- Menouﬁya University, Egypt
- Title:Dobutamine and Nitroglycerin Versus Milrinone for Perioperative Management of Pulmonary Hypertension in Mitral Valve Surgery A Randomized Controlled Study
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The study designed to compare the effects of dobutamine and nitroglycerin to milrinone in young patients with severe pulmonary hypertension undergoing mitral valve replacement. Forty patients had systolic pulmonary arterial pressure ≥ 60 mmHg and were scheduled for elective mitral valve replacement. The patients were divided randomly into 2 equal groups according to the drugs given during the study.
The patients in group I received 5 to 20 mg/kg/min of dobutamine and 0.5 to 3 mg/kg/min of nitroglycerin, and patients in group II received a loading dose of milrinone, 50 mg/kg over 10 minutes, followed by a maintenance dose of 0.25 to 0.75 mg/kg/min. The primary outcome was the effects of interventional drugs on mean pulmonary artery pressure. The secondary outcomes were the effects of interventional drugs on systemic and pulmonary hemodynamic parameters measured from induction of anesthesia until the ﬁrst 12 hours in the intensive care unit stay. There was a more signiﬁcant decrease in mean pulmonary artery pressure, pulmonary capillary wedge pressure, and central venous pressure in group II than group I at all time points after cardiopulmonary bypass. There were more signiﬁcant increases in heart rate, mean arterial pressure, cardiac output, and mixed venous oxygen tension in group I than group II, which became more obvious in time. In both groups, there was a signiﬁcant decrease in systemic vascular resistance and pulmonary vascular resistance at all times. We concluded milrinone provides adequate cardiac performance, causing a greater reduction in pulmonary artery pressure and pulmonary capillary wedge pressure.
Ashraf has completed his MD at the age of 35 years from Faculty of Medicine, Menoufia University and postdoctoral studies from Menoufia University School of Medicine. He is the director of Menoufia University Hospital theatres (40 surgical theatres). He has published more than 20 papers in reputed journals and has been serving as a reviewer of multiple anesthesia journals.
- Cádiz University School of Medicine, Spain
- Title:Transcriptomic as a novel diagnostic tool in familial dilated cardiomiopathy: An approach to cardiovascular precision medicine
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Dilated cardiomyopathy (DCM) is a complex heart disease with a common phenotype but heterogeneous pathological mechanisms. It is defined as ventricular dilation and systolic dysfunction in the absence of abnormal loading conditions or coronary artery disease. This heart disease shows a high prevalence, morbidity and mortality, being a major health problem. Early etiological diagnosis and prognosis stratification is crucial for the clinical management of the patient. Although imaging and genetic test avances have improved clinical practice, the diagnosis of the ethiology remains challenging. Novel accessible and veritable biomarkers are required. Advances in imaging technology and genetic tests have provided useful tools for clinical practice.
