Percutaneous left ventricular assist devices
This study also documented significantly greater increases in cardiac index and mean arterial blood pressure as well as significantly greater decreases in pulmonary capillary wedge pressure with TandemHeart. Severe adverse events and overall mortality were not significantly different between the two groups.
So we need more large scale studies on both types of percutaneous left ventricular assist devices and possibly improvements in their technical aspects to have a greater impact on survival in cardiogenic shock. Ongoing DanShock trial is one such study to look forward to.
References
Ergle K, Parto P, Krim SR. Percutaneou...
Source: Cardiophile MD - June 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Idarucizumab for reversal of direct thrombin inhibitor dabigatran
Idarucizumab is a monoclonal antibody fragment used to reverse the anticoagulant effect of direct thrombin inhibitor dabigatran. RE-VERSE AD (Reversal of Dabigatran Anticoagulant Effect With Idarucizumab) clinical trial evaluated the safety and efficacy of 5 g idarucizumab given intravenously [1]. An article on interim analysis of 90 patients was published first. In that report, 51 patients in group A of the study had serious bleeding while 39 patients in group B required an urgent procedure. Primary end point of the study was the maximum percentage reversal of the anticoagulant effect of dabigatran within four hours of a...
Source: Cardiophile MD - June 18, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
HOST-EXAM trial
This study is definitely hypothesis generating and calls for a multi national, double blind comparison on a larger scale to get a better conclusion on long term antiplatelet monotherapy after PCI with DES.
AUGUSTUS trial
A somewhat similar disadvantage for aspirin was suggested in the AUGUSTUS trial among patients with atrial fibrillation and recent ACS or PCI [2]. Adding apixaban to P2Y12 inhibitor resulted in lower bleeding compared with vitamin K antagonist and a lower rate of death or rehospitalization. Addition of aspirin resulted in greater bleeding without any difference in efficacy. 92.6% of the patients...
Source: Cardiophile MD - June 15, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
PerQseal+ for Large Diameter Arterial Closure: Interview with Andrew Glass, CEO of Vivasure Medical
Vivasure Medical, a medtech company based in Galway, Ireland, has developed the PerQseal device, a synthetic implant designed to seal large bore blood vessel punctures. The implant has utility in a wide variety of transcatheter endovascular procedures, such as transcatheter aortic valve replacement (TAVR), thoracic endovascular aneurysm repair (TEVAR), and endovascular abdominal aneurysm repair (EVAR), and aims to significantly improve on current approaches to close large vessel punctures.
The implant is an intravascular patch that is applied to the puncture from inside the vessel and is fully absorbable. The patch does...
Source: Medgadget - May 26, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiac Surgery Cardiology Exclusive Radiology Vascular Surgery Vivasure Source Type: blogs
Let's Talk About Hospitals And Rural Healthcare (Particularly Mother-Baby Care): My Letter To The NC Government Commission/NC State Treasurer In Support Of Randolph County's Application For A Loan To Save Randolph Health
Author ' s Note: The lawyers have a saying, " Res Ipsa Loquitur " " . Translated from Latin, it means, " The thing speaks for itself " . This is the text of the letter I sent to theNC Local Government Commission (embellished with a few links and additional comments in red) . . .in support of the state of North Carolina granting a loan to Randolph County (via the NC Rural Healthcare Stabilization Act) . . . for purposes of assisting in the " rescue " of Asheboro ' s Randolph Health - in a bankruptcy Court-approved buy-out of Randolph ' s assets by American Healthcare Systems, LLC.On May 4th, afte...
