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5-alpha-reductase deficiency (patient information)

Jinhui Wu — Fri, 20 Nov 2009 21:11:01 GMT

Diseases with similar symptoms:

←Older revision		Revision as of 21:11, 20 November 2009
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	:*[[Androgen insensitivity syndrome]]		:*[[Androgen insensitivity syndrome]]
	:*Testis degeneration		:*Testis degeneration
-	:*~~True~~ [[hermaphroditism]]	+	:*[[True hermaphroditism]]
	:*45,X/46,XY [[gonadal dysgenesis]]		:*45,X/46,XY [[gonadal dysgenesis]]

Image:Brief bio.doc

C Michael Gibson — Fri, 20 Nov 2009 21:10:57 GMT

uploaded a new version of "[[Image:Brief bio.doc]]"

New page

5-alpha-reductase deficiency (patient information)

Jinhui Wu — Fri, 20 Nov 2009 21:10:12 GMT

Diseases with similar symptoms:

←Older revision		Revision as of 21:10, 20 November 2009
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	==Who is at risk for 5-alpha-reductase deficiency?==		==Who is at risk for 5-alpha-reductase deficiency?==
		+	Researchs demonatrate that mutations in the SRD5A2 gene cause 5-alpha reductase deficiency. As a result of SRD5A2 mutations, the body cannot effectively convert [[testosterone]] to [[dihydrotestosterone]] (DHT), which plays an important role in the formation of external genitalia before birth.

	==How to know you have 5-alpha-reductase deficiency?==		==How to know you have 5-alpha-reductase deficiency?==
		+	:*[[Testosterone]]-to-[[dihydrotestosterone]] (T/DHT) level: In patients with 5-alpha-reductase deficiency, the testosterone level is normal or modestly elevated, whereas the DHT level is much low. Then, testosterone-to-dihydrotestosterone (T/DHT) level may be increased.
		+	:*Mutation analysis of the 5-alpha-reductase type 2 gene: It is primarily a research tool and not commercially available at present.
		+	:*Urinary ratios of various metabolites: These are also not commercially available currently.
		+	:*Pelvis [[ultrasonography]]: This is an painless test which uses sound waves to create a picture of the internal organs. For patients with 5-alpha-reductase deficiency, pelvis ultrasonography may be for differential diagnosis.
		+	:*Vaginogram: In patients with 5-alpha-reductase deficiency, vaginogram may be used to measure vaginal length and show no fistulous connections between the urinary tract and vagina.

	==When to seek urgent medical care?==		==When to seek urgent medical care?==
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	==Diseases with similar symptoms==		==Diseases with similar symptoms==
		+	:*[[Congenital adrenal hyperplasia]]
		+	:*[[Androgen insensitivity syndrome]]
		+	:*Testis degeneration
		+	:*True [[hermaphroditism]]
		+	:*45,X/46,XY [[gonadal dysgenesis]]

	==Where to find medical care for 5-alpha-reductase deficiency?==		==Where to find medical care for 5-alpha-reductase deficiency?==
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	==Prevention of 5-alpha-reductase deficiency==		==Prevention of 5-alpha-reductase deficiency==
		+	THe cause of 5-alpha-reductase deficiency is gene mutation. Preventive meaures are unknown. For people with family history, gene [[screening test]] may be needed.

	==What to expect (Outook/Prognosis)?==		==What to expect (Outook/Prognosis)?==

Rubella (patient information)

Mdoherty — Fri, 20 Nov 2009 19:47:46 GMT

←Older revision		Revision as of 19:47, 20 November 2009
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		+	{{Infobox_Disease
		+	\| Name = Rubella
		+	\| Image = Rash of rubella on skin of child's back.JPG
		+	\| Caption =
		+	\| DiseasesDB = 11719
		+	\| ICD10 = {{ICD10\|B\|06\|\|b\|00}}
		+	\| ICD9 = {{ICD9\|056}}
		+	\| ICDO =
		+	\| OMIM =
		+	\| MedlinePlus = 001574
		+	\| eMedicineSubj = emerg
		+	\| eMedicineTopic = 388
		+	\| eMedicine_mult = {{eMedicine2\|peds\|2025}} {{eMedicine2\|derm\|259}}
		+	\| MeshID =
		+	}}
		+
	'''For the WikiDoc page for this topic, click [[Rubella\|here]]'''		'''For the WikiDoc page for this topic, click [[Rubella\|here]]'''
	{{SI}}		{{SI}}
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	==When to seek urgent medical care==		==When to seek urgent medical care==
		+	Call for an appointment with your health care provider if:
		+	* You are a woman of childbearing age and are unsure of whether you have been vaccinated against rubella
		+	* You or your child develop a severe headache, stiff neck, earache, or vision problems during or after a case of rubella
		+	* You or your child need to receive [[MMR immunization]] (vaccine)

