COVID 19 and The Heart - Lessons Learnt from this Pandemicahvc0858
COVID 19 and The Heart - Lessons Learnt from this Pandemic
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Cardiovascular Disease Associated with SARS-CoV-2 and HIV InfectionsInsideScientific
Dr. Xuebin Qin discusses the development and characterization of new models of SARS-CoV-2 and HIV, and how his lab uses these models to study cardiovascular injury associated with infection.
Despite ongoing research around the world to better understand the pathogenesis of SARS-CoV-2, the ways in which it exacerbates cardiovascular disease (CVD) are not fully understood. While it is well accepted that SARS-CoV-2 infects lung epithelial cells, whether it can also infect endothelial cells is less clear.
In this webinar, Dr. Xuebin Qin discusses his lab’s development and characterization of new rodent models of COVID-19, and how they use these models to study endothelial dysfunction and injury resulting from immune activation. Dr. Qin also discusses why HIV infection is associated with increased risk of CVD. He provides an overview of the cellular and molecular mechanisms underlying HIV-1-associated CVD, and the mouse and NHP models he has worked with to elucidate them.
Key Topics Include:
- Cellular mechanisms by which SARS-CoV-2 and HIV contribute to cardiovascular disease
- Development, characterization and analysis of Mouse and NHP models for the study of COVID-19- or HIV-associated CVD
- Potential targets for therapeutic vaccine testing and pathogenesis studies
Covid 19 and the cardiovascular system implications for risk assessment dia...Ramachandra Barik
The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and
mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial
pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the
cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is
increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer.
The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular
fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant
myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically,
SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane
angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages,
perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis.
Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm
[interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and
continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization
may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures
COVID 19 and The Heart - Lessons Learnt from this Pandemicahvc0858
COVID 19 and The Heart - Lessons Learnt from this Pandemic
Presentation by Dr Jeremy Chow
Cardiologist, Electrophysiologist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Cardiovascular Disease Associated with SARS-CoV-2 and HIV InfectionsInsideScientific
Dr. Xuebin Qin discusses the development and characterization of new models of SARS-CoV-2 and HIV, and how his lab uses these models to study cardiovascular injury associated with infection.
Despite ongoing research around the world to better understand the pathogenesis of SARS-CoV-2, the ways in which it exacerbates cardiovascular disease (CVD) are not fully understood. While it is well accepted that SARS-CoV-2 infects lung epithelial cells, whether it can also infect endothelial cells is less clear.
In this webinar, Dr. Xuebin Qin discusses his lab’s development and characterization of new rodent models of COVID-19, and how they use these models to study endothelial dysfunction and injury resulting from immune activation. Dr. Qin also discusses why HIV infection is associated with increased risk of CVD. He provides an overview of the cellular and molecular mechanisms underlying HIV-1-associated CVD, and the mouse and NHP models he has worked with to elucidate them.
Key Topics Include:
- Cellular mechanisms by which SARS-CoV-2 and HIV contribute to cardiovascular disease
- Development, characterization and analysis of Mouse and NHP models for the study of COVID-19- or HIV-associated CVD
- Potential targets for therapeutic vaccine testing and pathogenesis studies
Covid 19 and the cardiovascular system implications for risk assessment dia...Ramachandra Barik
The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and
mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial
pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the
cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is
increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer.
The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular
fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant
myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically,
SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane
angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages,
perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis.
Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm
[interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and
continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization
may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures
Ventilator Associated Pneumonia (VAP) causes and preventive strategiesVeera Reddy Suravaram
Ventilator associated pnemonia is a cause of concern in today's medical practice due to wide spread of Gram negative pathogens in hospitals and lack of good hygienic practices due to high occupancy rate in ICUs.
By the end of the module, you will be able to learn:
Types of Dialysis Access
Define what is Central Venous Catheter
Identify the most common complications of CVC
Familiarise the use the MR VICTOR
Types of Catheter Locking Solution
Healthcare Associated Infections (HAIs) are the fourth leading cause of death in the USA. About 1.8 million patients suffer annually from care-related infections. HAIs cause 99,000 deaths every year in the US alone, at a cost of $3.1 billion dollars in excess healthcare costs in acute care hospitals. Besides HAIs kill more people than AIDS, breast cancer and auto accidents combined.