Source: Dr.J's HouseCalls - May 7, 2021 Category: American Health Tags: Asheboro Atrium Health Bankruptcy Cone Health Duke Lifepoint LGC Medical Whistle-blower Mother-Baby Care NC Rural Heatlh NCDHHS Non-profit Randolph Health UNC Health Wake Forest Baptist Source Type: blogs
Ultrasonic Biopsy Needle for Larger Tissue Samples
Researchers at Aalto University in Finland have developed an ultrasonically actuated needle that can retrieve a large amount of tissue during a biopsy, without the pain and complications associated with using bigger needles. The technique could be very useful when clinicians need to obtain tissue samples for molecular tumor diagnostics, since obtaining high quality samples is crucial, given the expense of molecular profiling procedures. The technique may also help to reduce patient inconvenience associated with repeat biopsies because of an initial poor tissue sample.
“Biopsy yields – the amount of tissue extrac...
Source: Medgadget - April 22, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Ob/Gyn Oncology Pathology Radiology Surgery Source Type: blogs
PRAMI Trial – Review
PRAMI Trial – Review
Preventive Angioplasty in Myocardial Infarction Trial (PRAMI) was conducted at five centres in the United Kingdom between 2008 and 2013. The study enrolled 465 patients with acute ST elevation myocardial infarction (STEMI) including 3 with left bundle branch block. Patients undergoing infarct related artery or culprit artery percutaneous intervention were randomized to either preventive PCI or no preventive PCI [1]. After primary PCI, subsequent PCI was recommended only for refractory angina with objective evidence of myocardial ischemia. Primary outcome measure in the PRAMI trial was a composit...
Source: Cardiophile MD - April 22, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Coronary Interventions Source Type: blogs
Rapid Compression Device to Prevent Deep Vein Thrombosis
Researchers at Penn Medicine have developed a wearable sleeve that provides rapid pulsatile compression, and aims to mimic the compression our calf muscles experience during walking. The technology, being commercialized by Osciflex, a spin out from Penn Medicine, is intended to prevent deep vein thrombosis in patients who are bed-bound for long periods of time.
Deep vein thrombosis tends to affect those that are not very mobile, so getting out of bed to stretch one’s legs is a challenge, making the condition tricky to prevent. At present, mechanical cuffs that periodically inflate around the leg are used, with mix...
Source: Medgadget - April 13, 2021 Category: Medical Devices Authors: Conn Hastings Tags: Cardiology Geriatrics Medicine Surgery Vascular Surgery Source Type: blogs
ISAR-REACT 5 Trial – Review
ISAR-REACT 5 Trial – Review
ISAR-REACT 5 Trial [1] was a multicenter study with randomized patients who presented which acute coronary syndrome for whom an invasive strategy was planned, to either ticagrelor or prasugrel. It was an open label trial. Primary end point was a composite of death, myocardial infarction or stroke at one year. A major secondary safety endpoint was bleeding. This was an investigator-initiated trial funded by German Center for Cardiovascular Research and Deutsches Herzzentrum München (German Heart Center Munich).
4,018 patients were randomized in the study. Primary composite endpoint occurr...
Source: Cardiophile MD - April 12, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Cardiology Source Type: blogs
Choosing Palliative Care as a Medical Specialty
by Sylvia Lane (@sylv_lane)There are few things more introspective than deciding on a specialty in medicine. The decision forces you to analyze what interests and values you hold but also who you are as a person. How do you solve problems? How do you work with others? What brings you joy? As a third-year medical student, I was able to try on many specialties. Rotating through various fields allowed me to soak up knowledge from almost every type of healthcare professional. But this experience comes with a heavy burden of choosing a future career path.From the beginning, I knew that I was not like most of my fellow medical s...
Source: Pallimed: A Hospice and Palliative Medicine Blog - April 9, 2021 Category: Palliative Care Tags: lane learner medical school medical student residency The profession Source Type: blogs
CULPRIT-SHOCK Clinical Trial – Review
CULPRIT-SHOCK Clinical Trial – Review
Culprit Lesion Only PCI Versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial investigated two strategies for percutaneous coronary interventions (PCI) in acute myocardial infarction with cardiogenic shock [1]. It was a multicenter randomized trial involving 706 patients who were randomized to either immediate PCI of the culprit lesion only with option for staged PCI of non-culprit lesions or immediate multivessel PCI. Primary composite endpoint included death and severe renal failure leading to renal replacement therapy within 30 days after randomization. Primary co...
