstructions in the vascu-
lar system occur first in the microcirculatory level; there-
fore, monitoring of the capillary changes is the most
informative in assessing the efficiency of a prescribed
treatment [3,18,23,25,27,28].
If the capillaries are evenly filled with blood, it is an
evidence of the correct functioning of the system (heart →
arteries → capillaries → veins → heart). Thus, normal
microcirculatory picture is an index of well-being in the
whole cardiovascular system. That is why the capillaro-
scopy can be applied for screening early changes in vessels,
and disorders in capillary picture require detailed examin-
ation of all segments in the cardiovascular system to detect
and correct the disorders in the vascular ‘pipeline’.
A regular capillary has a hairpin form. Deviations from
the ideal form indicate any pathology. Uneven blood sup-
ply, visualization of clots in the microcirculatory bed, or
occurrence of the so-called capillary shadows signify disor-
ders in blood pressure in the capillary or blood rheology.
Problems in the capillary functioning can cause circu-
latory disorders, leading to stagnation of the circulation
and derangement of metabolic processes, and as a result,
the immunity worsens, chronic diseases exacerbate, and
new ones develop. Therefore, detection of any microcir-
culation problems at early stages is so important for
forecasting the development of a cardiovascular disease
and for effective treatment. For example, reduction of
the circulation rate and formation of clots in microcircu-
latory bed can warn about the development of ischemic
Figure 12 Microcirculatory image.
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10. changes in the heart or in the brain and the threat of
microthromboembolism.
Capillaroscopy is the one of the supplementary diagnos-
tic methods of investigation that enables to observe the
functioning of the peripheral section in the cardiovascular
system of a human in the cutaneous and mucous surfaces.
The technology is unique because it is created on the basis
of new approaches—combination of technical compo-
nents, new scientific knowledge of microcirculation,
hemodynamics, and angioarchitectonics in a single diag-
nostic–rehabilitation complex. The capillaroscope is
intended for an individual estimation of an adequate level
of cortical blood supply according to necessities of cere-
bral tissues and for the examination of microcirculation
condition.
Regular capillaroscopic examination allows for the
diagnosis of microcirculation disturbances; control of
non-invasively efficiency of prescription of an anti-
aggregate therapy for patients with ischemic disease of
heart, pancreatic diabetes, cancer neovascularization,
etc.; and for studying the dynamics of microstructures'
and materials' reactions. The capillaroscope is sensitive
during examination in 98% of the cases (i.e., ischemic
heart disease 100%, diabetes mellitus 50%, thrombi for-
mation 80%, and abnormal vessel formations 100%).
Our studies have showed that coma patients almost
have no microcirculation in their finger nail beds. In
dynamics, when blood supply increases for the brain
and expressed signs of blood flow centralization are
diminished, gradual blood flow is recommenced in the
capillaries. This phenomenon can be as a prognostic
criterion of positive changes in the treatment process.
The capillaroscopic picture of stroke patients repre-
sents a tension degree of auto regulatory mechanisms
at microcirculatory level and allows distinguishing basic
pathogenetic links that require correction. Thus, capil-
laroscopy enables to choose the optimal approach to
treatment scheme and to monitor its efficiency at indi-
vidual evidence-based level.
Computer processing of the capillaroscopic investiga-
tions provides with the following:
possibility of the in vivo visualization of
microcirculatory changes in the capillary blood flow
on a computer monitor screen;
archiving of images of the capillary blood flow in a
database and also review them in a free way;
strengthening of image contrasts;
measurement of the capillary size, number of units
of the regular blood elements;
observation in dynamics of the capillary blood flow
under the enlargements in 100 times; and
prognosticating a pre-stroke and pre-infarction
states of patients.
An advantage of smart capillaroscopy over other meth-
ods of microcirculation investigation is the visualization
of the process, which significantly makes it easier for
doctors to comprehend capillary pictures and enables
them to study more deeply and to analyze the obtained
data. Processing obtained images with the application of
the mathematical modeling is another advantage because
it enables us to analyze the picture of the microcircula-
tion in more details and to present it in the figure char-
acteristics that can add to the quantitative assessment of
these virtual sections and reflect slight changes in the
quantitative equivalent. A doctor needs only 5 min to
get prior diagnosis of the presence or absence of any
pathology in the cardiovascular system.