It is estimated that 271 people died each day from healthcare-associated infections (HAIs) such as Methicillin-resistant Staphylococcus aureus (MRSA) infections. Which is equivalent to one airline crash per day.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
Role of infection control in patient safety [compatibility mode]drnahla
Infection Control and Patient Safety
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Ventilator Associated Pneumonia (VAP) causes and preventive strategiesVeera Reddy Suravaram
Ventilator associated pnemonia is a cause of concern in today's medical practice due to wide spread of Gram negative pathogens in hospitals and lack of good hygienic practices due to high occupancy rate in ICUs.
By the end of the module, you will be able to learn:
Types of Dialysis Access
Define what is Central Venous Catheter
Identify the most common complications of CVC
Familiarise the use the MR VICTOR
Types of Catheter Locking Solution
Healthcare Associated Infections (HAIs) are the fourth leading cause of death in the USA. About 1.8 million patients suffer annually from care-related infections. HAIs cause 99,000 deaths every year in the US alone, at a cost of $3.1 billion dollars in excess healthcare costs in acute care hospitals. Besides HAIs kill more people than AIDS, breast cancer and auto accidents combined.
It is estimated that 271 people died each day from healthcare-associated infections (HAIs) such as Methicillin-resistant Staphylococcus aureus (MRSA) infections. Which is equivalent to one airline crash per day.
It is important to realize that guidelines cannot always account for individual
variation among patients. They are not intended to supplant physician judgment
with respect to particular patients or special clinical situations. The IDSA considers
adherence to these guidelines to be voluntary, with the ultimate determination
regarding their application to be made by the physician in the light of each patient’s
individual circumstances.
Acute coronary syndrome for critical care examDr fakhir Raza
This presentation is made to help students prepare for EDIC exam. this is board review for any exam for critical care examining acute MI, myocardial infarction, acute coronary syndrome.
CALCIUM MODIFICATION TECHNIQUES IN COMPLEX PCIThieu Minh Son
Coronary artery calcification represents a major challenge associated with adverse outcomes after PCI
To avoid stent failure, optimal plaque preparation of calcified coronary lesions is required
Intracoronary imaging and determination of coronary calcification severity and characteristics are the keys to guiding further treatment decisions.
Available modification techniques includes: Balloon-Based Devices (Non-Compliant Balloons, High-Pressure Non-Compliant Balloons, Cutting Balloons, Scoring Balloons, Intravascular Lithotripsy) and Coronary Atherectomy (Rotational Atherectomy, Orbital Atherectomy, Laser Atherectomy)
The decision relating to which modification technique to use is based on numerous anatomic and technical factors, including the location of the lesion, the concentricity of the calcium pool, operator familiarity/expertise, and local device availability.
Role of infection control in patient safety [compatibility mode]drnahla
Infection Control and Patient Safety
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Effect of a Single High Dose ofVitamin D3 on Hospital LengthEvonCanales257
Effect of a Single High Dose of
Vitamin D3 on Hospital Length of
Stay in Patients With Moderate to
Severe COVID-19 A Randomized
Clinical Trial
Key Points
Question What is the effect of a single high dose of vitamin D3 on
hospital length of stay among hospitalized patients with moderate to
severe coronavirus disease 2019 (COVID-19)?
Findings In this randomized clinical trial that involved 240 hospitalized
patients with moderate to severe COVID-19, a single dose of 200 000
IU of vitamin D3, compared with placebo, did not significantly reduce
hospital length of stay (median of 7.0 vs 7.0 days; unadjusted hazard
ratio for hospital discharge, 1.07).
Meaning The study does not support the use of a high dose of vitamin
D3 for treatment of moderate to severe COVID-19 in hospitalized
patients.
Abstract
Importance The efficacy of vitamin D3 supplementation in coronavirus
disease 2019 (COVID-19) remains unclear.
Objective To investigate the effect of a single high dose of vitamin D3
on hospital length of stay in patients with COVID-19.
2021-02-19 下午7:17
⻚码:1/22
Design, Setting, and Participants This was a multicenter, double-
blind, randomized, placebo-controlled trial conducted in 2 sites in Sao
Paulo, Brazil. The study included 240 hospitalized patients with COVID-
19 who were moderately to severely ill at the time of enrollment from
June 2, 2020, to August 27, 2020. The final follow-up was on October 7,
2020.
Interventions Patients were randomly assigned to receive a single oral
dose of 200 000 IU of vitamin D3 (n = 120) or placebo (n = 120).