microRNAs (miRNAs), a group of small non-coding RNAs, have been established as key mediators of cell biology. Different cellular impairments, reponse to stress has been detected in a concentration impairment. Our previous research has suggested that the miRNA signature constitutes a novel source of non-invasive biomarkers for DCM, mainly for familial DCM. Several studies have reported the potential role of miRNAs as clinical indicators within the etiologies of DCM. But to our knowledge, none of them have been focused in DCM ethiology. I summarize the evidence of circulating miRNAs in DCM of different causes,- ischemic, familial and idiopathic,- and their usefulness in the development of novel diagnostic, prognostic and therapeutic approaches. Although the findings are still preliminary, miRNAs constitute a promising tool to assist in the clinical management of DCM. (Up to 250 words)
I am medical doctor, who has completed her PhD at the age of 26 years from Seville University and is Master of Science in novel imaging tools in cardiology diagnosis. My scientific activity has been focused on the fields of “Cardiomiopathies Diagnostics” and the “Molecular basis of Atherosclerosis”. I have a deep expertise in biomarker research, more specifically in the study of non-coding RNAs as biomarkers of cardiovascular-related conditions in the last five years. All my research lines have a strong translational perspective, from clinical needs to basic science. Focusing on my postdoctoral period, I have had both, a clinical and research activitiy. I have been asistant proffesor since 2009 at the Cadiz Medical School being involve in different national and international scientific commitees. I am author of several reviews based on non-coding RNA usefulness in cardiovascular diagnosis and excersise in which I discuss the clinical application of circulating non-coding RNAs and their potential technical and conceptual limitations (Up to 100 words)
- University of Leuven, Belgium
- Title:Role of Inflammation and Angiogenesis in the Pathogenesis of Chronic Thromboembolic Pulmonary Hypertension (CTEPH)
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Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare complication of pulmonary embolism (PE). It is characterized by fibro-thrombotic material obliterating large pulmonary arteries, resulting in increased pulmonary vascular resistance, progressive pulmonary hypertension, right ventricular failure and death if left untreated. The incidence of CTEPH after PE is about 3% and the disease is largely underdiagnosed. The absence of specific symptoms delays its diagnosis resulting in patients presenting at advanced stages with compromised haemodynamic profile and limited exercise capacity. Treatment is complex, involving high risk surgery, angioplasty and drugs.
There is a current need to understand why a subset of patients display persistent perfusion defects after an acute episode of PE and further develop CTEPH. Despite the presence of risk factors such as splenectomy, chronic inflammatory disorders, ventriculo-atrial shunts, infections, cancer or non-O blood group, the pathogenesis of CTEPH remains incompletely understood. Different hypotheses have been suggested such as i) dysregulated thrombolysis including elevated factor VIII and van Willebrand factor (vWF) or abnormalities in fibrinogen structure and function; ii) activation of pulmonary arterial smooth muscle and endothelial cells and involvement of progenitor cells; iii) a concept of inflammatory thrombosis, based on an elevated prevalence of inflammatory diseases, the presence of inflammatory cells within the fibro-thrombotic material obstructing proximal pulmonary and elevated circulating inflammatory mediators; and iv) defective angiogenesis by preventing proper thrombus resolution and its association with adverse outcome in CTEPH patients.
The aim will be to discuss the recently published aspects of the involvement of inflammatory thrombosis and defective angiogenesis in the pathogenesis of CTEPH.
Rozenn Quarck completed her PhD in biomedical sciences at the University Denis Diderot in Paris (France) in 1996.
Since 2015, she is holding a position as scientific research expert within the division of Respiratory Diseases at the University of Leuven and as clinical data manager within the Centre of Pulmonary Vascular Diseases at the University Hospitals of Leuven.
Her research interest is focused on the biology of the pulmonary circulation, pulmonary vascular diseases, physiopathology and genetics of pulmonary hypertension using in vitro and animal models.
She has published 40 peer-reviewed articles in the field of vascular biology and pulmonary hypertension.
- Harvard Medical School, Boston
- Title:Aspirin to Prevent Sudden Cardiac Death in Athletes with High Coronary Artery Calcium Scores
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While proficient cardiac resuscitation has improved survival following cardiac arrest during road races in Japan, this accomplishment does not address coronary artery disease as the underlying cause of an increasing frequency of cardiac arrest in middle-aged men during marathons and ironman triathlons in the United States since the year 2000. Based on the high prevalence of subclinical coronary artery disease by cardiac computed tomography in endurance athletes with low conventional cardiac risk-factor profiles, we recommend coronary artery calcium scores as a more reliable and independent predictor of incident cardiac events, including death, as validated among adults aged 30-46 years. Scores of over 100 Agatston units indicate a 10-year cardiac risk of 7.5%, at which additional measures for primary prevention are recommended, including aspirin, as shown conclusively to reduce first myocardial infarctions in same-aged men in a prospective double-blind controlled trial. Targeted screening for subclinical coronary atherosclerosis with coronary artery calcium scores is prudent to guide appropriately dosed aspirin use to mitigate the increasing frequency of sports-related sudden cardiac death due to plaque rupture.