The device features, like easy to use, non-invasive,
high quality of visualization, and archiving of static and
video images, are very important for medical staff who
use the smart capillaroscopy: mistaken diagnosis is prac-
tically excluded, results of the disease development are
highly predictable, qualitative and quantitative assess-
ment of the efficiency of the performed therapy can be
done, and the possibility of obtaining unique microcircu-
latory changes for prognostication of sub- and decom-
pensated states of patients.
Doctors' should pay attention to the necessity of the
investigation and control of the dynamics of the size
of the perivascular area to make objective assessment
on the effect of diuretic therapy in patients with cardiac in-
sufficiency and intracranial and intracellular hypertension.
The problem of the capillaroscopy application lies in
the examination of microprocesses. Therefore, a diagnos-
tic apparatus must be sensible enough, and instruments
for measuring must be extraordinarily accurate. To avoid
such errors, the software has been developed to hold ac-
curate primary measuring and to get analytical conclu-
sions, thanks to authorial algorithms put into basis of the
data processing. The approach enables to get compared
data and possibility to make correlation analysis between
results of researches in different treatment periods.
Monitoring the treatment effectiveness with capillaroscopy
Using capillaroscopy, you can not only detect a disease but
also periodically evaluate the treatment efficiency. The
examination does not require any special preparation of
the patient [9,25,27-29]. However, capillaroscopy appli-
cation in dynamics with visualization of microcircula-
tory picture and data processing enables to make sure
treatment efficiency, revealing tendencies in vascular
reconstructions.
The clinic ‘Victoria Veritas’ has examined the effi-
ciency of the vascular therapy by means of an innovative
technology—dynamic capillaroscopy. The monitoring of
the microcirculation processes starts during acute
pharmacological tests. According to the clinic's data,
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11. the primary microcirculatory changes have appeared in
15–20th min of holding the acute pharmacological
test in the form of reduction of expressiveness of the
venular phlebectasia by 14%–29%, reduction of the
perivascular edema area by 23%, and increase of ve-
locity of pulse wave in capillaries in 73% of the
examined patients.
After making the correlation analysis of the background
data and conducting the treatment course, we have con-
cluded using the capillaroscopy method that all patients
had the positive dynamics of the microcirculatory picture.
Positive changes took place mostly in the caliber and tonus
of capillaries (in 67% of the examined patients), in a state
of capillary filling (in 89% of the examined patients), and
reduction of expressed capillary tortuosity (57% of
patients) and size of the perivascular edema (96% of the
examined patients who were diagnosed to have the
edema during the background examination). There was
a tendency to the arteriolar-venular balance (65% of
patients) by the combined signs confirmed by accurate
calculations.
The capillaroscopy complex
The capillaroscopy complex includes the following
technical device
software
references
special training course for the device operation
supporting documents (certificates, licenses)
information support.
The device is demonstrated in Figure 13.
Recommendations
Regular capillaroscopic investigation enables to perform
diagnostics of microcirculatory disorders, to control effi-
ciency of the therapy almost for every patient non-
invasively (psychoneurological, therapeutic, angiological,
endocrinological, and cancer neovascularization profiles
for the assessment of congenital and acquired vascular
anomalies) and during prophylactic exanimations of
healthy people who are under influence of external factors
(stress, geomagnetic, temperature, and meteorological),
and to control the state of railway men, pilots, and astro-
nauts etc., who are connected with a risk due to their pro-
fessions, resuscitation departments (control of a level of
blood circulation restoration after critical states), insur-
ance medicine (almost immediate determination of the
cardiovascular system condition in the organism of an
insurant), and sports medicine (control and dosage of the
physical load system during sport trainings).
Thus, the described approaches to the analytical estima-
tion of the vascular pipeline on macro- and microlevels
allow newly considered problems in the blood supply for
organs and systems in the human organism. Such innova-
tive approach enables to estimate the possibility of sano-
genic reconstructions in the vascular bed on local,
Figure 13 The capillaroscopy complex. For visualization, archiving, mathematical processing, and clinical interpretation of etiopathogenesis of
microcirculatory disorders [28,30].
