The document discusses bleeding as a complication of percutaneous coronary intervention (PCI) and antiplatelet therapy, noting that bleeding is associated with significantly increased mortality and morbidity, and that assessing bleeding risk, optimizing vascular access through the radial approach, and tailoring antiplatelet treatment can help address this problem. Major causes of bleeding include access site complications and prolonged dual antiplatelet therapy beyond 6 months without clear benefits.
Lower Mortality with Transradial PCI Compared to Transfemoral PCI in 21 000 Patients with Acute Myocardial Infarction - Results from the SCAAR Database
Same Wrist Intervention via the Cubital (Ulnar) Artery in Case of Radial Puncture Failure for Percutaneous Cardiac Catheterization or Intervention: The Multicenter Prospective SWITCH Registry
Chronic Kidney Injury in Patients after Cardiac Catheterization or Percutaneous Coronary Intervention. A Comparison of Radial and Femoral Approaches (from the British Columbia Cardiac and Renal Registries).
Guidelines for dvt prophylaxis in surgical patientsLajpat Rai
This is presentation about guidelines for DVT prophylaxis in surgical patients. i have come accross all guidliens of different countries. all are bit same, only minor differences. i found Australian guidelines bit easy that why my presentation is based on australian guidelines
Lower Mortality with Transradial PCI Compared to Transfemoral PCI in 21 000 Patients with Acute Myocardial Infarction - Results from the SCAAR Database
Same Wrist Intervention via the Cubital (Ulnar) Artery in Case of Radial Puncture Failure for Percutaneous Cardiac Catheterization or Intervention: The Multicenter Prospective SWITCH Registry
Chronic Kidney Injury in Patients after Cardiac Catheterization or Percutaneous Coronary Intervention. A Comparison of Radial and Femoral Approaches (from the British Columbia Cardiac and Renal Registries).
Guidelines for dvt prophylaxis in surgical patientsLajpat Rai
This is presentation about guidelines for DVT prophylaxis in surgical patients. i have come accross all guidliens of different countries. all are bit same, only minor differences. i found Australian guidelines bit easy that why my presentation is based on australian guidelines
CTO and atrial fibrillation – Do we apply the ESC recommendations?Euro CTO Club
CTO and atrial fibrillation – Do we apply the ESC recommendations?
Sudhir Rathore, Canberley, Great Britain
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
CTO PCI and length of dual antiplatelet regimenEuro CTO Club
CTO PCI and length of dual antiplatelet regimen
Maciej Lesiak, Poznan, Poland
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
CTO and atrial fibrillation – Do we apply the ESC recommendations?Euro CTO Club
CTO and atrial fibrillation – Do we apply the ESC recommendations?
Sudhir Rathore, Canberley, Great Britain
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
CTO PCI and length of dual antiplatelet regimenEuro CTO Club
CTO PCI and length of dual antiplatelet regimen
Maciej Lesiak, Poznan, Poland
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Bleeding and coagulation in cirrhosis.pptxShivPathak11
this presentation contains different parameter to be kept in mind before dealing a patient of cirrhosis regarding any bleed or coagulation abnormality.
This presentation discusses the latest evidence for blood transfusion triggers in the intensive care unit of various clinical condition including severe sepsis, GI bleed, post surgical cases, and post cardiac surgery among other cnditions
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
1. Rencontres Interventionnelles - Transradial Approach
Prague, Czech Republic,
Thursday 29th & Friday 30th September 2011
BLEEDING
IS IT A REAL PROBLEM?