Main Outcomes and Measures The primary outcome was length of
stay, defined as the time from the date of randomization to hospital
discharge. Prespecified secondary outcomes included mortality during
hospitalization; the number of patients admitted to the intensive care
unit; the number of patients who required mechanical ventilation and
the duration of mechanical ventilation; and serum levels of 25-
hydroxyvitamin D, total calcium, creatinine, and C-reactive protein.
Results Of 240 randomized patients, 237 were included in the primary
analysis (mean >[email protected] age, 56.2 >[email protected] years; 104 >43.9%@ women; mean
>[email protected] baseline 25-hydroxyvitamin D level, 20.9 >[email protected] ng/mL). Median
(interquartile range) length of stay was not significantly different
between the vitamin D3 (7.0 >[email protected] days) and placebo groups (7.0
>[email protected] days) (log-rank P = .59; unadjusted hazard ratio for hospital
discharge, 1.07 >95% CI, [email protected]; P = .62). The difference between
the vitamin D3 group and the placebo group was not significant for in-
hospital mortality (7.6% vs 5.1%; difference, 2.5% >95% CI, –4.1% to
9.2%@; P = .43), admission to the intensive care unit (16.0% vs 21.2%;
difference, –5.2% >95% CI, –15.1% to 4.7%@; P = .30), or need for
mechanical ventilation (7.6% vs 14.4%; difference, –6.8% >95% CI, –
15.1% to 1.2%@; P = .09). Mean seru ...
Prevention of Surgical Site Infection- SSI [compatibility mode]drnahla
Infection Control Guidelines for Prevention of Surgical Site Infection- SSI
Dr. NAHLA ABDEL KADERوMD, PhD.
INFECTION CONTROL CONSULTANT, MOH
INFECTION CONTROL CBAHI SURVEYOR
Infection Control Director, KKH.
Современное лечение ВИЧ: новые парадигмы в АРТ / Contemporary Management of H...hivlifeinfo
Набор слайдов c рассмотрением важных вопросов об АРТ первого ряда, арв-препаратами пролонгированного действия и схемами АРТ с двумя препаратами, акцент в публикации на роль новых стратегий.
Assignment on Covid 19 | Tutors India.pptxTutors India
Tutors india thesis and dissertation writing help guarantees that your dissertation is confidential, and so you do not have to worry about it.
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Objectives:
•Learn about the current of SSI prevention in Canada
•Review the updated SSI-GSK
•Compare CPSI SSI-GSK to national and international literature
Despite the routine use of prophylactic systemic antibiotics, surgical-site infection continues to be associated with significant morbidity and cost after colorectal sur- gery. The gentamicin–collagen sponge, an implantable topical antibiotic agent, is approved for surgical implantation in 54 countries. Since 1985, more than 1 million patients have been treated with the sponges.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Low Lee Lee, Infectious Disease Physician at the Hospital Sultanah Bahiyah, Ministry of Health Malaysia.
- 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
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.
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.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
3. BACKGROUND
Infections after placement of cardiac implantable
electronic devices (CIEDs) are associated with
substantial morbidity and mortality.
There is limited evidence on prophylactic
strategies, other than use of preoperative
antibiotics, to prevent such infections.
4. In a trial of 1000 consecutive CIED procedures at
a single center, iv administration of cefazolin
before procedure reduced the risk of infection by
81%.
Unblinded, cluster-randomized, crossover trial
(Prevention of Arrhythmia Device Infection Trial
[PADIT]) was conducted to assess the effect of
incremental prophylaxis antibiotics before,
during, and after CIED procedure. The rates of
hospitalization due to infection were not
significantly reduced with incremental antibiotics
6. Multifilament knitted mesh
coated with an absorbable polymer
mixed with minocycline and rifampin,
elutes the antibiotics into the local tissue for a
minimum of 7 days
fully absorbed in approx. 9 wks.
7. Aim
To evaluate the safety & effectiveness of envelope
in reducing CIED infection as adjunctive therapy to
standard infection-prevention strategies
8. Trial design
Multicenter, randomized, controlled, prospective,
singleblind, postmarketing, interventional clinical
trial.
It compared the incidence of major CIED
infections through 12 months after implantation
among patients with/without absorbable
antibacterial envelope.
Standard-of-care infection-prevention strategies
(preprocedure iv antibiotics & sterile technique)
used in all.
9. Patients were randomly assigned in 1:1 ratio,
with stratification according to trial site & device
type (pacemaker or CRT-P vs. ICD or CRT-D)
Patients were followed at hospital discharge & at
6-month intervals till all patients completed a
min. of 12 months follow-up.