Dr Siegel’s research on Boston Marathon runners has advanced the prevention and treatment of rare but life-threatening conditions such as acute water intoxication and cardiac arrest in young female and middle-aged male participants, respectively. Novel emergent treatments for the former have been incorporated into consensus statements accepted worldwide and also into the evaluation of hyponatremia in psychiatric practice. Pre-race aspirin use to mitigate the increasing frequency of marathon-related cardiac arrest in middle-aged male runners has been most recently advanced in the Annals of Internal Medicine, July, 2019. His interest in strategies to promote workplace resilience will be presented at the Creativity and Madness Conference in Charleston, South Carolina, in 2020, after attending this meeting as a recipient of a Joy in Learning Mini-Sabbatical from the MGH Center for Physician Well-Being,
- Heart Center of North Texas, USA
- Title:Managing the Acute Coronary Syndrome Patient: Evidence Based Recommendations for Anti-Platelet Therapy
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Acute coronary syndrome (ACS) is best managed by a multidisciplinary team in which primary care physicians, physician assistants, nurse practitioners, and pharmacists play a key role. This article summarizes recent updates to American College of Cardiology Foundation/American Heart Association guidelines for the management of unstable angina (UA)/non ST-segment elevation ACS (NSTE-ACS) and ST-segment elevation myocardial infarction (STEMI), focusing on antiplatelet therapy. Dual antiplatelet therapy comprising aspirin plus a P2Y12 inhibitor (clopidogrel, prasugrel, or ticagrelor) is recommended for patients with NSTE-ACS, and those with STEMI both during and after reperfusion. The guidelines provide recommendations regarding the utilization of P2Y12 inhibitors in specific circumstances and are discussed in this review. Health care teams with a key role in post-ACS care need to be familiar with the latest guidelines and support patients with education on risk reduction and the benefits of long-term medication adherence.
- University of Cambridge, United Kingdom
- Title:Drug Therapy After Bariatric Surgery
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Drug therapy in a post-bariatric patient can be significantly different due to the changes in the patient’s anatomy and ADME process. There are very little resources available to help practitioners make adjustments to drug therapies. This presentation will provide guidance on choosing appropriate dosage forms, adjusting doses to optimize therapy, and alternative options for commercial products to meet patient-specific needs.
The learning objectives include:
Describe the ADME process for drugs and how bariatric procedures affect it
Identify dosage forms that are suitable for bariatric surgery patients
Discuss alternative compounded options for bariatric surgery patients
Make recommendations on dosing medications for bariatric surgery patients
This presentation is based on the article cited below and a presentation in 2018:
McElhiney LF. Providing Pharmacy Services to Bariatric Surgery Patients. Inter J Pharm Compounding 2018; 22(1):30-39.
McElhiney LF. Drug Therapy After Bariatric Surgery. Indiana University Health Obesity Symposium, Indianapolis, IN, October 26, 2018.
Dr. McElhiney is the Team Lead Compounding Pharmacist and a preceptor for Indiana University Health in Indianapolis, Indiana. It is one of the largest health-systems in the United States, consisting of 20 hospitals and dozens of outpatient clinics and surgery centers.
She is an author for the International Journal of Pharmaceutical Compounding and contributing author in pharmacy and medical textbooks. Dr. McElhiney is a full fellow in the American College of Apothecaries (ACA), American Society of Health-System Pharmacists (ASHP), and the International Academy of Compounding Pharmacists (IACP). She has served on several national committees and board of directors in professional pharmacy organizations and received several awards. Dr. McElhiney currently serves as the President-Elect for the American College of Apothecaries.
Dr. McElhiney earned a B.S. in Pharmacy from Purdue University in 1984. Dr. McElhiney earned a Pharm.D. (2002) and a Masters (2012) from the University of Florida.