Lushchyk et al. The EPMA Journal 2012, 3:12 Page 11 of 13
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12. Written informed consent was obtained from the
regional, and systemic levels, and the adequacy of such
alterations according to the necessities of the ill organism.
Conclusions
Based on the data above, the following conclusions were
made:
1. Integrative approach to overall examination of the
vascular system requires permanent monitoring of
the functional state of all segments of the
cardiovascular system. Only predictive, preventive,
and personalized CVS management enables to get
stable results in those who struggle with CVD
epidemic.
2. The proposed approach to diagnostics and treatment
of disorders in functioning of the integral
cardiovascular system has had long approbation by
life; its efficiency has been proven by the
evidence-based medicine methods and long-term
catamnesis of crisis-free course of CVDs in treated
patients [27].
3. Therefore, we offer Ukrainian vascular technologies
as PPP approach for the correction of a vascular
pathology (the technology for evidence-based
vascular correction of pathological and sanogenic
adaptive CVS reconstructions [25-28,30]. The
technology enables not only to make accurate
diagnoses but also to treat efficiently that reduces
financial burden of a patient and his relatives. The
presented medical technology will be useful in
prophylactic and preventive medicine of the world
for the health improvement of CVD patients.
4. The above-mentioned data show certain positive
results in the approach to the examination and
correction of cardiovascular diseases, but there are
many unsolved problems in the vascular pathology
field, which to our opinion, require joint efforts of
the international scientific schools for a global
scientific project.
Consent
panying images.
Abbreviations
CVS: Cardiovascular system; CVDs: Cardiovascular diseases; PPP: Predictive,
preventive and personalized.
Competing interests
The authors declare that they have no competing interests.
Authors’ contributions
UL is an initiator of the vascular angiopsychoneurology, proposed and
developed principles for the arteriovenous balance in the human
cardiovascular system and mathematical models of the hemodynamics in
living systems, analyzed the efficiency of the applied technologies, and
designed and drafted the manuscript. VN was engaged in modeling of
biophysical processes in the human organism and modeling of
biomechanics of the cardiovascular system. IB and NL carried out the
diagnostics and treatments according to the proposed approaches. LR
conducted the instrumental functional diagnostics and helped draft the
manuscript. All authors read and approved the final manuscript.
Authors’ information
UL is a doctor of medicine. She is an associate professor of the
Nondestructive Control Department in Kyiv Polytechnic Institute, the head of
the Department of Science, International Cooperation and Control on
Medical Services in the Clinical Hospital ‘Feofania’, State Administration of
the President’s Affairs of Ukraine. She is also an associate professor of the
Medical Law Department in Solomon International University, Kyiv, Ukraine.
In addition, she is an initiator of the vascular angiopsychoneurology.
Furthermore, she is a member of the European Association of Neurologist
and an academician of the European Academy of Natural Sciences. VN is a
professor, a Ph.D. degree holder of Physical and Mathematical Sciences, an
academician of the European Academy of Natural Sciences, a scientific
consultant on biophysical problems in the scientific center ‘Veritas’, and the
president of the social organization ‘Alcesta’. Also, he is the head of the
Department of Analytical Mechanics and Control of Processes in Dynamic
Systems in the Institute for Mathematics of National Academy of Sciences of
Ukraine.
Acknowledgements
We extend our gratitude to Kavchak IV for helping us translate and edit our
article.
Author details
1
Research Center Veritas, 31 Obolonska Str., of. 9, Kyiv 04071, Ukraine. 2
Clinic
Victoria Veritas, 4 Williams Str., Kyiv 03191, Ukraine. 3
Center for Innovative
Medical Technologies Veritas IT Med, 4 Williams Str., Kyiv 03191, Ukraine.
Received: 21 April 2012 Accepted: 11 September 2012
Published: 19 October 2012
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doi:10.1186/1878-5085-3-12
Cite this article as: Lushchyk et al.: Predictive and preventive strategies
to advance the treatments of cardiovascular and cerebrovascular
diseases: the Ukrainian context. The EPMA Journal 2012 3:12.
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