събота, 31 октомври 2015 г.
ACS, some additional data
ИЗТОЧНИК : http://content.onlinejacc.org/
Ще го преведа на български, когато имам време....
Pr ognostic Utility of Fibroblast Gr owth Factor-23 Af ter an Acute Coronary
Syndrome
Background: Fibroblast growth factor (FGF)-23 is a phosphatonin that may promote myocardial fibrosis and atherothrombotic plaque instability. Higher FGF-23 levels are associated with adverse cardiovascular (CV) events in stable CAD. The prognostic utility of FGF-23 in
patients after an acute coronary syndrome (ACS) is unknown.
Methods: FGF-23 was measured in plasma using an established ELISA (Immunotopics) in 4,947 patients w/in 30 days of ACS (median 14d) in the SOLID-TIMI 52 trial (median follow-up 2.5y). Analyses were adjusted for clinical risk predictors, eGFR, cystatin C, hsTroponin I, hsCRP, BNP and treatment arm.
Results: The median FGF-23 level was 63.1 (IQR 46.0-93.5) reference units/ml. Patients with higher FGF-23 levels were older, more likely female and with a history of HTN, DM and prior MI, but less likely to present with STEMI. FGF-23 levels were moderately to weakly correlated w/ eGFR, cystatin C, hsTnI, hsCRP and BNP. After multivariable adjustment, FGF-23 levels in the top quartile were independently associated with an increased risk of CV death or heart failure hospitalization (HR 2.43, 95% CI 1.90-3.13, P<0.001, Fig A)
and the individual components. Elevated FGF-23 levels were also associated with an increased risk of CV death, MI or stroke (HR 1.46, 95% CI 1.22-1.76, P<0.001, Fig B).
Conclusion: FGF-23 is associated with recurrent major CV events in patients stabilized after ACS, providing information independent of established clinical factors and cardiorenal biomarkers.
Telomerase Activity in Older Patients Pr esenting with Non-ST Elevation Acute
Coronary Syndrome
Conclusion: There is no correlation between TA, cardiovascular risk factors or frailty phenotype in high-risk older patients presenting with NSTEACS. Further studies are required to evaluate the underlying biological interactions of telomerase, particularly in coronary artery
disease.
Common Non-Cardiac Contributors to Anginal Pain: Experience of Emergency Chest
Pain Evaluation Center
Conclusion: In our cohort of low risk acute chest pain patients, depression, anxiety, and GERD were associated with higher self-reported severity of angina and angina frequency. These disorders were each more common than CAD in this population. Noncardiac conditions which contribute to or mimic cardiac chest pain should be assessed to best achieve relief for patients seeking acute evaluation of their symptoms.
Platelet Function Testing and Heart-Type Fatty Acid Binding Pr otein Levels for
Risk Stratification in Patients with Acute Coronary Syndrome Who Undergo
Percutaneous Coronary Intervention
Authors: Ian Pearson, Alistair Hall, Chris Gale, Mohan Sivananthan, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Background: Patients with acute coronary syndrome (ACS) who undergo percutaneous coronary intervention (PCI) but fail to respond to clopidogrel are at risk of recurrent ACS. Yet the majority of poor responders do not experience recurrent events. The highly cardio-specific biomarker, Heart-type Fatty Acid Binding Protein (H-FABP), may improve risk stratification
Methods: We studied a combined endpoint (death, definite/probable stent thrombosis and recurrent myocardial infarction) at 1 year in 758 patients presenting with ACS without cardiogenic shock and undergoing PCI. Cardiac biomarkers measured at 0, 4 and 12 hours following
PCI. A platelet function test (VerifyNow) was performed prior to PCI.
Results: Clinical syndrome: 111 unstable angina; 536 non-STEMI; 111 STEMI. Mean age: 62 (12) years; female: 25%; median SYNTAX score: 8.0 (11.0). 28% IIbIIIa inhibitors. Clopidogrel hypo-response (PRU ≥ 238) found in 52.8%. H-FABP was elevated (≥ 2.0 μg/L) at baseline in 40%; of these, H-FABP was also elevated in 90% and 93% at 4 and 12 hours. Patients with both clopidogrel hypo-response and elevated baseline H-FABP (22.8%) had a higher rate of the endpoint at 1 year: adjusted hazard ratio (95% C.I.) 2.78 (1.34 to 5.69), p < 0.01. Hypo-responders with normal H-FABP levels at baseline had a similar event rate to clopidogrel responders
Conclusion: Combining H-FABP and platelet function testing improves risk stratification in ACS patients undergoing PCI.
петък, 30 октомври 2015 г.
сряда, 28 октомври 2015 г.