	==Treatment options==		==Treatment options==
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	==Diseases with similar symptoms==		==Diseases with similar symptoms==
-		+	* Dengue fever
		+	* Encephalitis
		+	* Measles
		+	* Mononucleosis

	==Where to find medical care for Rubella==		==Where to find medical care for Rubella==
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	==Prevention of Rubella==		==Prevention of Rubella==
		+	There is a safe and effective vaccine to prevent rubella. The rubella vaccine is recommended for all children. It is routinely given when children are 12 - 15 months old, but is sometimes given earlier during epidemics. A second vaccination (booster) is routinely given to children ages 4 - 6. MMR is a combination vaccine that protects against measles, mumps, and rubella.
		+
		+	Women of childbearing age usually have a blood test to see if they have immunity to rubella. If they are not immune, women should avoid getting pregnant for 28 days after receiving the vaccine.
		+
		+	Those who should not get vaccinated include:
		+	* Women who are pregnant
		+	* Anyone whose immune system is affected by [[cancer]], ppcorticosteroid medications]], or [[radiation]] treatment.
		+
		+	Great care is taken not to give the vaccine to a woman who is already pregnant. However, in the rare instances when pregnant women have been vaccinated, no problems have been detected in the infants.

	==What to expect (Outlook/Prognosis)==		==What to expect (Outlook/Prognosis)==
		+	Rubella is usually a mild infection.
		+
		+	However, if a mother is infected during early pregnancy, rubella can cause defects in the developing baby. The unborn baby can develop congenital rubella syndrome, which typically has a poor outcome. Defects are rare if the infection occurs after the 20th week of pregnancy.
		+
		+	===Possible Complications===
		+
		+	Complications that can occur in the unborn baby:
		+	* [[Cataracts]]
		+	* [[Congenital heart defects]]
		+	* [[Congenital rubella syndrome]]
		+	* [[Deafness]]
		+	* [[Ear infection]] ([[otitis media]])
		+	* [[Encephalitis]] (rare)
		+	* [[Mental retardation]]
		+	* [[Microcephaly]]
		+	* [[Transient arthritis]] (common in adolescents and adults with rubella)
		+
		+	A [[miscarriage]] or [[stillbirth]] may occur.

	==Sources==		==Sources==
		+	*http://www.nlm.nih.gov/medlineplus/ency/article/001574.htm
		+	*http://www.wrongdiagnosis.com/r/rubella/misdiag.htm

5-alpha-reductase deficiency (patient information)

Jinhui Wu — Fri, 20 Nov 2009 19:41:59 GMT

How do I know if I have 5-alpha-reductase deficiency and what are the symptoms of 5-alpha-reductase deficiency?:

←Older revision		Revision as of 19:41, 20 November 2009
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	:*Infancy: Some patients with 5-alpha reductase deficiency may show female external genitalia. Some may appear male external genitalia. Others show with ambiguous genitalia.		:*Infancy: Some patients with 5-alpha reductase deficiency may show female external genitalia. Some may appear male external genitalia. Others show with ambiguous genitalia.

-	:*Puberty: Patients raised as girls often appear [[virilisation]], such as [[amenorrhoea]], [[hirsuitism]], deepening of the voice, descending of the testes, enlarged clitoris or microphallus, and the urethra attaching to the phallus.	+	:*Puberty: Patients raised as girls often appear [[virilisation]], such as [[amenorrhoea]], [[hirsuitism]], deepening of the voice, descending of the testes, enlarged [[clitoris]] or [[microphallus]], and the [[urethra]] attaching to the [[phallus]].