10. Inclusion Criteria:
Patient is planned to undergo at least one of the
following:
a) Patient having CIED & undergoing pacemaker
(including CRT-P), ICD or CRT-D replacement or
upgrade with a new Medtronic generator
i. Subjects planned to have leads added, or extracted &
added for upgrades can be enrolled OR
b) Patient will undergo a de novo Medtronic CRT-D system
implant per approved indications OR
c) Patient has existing study eligible Medtronic CIED & the
pocket was not accessed in last 365 days, and is
undergoing pocket or lead revisionNote:
Pacemaker (including CRT-P) randomizations were capped
at 25% of target sample size
11. Exclusion Criteria
Known allergy to minocycline or rifampin or any other known
contraindications to TYRX envelope.
Current therapy with chronic oral immunosuppressive agents or ≥
20mg/day of Prednisone or equivalent.
Hemodialysis or peritoneal dialysis.
Prior Cardiac transplantation or existing Ventricular Assist Device (VAD).
Require long-term vascular access for any reason.
Prior history of a CIED infection, other prosthetic device infection, or
endovascular infection, including endocarditis, in the past 12 months.
Physical, clinical, or laboratory signs or symptoms consistent with an
active infection (including but not limited to pneumonia, urinary tract,
cellulitis, or bacteremia)
Systemic lupus erythematous (SLE), because minocycline known to
aggravate this condition
Female patient who is pregnant, or of childbearing potential and not
on a reliable form of birth control.
Participation in another study that may confound the results of this study.
12. Definitions:
CIED infection was defined as superficial cellulitis with
◦ wound dehiscence, erosion, or purulent drainage;
◦ deep incisional or pocket surgical-site infection that met the CDC and
Prevention criteria, independent of time from surgery;
◦ persistent bacteremia; or
◦ endocarditis.
Major CIED infections were defined as infections that
resulted in
◦ CIED system removal,
◦ an invasive CIED procedure (e.g., pocket revision without removal),
◦ treatment with long-term antibiotic therapy (if the patient was not a
candidate for system removal) with infection recurrence after
discontinuation of antibiotic therapy, or
◦ death.
CIED infections that did not meet one or more of the
criteria for major infection were classified as minor CIED
infections.
13. END POINT
Primary end point
◦ Major CIED infection within 12 months after the
CIED procedure.
Secondary end points were
◦ CIED procedure/system-related complications
within 12 months after the procedure,
◦ Major/minor CIED infection within 12 months, &
◦ Maj. CIED infection regardless of time of
occurrence.
Death from any cause was a ancillary end
point of interest.
14.
15.
16. Procedure Characteristics
The mean procedure time did not differ
significantly between the two groups (56.3±46.2
minutes in the envelope group and 55.0±48.0
minutes in the control group; between-group
difference, 1.3 minutes
Though the envelope was not successfully
implanted in 10 procedures owing to limited
pocket space (successful in 99.7%).
17. Patient follow up
During the 12-month follow-up, 181 system
revisions occurred in 153 patients in the
envelope group and 229 in 186 patients in the
control group
18. Within 12 months after the index CIED
procedure, there were 30 major infections in 25
patients in the envelope group and 45 major
infections in 42 patients in the control group.
19.
20.
21. Subgroup Analysis
Subgroup analysis was conducted to test for
interaction among various baseline variables for
the primary end point through 12 months.
None of the differences between subgroups,
inclusive of age, sex, or baseline characteristics,
or high power v/s low power device were
significant.
22.
23. Disscussion:
Population of patients who were at increased risk for
CIED pocket infection, envelope was significantly
more effective at preventing infection than standard
care alone.
efficacy objective was met, with 40% fewer patients
in the envelope group than in the control group
having a major infection.
envelope was successfully implanted in 99.7% of
procedure attempts.
The safety objective was met as envelope group did
not have a higher incidence of procedure/system-
related complications
24. the use of the envelope may require dissection of
a slightly larger CIED pocket
The beneficial effects of the envelope in
preventing major CIED infection in 12 months
were more pronounced in patients with high-
power than in low-power devices or an initial
CRT-D.
25. Limitations of this trial
Use of immunosuppressive agents was not
balanced between the trial groups
Periprocedure and postprocedure infection-
prevention strategies including antibiotic use
were not controlled
Higher incidence of bacteremia and endocarditis
in the envelop group was not properly evaluated.
This also further raises the concern about the
antibiotic resistance, the data for which is lacking