Source: Cardiophile MD - April 8, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: Angiography and Interventions Coronary Interventions Source Type: blogs
Postural orthostatic tachycardia syndrome
Postural orthostatic tachycardia syndrome (POTS) is characterized by orthostatic tachycardia in the absence of orthostatic hypotension. Criteria for diagnosis of POTS are as follows: 1. Heart rate increase ≥30 beats per minute from supine to standing (5-30 min) 2. Symptoms get worse with standing and better on lying down 3. Symptoms lasting ≥6 months 4. Absence of other overt cause of orthostatic symptoms or tachycardia like active bleeding, acute dehydration and medications [1]. As children have higher orthostatic tachycardia, a cut off of ≥40 beats per minute within 5 minutes of head up tilt has been suggested in...
Source: Cardiophile MD - April 6, 2021 Category: Cardiology Authors: Prof. Dr. Johnson Francis Tags: ECG / Electrophysiology Source Type: blogs
The Art of Clinical Decision Making: Friday Afternoon Dilemmas
By HANS DUVEFELT
The woman had a bleeding ulcer and required a blood transfusion. The hospital discharge summary said to see me in three days for a repeat CBC. But she had a late Friday appointment and there was no way we would get a result before the end of the day. She also had developed diarrhea on her pantoprazole and had stopped the medication. As if that wasn’t enough, her right lower leg was swollen and painful. She had been bed bound for a couple of days in the hospital and sedentary at home after discharge.
She could still be bleeding and she could have a blood clot. There were no openings for an ultrasoun...
Source: The Health Care Blog - March 22, 2021 Category: Consumer Health News Authors: Christina Liu Tags: Medical Practice Physicians Primary Care Hans Duvefelt Source Type: blogs
5 unusual headaches: Signs to watch for and what to do
Headaches come in lots of varieties, and some are easily recognizable. A migraine classically causes throbbing, pounding pain that lasts for hours — sometimes even days — on one side of the head. A tension headache usually feels like a tight band squeezing around your noggin. And a sinus headache shows up as pressure on one side of the face, behind the nose, or above one eye when you have a sinus infection.
Some headaches, however, aren’t as well-known.
What’s happening to me?
When less familiar headache pain strikes, the symptoms or patterns may be puzzling, or even frightening.
For example, a thunderclap headache...
Source: Harvard Health Blog - March 2, 2021 Category: Consumer Health News Authors: Heidi Godman Tags: Brain and cognitive health Headache Pain Management Source Type: blogs
A North Carolina Pediatric Hospitalist Tells Her Pandemic Story to Senator Richard Burr: Thirteen Months (And Counting) In Medical Whistle-blower Hell - Courtesy Of Private Equity/For-Profit Healthcare And Cruelly-Indifferent/Morally-Bankrupt State & Federal Oversight
Author ' s Note: I cannot " sound-bite " the last year - and perhaps it ' s time to write the book. Scroll about half-way down to read the letter to Senator Burr. The bottom line is that for thethird time in 23 years, as a Pediatrician staffing a community hospital, I was fired " with-out cause " immediately after intervening in a neonatal ( " bad baby " ) case, rescuing the situation/ " saving " the baby, and reporting it INTERNALLY to Peer Review. NO discussion. NO recourse. NO review. A total cover-up. And EVERY SINGLE TIME I ' ve asked the state/Federal government to enfor...
Source: Dr.J's HouseCalls - February 28, 2021 Category: American Health Tags: ACA Apollo Global Management ApolloMD Ballad Heath Central Carolina Hospital CMS Duke Lifepoint ETSU Medicaid Medical Whistleblower NCDHHS Pandemic Quality Assruance Randolph Health Richard Burr Trump Source Type: blogs