-	:*Adulthood:	+	:*Adulthood: In adulthood, lack of [[dihydrotestosterone]] (DHT), patients with 5-alpha-reductase deficiency may not appear [[virilisation]] and experience male-pattern baldness.

	==Who is at risk for 5-alpha-reductase deficiency?==		==Who is at risk for 5-alpha-reductase deficiency?==

Rubella (patient information)

Mdoherty — Fri, 20 Nov 2009 19:36:33 GMT

New page

'''For the WikiDoc page for this topic, click [[Rubella|here]]'''
{{SI}}

'''Editor-in-Chief:''' Meagan E. Doherty

{{EJ}}

==What is Rubella?==
Rubella is a contagious [[infection]] in which there is a [[rash]] on the skin.

==What are the symptoms of Rubella?==
Children generally have few symptoms. Adults may experience a [[fever]], [[headache]], general discomfort ([[malaise]]), and a runny nose before the rash appears. They may not notice the symptoms.

Other symptoms may include:
* Bruising (rare)
* [[Inflammation]] of the eyes (bloodshot eyes)
* Muscle or joint pain

==What are the causes of Rubella?==
The disease is caused by a virus that is spread through the air or by close contact.

A person can transmit the disease from 1 week before the rash begins, until 1 - 2 weeks after the rash disappears. The disease is less contagious than [[rubeola]] (measles). After an infection, people have immunity to the disease for the rest of their lives.

In children and adults, rubella is usually mild and may even go unnoticed.

==Who is at risk for Rubella?==
* Not being vaccinated against rubella
* Exposure to an active rubella virus

==How to know you have Rubella?==
Tests include:
* Nasal or throat swab for viral culture
* Rubella [[serology]]

==When to seek urgent medical care==

==Treatment options==
There is no treatment for this disease.

Patients can take [[acetaminophen]] to reduce fever.

Defects that occur with congenital rubella syndrome can be treated.

==Diseases with similar symptoms==

==Where to find medical care for Rubella==
[http://maps.google.com/maps?f=q&hl=en&geocode=&q={{urlencode:{{#if:{{{1|}}}|{{{1}}}|yourdisease}}}}&sll=37.0625,-95.677068&sspn=65.008093,112.148438&ie=UTF8&ll=37.0625,-95.677068&spn=91.690419,149.414063&z=2&source=embed Directions to Hospitals Treating Rubella]

==Prevention of Rubella==

==What to expect (Outlook/Prognosis)==

==Sources==

{{SIB}}
{{WH}}
{{WS}}
[[Category:Patient Information]]
'''Bold text'''

Rubella

Mdoherty — Fri, 20 Nov 2009 19:24:26 GMT

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	\| MeshID =		\| MeshID =
	}}		}}
		+
		+	'''For patient information click [[{{PAGENAME}} (patient information)\|here]]'''
		+
	{{SI}}		{{SI}}
	{{CMG}}		{{CMG}}
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	{{dablink\|This page is for the disease. For the virus, see [[Rubella virus]].}}		{{dablink\|This page is for the disease. For the virus, see [[Rubella virus]].}}

-		+	==Overview==
	'''Rubella''', commonly known as '''German measles''', is a [[disease]] caused by Rubella virus. The name is derived from the Latin, meaning ''little red''. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is often mild and attacks often pass unnoticed. The disease can last one to five days. Children recover more quickly than adults. Infection of the mother by Rubella virus during pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy, the child may be born with [[congenital rubella syndrome]] (CRS), which is a range of serious incurable illnesses. Spontaneous abortion occurs in up to 20% of cases.<ref name="pmid5581012">{{cite journal		'''Rubella''', commonly known as '''German measles''', is a [[disease]] caused by Rubella virus. The name is derived from the Latin, meaning ''little red''. Rubella is also known as German measles because the disease was first described by German physicians in the mid-eighteenth century. This disease is often mild and attacks often pass unnoticed. The disease can last one to five days. Children recover more quickly than adults. Infection of the mother by Rubella virus during pregnancy can be serious; if the mother is infected within the first 20 weeks of pregnancy, the child may be born with [[congenital rubella syndrome]] (CRS), which is a range of serious incurable illnesses. Spontaneous abortion occurs in up to 20% of cases.<ref name="pmid5581012">{{cite journal
	\|author=Siegel M, Fuerst HT, Guinee VF		\|author=Siegel M, Fuerst HT, Guinee VF