Philip Urban
La Tour Hospital
Geneva, Switzerland
3. PCI
&
Bleeding
• The
problem
– Nature
and
8ming
– Prognos8c
impact
• The
solu8ons
– Assess
bleeding
risk
prior
to
PCI
– Op8mize
vascular
access
– An8platelet
treatment
• Drugs
• Dose
• Dura8on
4. Circula8on
2011;123:
2736
• Type 1: not actionable
• Type 2: requiring medical intervention and/or admission and/or
evaluation
• Type 3:
– 3a) Hb drop 3-5 g/dl and/or any blood transfusion
– 3b) Hb drop > 5 g/dl, tamponade, surgery or vasoactive treatment
– 3c) Intracranial or intraocular bleeding with vision impairment
• Type 4: CABG related
– chest tubes > 2 liters/24h, transfusion > 5 units
– intracerebral bleed < 48h
– any reoperation for bleeding
• Type 5: fatal
5. Bleeding in patients admitted for AMI
Spencer FA et al Circulation 2007; 116: 2793
MB = 2.8%
10% of all deaths
Access = 29% of MB
40087 patients, GRACE registry
6.
7. Bleeding
and
DAPT
compliance
Wang
T
et
al,
Circula8on
2008;
118:2139
2498 patients from the PREMIER registry: patients with vs. without bleeding
9. Number of stent thrombosis major bleedings
15157 patients treated with SES
Weeks after stent implantation
Urban P et al. J Am Coll Cardiol 2011; 57: 1445
10. PCI
&
Bleeding
• The
problem
– Nature
and
8ming
– Prognos8c
impact
• The
solu8ons
– Assess
bleeding
risk
prior
to
PCI
– Op8mize
vascular
access
– An8platelet
treatment
• Drugs
• Dose
• Dura8on
11. %
15157 patients treated with SES – 1 year follow-up
Urban P et al. J Am Coll Cardiol 2011; 57: 1445
12. PCI
&
Bleeding
• The
problem
– Nature
and
8ming
– Prognos8c
impact
• The
solu8ons
– Assess
bleeding
risk
prior
to
PCI
– Op8mize
vascular
access
– An8platelet
treatment
• Drugs
• Dose
• Dura8on
20. Radial
vs.
Femoral
access
Pooled
analysis
of
23
RCT’s
(n=
7020)
Jolly
et
al
AHJ
2009;157:132
21. Lancet 2011;377:1409
• 7021 ACS patients
• Radial vs.femoral access
• Primary EP @ 30 days:
• Death
• MI
• Stroke
• Non CABG bleed
22. Bleeding in the RIVAL trial
Lancet 2011; 377:1409
Fatal
TF of > 2 units
Hb drop > 5 g/dl
Hemodynamic impact
Need for surgery
Lasting sequellae
Intracebral/ocular
* p<0.0001 - Includes large hematomas and surgically treated pseudo-aneurysms
23. PCI
&
Bleeding
• The
problem
– Nature
and
8ming
– Prognos8c
impact
• The
solu8ons
– Assess
bleeding
risk
prior
to
PCI
– Op8mize
vascular
access
– An8platelet
treatment
• Drugs
• Dose
• Dura8on
24. ACUITY
Stone
G
et
al,
NEJM
2008;358:21
P<0.0001
P=0.03
29. Conclusions
(I)
• Bleeding
during/ader
PCI
is
associated
with
a
significantly
increased
morbidity
and
mortality
• This
is
par8ally
due
to
the
direct
consequences
of
bleeding
(including
medica8on
adjustments,
transfusions,
etc)
but
is
also
explained
by
the
fact
that
bleeding
is
a
powerful
marker
of
comorbidity
• Early
ader
PCI,
major
bleeding
appears
less
dangerous
than
stent
thrombosis,
and
this
should
be
kept
in
mind
when
adjus8ng
an8thrombo8c
treatment
•
Some
types
of
an8thrombo8c
treatment
can
decrease
both
bleeding
and
mortality
without
loss
of
efficacy
(ACUITY)
• Prolonged
dura8on
of
DAPT
beyond
6
months
may
increase
the
risk
of
bleeding
without
any
gain
in
efficacy
(PRODIGY)
30. Conclusions
(II)
• Access
site
bleeding
accounts
for
30-‐70%
of
all
significant
bleeding
episodes
in
series
with
100%
femoral
access
• Radial
access
is
associated
with
a
decreased
risk
of
local
vascular
complica8ons
and
bleeding
• Using
a
common
defini8on
for
bleeding
events
(BARC)
will
allow
to
clarify
several
issues
and
compare
different
trials