It is Entirely Reasonable to Consider That There Is No Limit to Human Life Span
The author of this commentary is entirely too enthusiastic about mTOR inhibitors as a tool to slow the aging process, but here he is largely focused on a different question. He argues (a) the sensible point that limits to aging and longevity are entirely determined by medical technology, and (b) the more debatable point that old people do not receive sufficient application of present forms of medical technology, and this is life-limiting. How much of the observed compression of morbidity of recent decades, meaning that people are living more healthy, functional years without an increase in overall life expectancy, is the r...
Source: Fight Aging! - December 14, 2021 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays
Written by Pendell MeyersA man in his early 60s presented with acute chest pain rated 10/10 with associated nausea and vomiting with known history of multivessel CAD. He presented at 2300 with onset of symptoms at 2230. He was awoken from sleep by the symptoms, which were identical to prior MI for which he received a stent years ago. On arrival his heart rate was 43 bpm and blood pressure 91/62. Atropine and IV fluid was given.Here was his triage ECG:What do you think? Baseline below for comparison, but try first without it.His baseline ECG was available on file:The presentation ECG shows diagnostic evidence of poste...
Source: Dr. Smith's ECG Blog - December 1, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
PEA cardiac arrest, ROSC, and no STEMI on ECG. Randomized trials say emergent reperfusion is not indicated, right?
This study had a fatal flaw: they did not keep track of all the " Non-STEMI patients " who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients whom they suspected had Occlusion MI (OMI), even if they did not have STEMI. These physicians did not want a patient with an OMI that was not a STEMI to be randomized to no angiogram. This strong suspicion is supported by their data: only 22 o...
Source: Dr. Smith's ECG Blog - November 4, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
An elderly man who dies 12 hours later - could he have been saved?
Sent by Anonymous, written by Pendell Meyers and Steve SmithAn elderly man with good neurologic baseline but history of CABG presented to the ED with acute lightheadedness, shortness of breath, and chest pressure radiating to both arms. He had just recently been admitted for similar symptoms which had been diagnosed as an NSTEMI, and he received a stent to the ostial LCX one week ago. At that time his EF was 30%. He returned to the same hospital where he had just received his LCX stent.Here is his first ECG at triage, with chest pain temporarily resolved:He then had spontaneous return of chest pain while in the ED, wi...
Source: Dr. Smith's ECG Blog - October 22, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
What's new in midwifery - 20th October 2021 - New research
Some recent research you might need to know about:A study ofsunflower seed oil to reduce neonatal sepsis and mortality, a study carried out in Uttar Pradesh. A systematic review of howsonographic knowledge can help decrease failed operative vaginal delivery.ThePregnancy Adapted Geneva score (PAG) to assess the probability of pulmonary embolism during pregnancy.A study looking at any association ofepidural anaesthesia with autism spectrum disorder in children.Three Cochrane systematic reviews:Paracetamol/acetaminophen for perineal pain in the postnatal periodInstruments for assisted vaginal birth Physiologica...
Source: Browsing - October 20, 2021 Category: Databases & Libraries Tags: midwifery Source Type: blogs
Some health issues should not be evaluated in the office
I received a phone call from an elderly gentleman who was closer to ninety years of age than 80, was taking an aspirin, and had just suffered a fall and hit his head. He did not know why or how he fell. He asked for an appointment the same day to “check me out.” MyRead more …Some health issues should not be evaluated in the office originally appeared inKevinMD.com. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - October 18, 2021 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > < /span > Tags: Physician Primary Care Source Type: blogs
A man in his 60s woken from sleep by epigastric pain. Would you have been able to correctly diagnose him?
Written by Pendell MeyersA man in his mid 60s with history of CAD and stents experienced sudden onset epigastric abdominal pain radiating up into his chest at home, waking him from sleep. He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG:I sent this ECG, without any text at all, to Dr. Smith, and he replied: " LAD OMI with low certainty. V3 is the one that is convincing. " After his response I sent him the baseline ECG (below), still with no context at all except that this was his prior ECG:Dr. Smith replied: " Now high certainty. By the way,...
Source: Dr. Smith's ECG Blog - October 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Chest pain in a 30-something: Is it Normal variant STE or OMI? Get the prior ECG, and don't trust Point of Care troponin assays!