5-alpha-reductase deficiency (patient information)

Jinhui Wu — Fri, 20 Nov 2009 19:21:34 GMT

How do I know if I have 5-alpha-reductase deficiency and what are the symptoms of 5-alpha-reductase deficiency?:

←Older revision		Revision as of 19:21, 20 November 2009
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	==How do I know if I have 5-alpha-reductase deficiency and what are the symptoms of 5-alpha-reductase deficiency?==		==How do I know if I have 5-alpha-reductase deficiency and what are the symptoms of 5-alpha-reductase deficiency?==
		+	:*Infancy: Some patients with 5-alpha reductase deficiency may show female external genitalia. Some may appear male external genitalia. Others show with ambiguous genitalia.
		+
		+	:*Puberty: Patients raised as girls often appear [[virilisation]], such as [[amenorrhoea]], [[hirsuitism]], deepening of the voice, descending of the testes, enlarged clitoris or microphallus, and the urethra attaching to the phallus.
		+
		+	:*Adulthood:

	==Who is at risk for 5-alpha-reductase deficiency?==		==Who is at risk for 5-alpha-reductase deficiency?==

Hypoglycemia (patient information)

Mdoherty — Fri, 20 Nov 2009 19:20:50 GMT

Sources:

←Older revision		Revision as of 19:20, 20 November 2009
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	==Diseases with similar symptoms==		==Diseases with similar symptoms==
		+	* Insulinoma
		+	* Addison's disease
		+	* Pituitary disorders
		+	* Liver disease

	==Where to find medical care for Hypoglycemia==		==Where to find medical care for Hypoglycemia==
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	==Sources==		==Sources==
-		+	*http://www.wrongdiagnosis.com/h/hypoglycemia/misdiag.htm
		+	*http://www.nlm.nih.gov/medlineplus/hypoglycemia.html

Unstable angina / non ST elevation myocardial infarction anticoagulant therapy

Kogando — Fri, 20 Nov 2009 16:01:30 GMT

changed protection level for "[[Unstable angina / non ST elevation myocardial infarction anticoagulant therapy]]" [edit=autoconfirmed:move=autoconfirmed]

New page

Unstable angina / non ST elevation myocardial infarction antiplatelet therapy

Kogando — Fri, 20 Nov 2009 16:01:00 GMT

changed protection level for "[[Unstable angina / non ST elevation myocardial infarction antiplatelet therapy]]" [edit=autoconfirmed:move=autoconfirmed]

New page

Chronic stable angina

Smitakohli — Fri, 20 Nov 2009 15:49:10 GMT

←Older revision		Revision as of 15:49, 20 November 2009
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	==Prevention==		==Prevention==
	===[[Chronic Stable Angina Secondary Prevention\|Prevention]]===		===[[Chronic Stable Angina Secondary Prevention\|Prevention]]===
-
-	~~==Complications==~~
-
-
-