Cocaine induced MI
source:HTTP://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC2111405/
CONCLUSION
Cocaine use may lead to the development of acute myocardial infarction, but the incidence of infarction is difficult to determine, and varies widely in the literature. Some, but not all, studies suggest that cocaine hastens the development of coronary artery atherosclerosis. However, the most plausible mechanism for the development of myocardial infarction in the cocaine user is coronary artery spasm at a time when oxygen demand is increased due to an increase in heart rate and blood pressure that are accompanied by platelet activation, and together culminate in coronary artery occlusion, particularly if the patient has underlying coronary artery disease (figure 1▶). Thrombolytic therapy or acute intervention should be initiated promptly after assessing for the risk of bleeding and other major complications, such as aortic dissection, severe hypertension or intracerebral hemorrhage. Acute beta blocker use should be viewed with caution, since it may lead to a decrease in coronary flow and an increase in coronary artery resistance. The most important long-term interventions are to enter the patient into a substance abuse program and to educate the patient about the harmful effects that cocaine has upon the heart.
Music section: FEAR
it's very sad i waste so much energy for that particular feeling... it closes so many doors
cardiology_pacemakers & CRT & electrocardioversion
These are interventions that i've seen this month at my practice for my last year of medicine school, not participated... just watched , but nontheless this experience was very usefull for my understanding of the procedures.
Here are some videos i found in you tube which i consider also useful since they also have description.
after 5 minute starts the essential part
i haven't seen ablation
вторник, 27 октомври 2015 г.
събота, 24 октомври 2015 г.
петък, 23 октомври 2015 г.
четвъртък, 22 октомври 2015 г.
Music section:Korean music
i got story for this one ...
and how i found the band "Big Bang" last year...
вторник, 20 октомври 2015 г.
събота, 17 октомври 2015 г.
петък, 16 октомври 2015 г.
Music section: sparkle
i can watch and comment for hours and hours about the music videos... music videos could be powerful tool for expression. i particularly like videos that tell stories ...whole life stories in 3 or 4 minutes that is art for sure . This article is not about the stories, it is about the visual part ... sometimes i may not like the music or the lyrics, or i may not get the entire story right..but the images ..some music videos are pure eye candy !
So...sparkling faces is the theme and ...yep, i like it so much that i tried it and i hope i find some crazy event to remake it :) enjoy
четвъртък, 15 октомври 2015 г.
WAARDENBURG syndrome
един човек да чуя, че е транс и ок с мъжко тяло, но уви... и той вече взима Т- блокери ... няма значение . Добро образователно видео + няколко искрени думи за хората, които имат ниско самочувствие !
сряда, 14 октомври 2015 г.
вторник, 13 октомври 2015 г.
понеделник, 12 октомври 2015 г.
Морфин
Днес ми препоръчаха да прочета Морфин на Булгаков... аз харесвам Булгаков и "прочитането му" ми беше в плановете ми, но защо сега се появява, когато имам толкова много работа (?!?)....ех, мое пусто любопитство! За пореден път трябва да се боря за удържането на импулса да прочета нещо, което няма да ми трябва непосредствено за "сега", за най-близкия изпит, а за живота!!! :)
Усмихвам се и физически, но отвътре цари пълен ужас ... дам, иска ми се да имах повече време... и веднага гласът на Коста прозвучава "Нямам време е глупаво оправдание! Който наистина иска нещо, намира времето " и Коста е прав...
неделя, 11 октомври 2015 г.
събота, 10 октомври 2015 г.
!Ramachandran !
I was so fascinated by this lecture that i tried to recreated some of the main points in it for my presentation for English class at the third semerter of Uni. i will probably upload on you tube my version in the near future.
if it hadn't been for this lecture and this lecturer, i probably woudn't be the same person... first time i came across it i was thrilled that scientific lecture could sound so interesting, it kept my attention keen throughout the whole talk and i learned most of the stuff much quicker than in a normal lecture... and also being available on the Internet made it possible for me to go back to it when i was working on my english assignment.
but this wasn't my first encounter with dr Rama... he appeared numerous times on Discovery documentaries.
Discrimination
Това е голяма тема, повдига много въпроси и искам да започна дискусията ...
Способността да приемаш и оценяваш хората обективно въз основа на характера и поведението им; въз основа на качествата, които проявяват в определени ситуации и способността им на кооперация ...тази способност, според мен, е сама по себе си добродетел, която трябва да бъде развивана.
Има много ситуации, които провокират да проявяваме тази добродетел или да я поставяме под въпрос.
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.
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Бежанският въпрос, които връхлита България като част от Европа и като канал към Европа е твърде актуален и ясно се вижда, че е проблем ... само че аз виждам, че проблемът е икономически и върху тази основа ЕДНОВРЕМЕННО и естествено, и нарочно ( чрез медия и политика) се наслагват и други страхове.
сряда, 7 октомври 2015 г.
Music section : Prata Vetra
Brainstorm sounds very nice as a word, it holds an inner antagonism but in my mind the emphasis is on the choas rather than the brain as highly complex and organized system... ... i coined it for the title of my blog.
first song i herd...
when i tried to figure out the text, looked for the English translation and so on... i knew i had to found out more about the novel "Master and Margarita".It was like nothing i've ever read...
(...)
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