In this study, Smith and others show that the initial high sensitivity troponin is often below the 99th percentile in true STEMI (+) OMI (and sometime even below a very low threshold).[1] Wereski, R., Chapman, A. R., Lee, K. K., Smith, S. W., Lowe, D. J., Gray, A.,& Mills, N. L. (2020). High-Sensitivity Cardiac Troponin Concentrations at Presentation in Patients With ST-Segment Elevation Myocardial Infarction. JAMA Cardiology, 5(11), 1302 –1304. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - October 2, 2021 Category: Cardiology Authors: Bracey Source Type: blogs
A man in his late 40s with chest pain
Written by Pendell MeyersA man in his late 40s with no known medical problems was at work when he suddenly experienced midsternal chest pain radiating down both arms. Approximately 1 hour after onset of symptoms he was triaged at the ED, with ongoing chest pain, normal vitals, and this triage ECG:What do you think?Twice, months apart, I sent this ECG to Dr. Smith without any context or other information (I do this many times per day, with many normal or false positive cases mixed in). The first time he responded " acute ischemia but not active occlusion " . The second time he responded " LVH and subendocardial ischem...
Source: Dr. Smith's ECG Blog - September 13, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Fight Aging! Newsletter, August 30th 2021
Fight Aging! publishes news and commentary relevant to the goal of ending all age-related disease, to be achieved by bringing the mechanisms of aging under the control of modern medicine. This weekly newsletter is sent to thousands of interested subscribers. To subscribe or unsubscribe from the newsletter, please visit:
https://www.fightaging.org/newsletter/
Longevity Industry Consulting Services
Reason, the founder of Fight Aging! and Repair Biotechnologies, offers strategic consulting services to investors, entrepreneurs, and others interested in the longevity industry and its complexities. To find out mo...
Source: Fight Aging! - August 29, 2021 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Procaine as an Example of the Slow Reclassification of Known Small Molecule Drugs as Geroprotectors
The classification of "geroprotector" is fairly recent. In present use, it largely means a small molecule drug that can favorably target mechanisms known to be associated with aging. Some of these small molecules come with evidence for a slowing of aging in animal studies. A very few can boast evidence for the same from human trials. Most geroprotectors target stress response mechanisms, those involved in calorie restriction, but senotherapeutic drugs that reduce the burden of cellular senescence might also be classed as geroprotectors.
That a drug can be called geroprotective is no guarantee that it is actually use...
Source: Fight Aging! - August 24, 2021 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Crushing Chest pain, Tachycardia, and Very Elevated Blood Pressure in a 40-something Man.
A 40-something male called 911 for 2 hours of crushing, non-radiating, chest pain at about 11 AM. He reported a similar episode last year when his blood pressure was very out of control and that again he has not taken his BP meds for 2 months. He stated he had drunk 12 cans of Mountain Dew (high caffeine content) overnight. On exam, he was very anxious, holding his chest, breathing normally. Chest pain was worse with palpation. His BP was 250/150 with a heart rate of 150.Here are 2 prehospital ECGs, 6 minutes apart:Heart rate 156. ST Elevation. Large T-wavesThe computer re...
Source: Dr. Smith's ECG Blog - August 23, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
A 52 year old female with chest pain
Written by Pendell Meyers, edits by Steve SmithA 52 year old female with history of hypothyroidism and smoking presented to the ED with an episode of chest pain that began suddenly around 1500 while sitting down at work. She states it felt like a central chest pressure that radiated to her jaw. The pain had been persistently present since since 1500 (seen at 1615 in the ED), but had waxed and waned in severity, with the initial onset of pain being the worst. She had dyspnea and diaphoresis when the pain began. Coworkers called EMS who administered aspirin and NTG, which the patient says did not relieve her pain. During ini...
Source: Dr. Smith's ECG Blog - August 16, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
Hypotension, altered mental status, and aVR sign - activate the cath lab?
ConclusionsSTE-aVR with multilead ST depression was associated with acutely thrombotic coronary occlusion in only 10% of patients. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - July 21, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
A 64 year old man with chest tightness
Submitted and written by Kaley El-Arab MDPeer reviewed by Pendell Meyers, Alex Bracey, Stephen Smith A 64-year-old male with past medical history of coronary artery disease with prior MI s/p stent to RCA (2008), hypertension, dyslipidemia, and diabetes presented with acute onset of chest pain. Around 15:00 while at work he developed left-sided chest tightness that lasted for a few hours, then eventually went away, but returned the same evening around 22:00 when it woke him from sleep. He reportedly tried to “walk it off” which relieved the pain transiently. When the pain returned it was more severe and assoc...
Source: Dr. Smith's ECG Blog - July 5, 2021 Category: Cardiology Authors: Pendell Source Type: blogs