Percutaneous Coronary Intervention (PCI): Basic Principles and Guidelines

Smitakohli — Fri, 20 Nov 2009 15:42:21 GMT

←Older revision		Revision as of 15:42, 20 November 2009
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	== Other Diagnostic Studies ==		== Other Diagnostic Studies ==
-	'''Coronary Artery Pressure and Flow: Use of Fractional Flow Reserve and Coronary Vasodilatory Reserve'''	+	'''Coronary Artery Pressure and Flow: Use of Fractional Flow Reserve and Coronary Vasodilatory Reserve'''<ref>[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>
		+
	* ''Class IIa''		* ''Class IIa''
-	~~It is reasonable to use intracoronary physiologic~~	+	Coronary pressure (fractional flow reserve [FFR]) or Doppler
-	~~measurements~~ (~~Doppler ultrasound,~~ fractional flow	+	velocimetry can be useful to determine whether PCI of a
-	reserve) ~~in the assessment of the effects of intermediate~~	+	specific coronary lesion is warranted. FFR or Doppler
-	~~coronary stenoses (30%~~ to ~~70% luminal narrowing)~~	+	velocimetry can also be useful as an alternative to
-	~~in patients with anginal symptoms~~. ~~Coronary~~	+	performing noninvasive functional testing (e.g., when the
-	~~pressure~~ or Doppler velocimetry ~~may~~ also be useful as	+	functional study is absent or ambiguous) to determine
-	an alternative to performing noninvasive functional	+	whether an intervention is warranted. It is reasonable to
-	testing (e.g., when the functional study is absent or	+	use intracoronary physiological measurements (coronary
-	ambiguous) to determine whether an intervention is	+	pressure (FFR) (Level of Evidence: A) or
-	warranted. (Level of Evidence: B)	+	Doppler velocimetry (Level of Evidence: C)) in the
		+	assessment of the effects of intermediate coronary
		+	stenoses (30% to 70% luminal narrowing) in patients with
		+	anginal symptoms.
	* ''Class IIb''		* ''Class IIb''
	1. Intracoronary physiologic measurements may be considered		1. Intracoronary physiologic measurements may be considered
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	lesion. (Level of Evidence: C)		lesion. (Level of Evidence: C)
	* ''Class III''		* ''Class III''
-	Routine assessment with intracoronary ~~physiologic~~	+	Routine assessment with intracoronary physiological
-	measurements such as Doppler ~~ultrasound or fractional~~	+	measurements such as coronary pressure (FFR) or Doppler
-	~~flow reserve~~ to assess the severity of angiographic	+	ultrasound to assess the severity of angiographic disease in
-	disease in patients with a positive, unequivocal	+	concordant vascular distribution in patients with angina and
-	noninvasive functional study is not recommended.	+	a positive, unequivocal noninvasive functional study is not
-	(Level of Evidence: C)	+	recommended. (Level of Evidence: C)

	== Treatment ==		== Treatment ==
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	Evidence: B)		Evidence: B)

-	'''Drug-Eluting Stents'''	+	'''Drug-Eluting Stents'''<ref>[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>
	* ''Class I''		* ''Class I''
	A drug-eluting stent (DES) should be considered as an		A drug-eluting stent (DES) should be considered as an
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	patients in whom trial data suggest efficacy. (Level of		patients in whom trial data suggest efficacy. (Level of
	Evidence: A)		Evidence: A)
		+	* ''Class IIa''
		+	It is reasonable to use a DES as an alternative to a
		+	BMS for primary PCI in STEMI. (Level of
		+	Evidence: B)
	* ''Class IIb''		* ''Class IIb''
-	A DES may be considered for ~~use in~~ anatomic ~~settings~~	+	A DES may be considered for clinical and anatomic
-	in which the ~~usefulness, effectiveness, and~~ safety ~~have~~	+	settings in which the efficacy/safety profile appears
-	~~not been fully documented in published trials~~. (Level	+	favorable. (Level of Evidence: B)
-	of Evidence: C)	+
		+	==References==
		+	{{reflist\|2}}

	== Acknowledgements ==		== Acknowledgements ==

Door-to-balloon

Smitakohli — Fri, 20 Nov 2009 15:27:53 GMT

←Older revision		Revision as of 15:27, 20 November 2009
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	2. [[STEMI]] patients presenting to a hospital without [[PCI]] capability and who cannot be transferred to a [[PCI]] center and undergo [[PCI]] within 90 minutes of first medical contact should be treated with [[fibrinolytic therapy]] within 30 minutes of hospital presentation as a systems goal unless [[fibrinolytic therapy]] is contraindicated ''(Level of Evidence: B)''}}		2. [[STEMI]] patients presenting to a hospital without [[PCI]] capability and who cannot be transferred to a [[PCI]] center and undergo [[PCI]] within 90 minutes of first medical contact should be treated with [[fibrinolytic therapy]] within 30 minutes of hospital presentation as a systems goal unless [[fibrinolytic therapy]] is contraindicated ''(Level of Evidence: B)''}}
		+
		+	==ACC/AHA Guidelines-Recommendations for Triage and Transfer for PCI(DO NOT EDIT)<ref>[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>==
		+
		+	{{cquote\|
		+	===Class I===
		+
		+	1. Each community should develop a STEMI system of care that follows standards at least as stringent as those developed for the AHA’s national initiative, Mission: Lifeline, to include the following:
		+	*ongoing multidisciplinary team meetings that include emergency medical services, non–PCI-capable hospitals/STEMI referral centers, and PCI-capable hospitals/STEMI receiving centers to evaluate outcomes and quality improvement data;
		+	*a process for prehospital identification and activation;
		+	*destination protocols for STEMI receiving centers;
		+	*transfer protocols for patients who arrive at STEMI referral centers who are primary PCI candidates, are ineligible for fibrinolytic drugs, and/or are in cardiogenic shock. ''(Level of Evidence: C)''
		+
		+	===Class IIa===
		+
		+	1. It is reasonable for high-risk patients who receive fibrinolytic therapy as primary reperfusion therapy at a non–PCI-capable facility to be transferred as soon as possible to a PCI-capable facility where PCI can be performed either when needed or as a pharmacoinvasive strategy. Consideration should be given to initiating a preparatory antithrombotic (anticoagulant plus antiplatelet) regimen before and during patient transfer to the catheterization laboratory. ''(Level of Evidence: B)''
		+
		+	===Class IIb===
		+
		+	1. Patients who are not at high risk who receive fibrinolytic therapy as primary reperfusion therapy at a non–PCI-capable facility may be considered for transfer as soon as possible to a PCI-capable facility where PCI can be performed either when needed or as a
		+	pharmacoinvasive strategy. Consideration should be given to initiating a preparatory antithrombotic (anticoagulant plus antiplatelet) regimen before and during patient transfer to the catheterization laboratory. ''(Level of Evidence: C)''}}
		+

	==Sources==		==Sources==

Unstable angina / non ST elevation myocardial infarction overview

Smitakohli — Fri, 20 Nov 2009 15:05:16 GMT

←Older revision		Revision as of 15:05, 20 November 2009
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	*Increasing angina-previously diagnosed angina that has become distinctly more frequent, longer in duration, or lower in threshold (i.e., increased by 1 or more CCS class to at least CCS class III severity)		*Increasing angina-previously diagnosed angina that has become distinctly more frequent, longer in duration, or lower in threshold (i.e., increased by 1 or more CCS class to at least CCS class III severity)

-	[[NSTEMI]] generally presents as prolonged, more intense rest angina or angina equivalent. Patients with suspected ACS must be evaluated rapidly. Evaluation should not be done over the phone but in person and in a place where a 12 lead ECG can be obtained. A focused history, examination, ECG and cardiac biomarkers are helpful to determine where the patient will be managed and whether the patient needs to be transferred or referred to a different hospital/setting. Physical examination should focus on identifying the precipitating factors, comorbid conditions, rule out alternative diagnosis and assess hemodynamic status of the patient. Unstable angina is associated with negative cardiac biomarkers whereas NSTEMI is associated with elevated cardiac biomarkers.	+	[[NSTEMI]] generally presents as prolonged, more intense rest angina or angina equivalent. Patients with suspected ACS must be evaluated rapidly. Evaluation should not be done over the phone but in person and in a place where a 12 lead ECG can be obtained. A focused history, examination, ECG and cardiac biomarkers are helpful to determine where the patient will be managed and whether the patient needs to be transferred or referred to a different hospital/setting. Physical examination should focus on identifying the precipitating factors, comorbid conditions, rule out alternative diagnosis and assess hemodynamic status of the patient. Unstable angina is associated with negative cardiac biomarkers whereas NSTEMI is associated with elevated cardiac biomarkers.
		+	Depending on the patient's symptoms and degree of suspicion for ACS, early coronary angiography can be performed to make a definitive diagnosis.

	==Risk stratification==		==Risk stratification==
-	Early risk stratification is recommended and is based on the initial history, physical exam, ECG, assessment of renal function and cardiac biomarkers. Various models to calculate risk score and determine prognosis are available for example TIMI score, PURSUIT risk model, GRACE risk score etc. This evaluation is helpful in selecting the site of care and type of therapy. Physician should document their opinion of the likelihood of [[ACS]] in one of the three categories of low, intermediate or high likelihood.	+	Patients with [[UA]] have lower short term mortality than [[NSTEMI]] or [[STEMI]]. Early risk stratification is, therefore, recommended and is based on the initial history, physical exam, ECG, assessment of renal function and cardiac biomarkers. Various models to calculate risk score and determine prognosis are available for example TIMI score, PURSUIT risk model, GRACE risk score etc. This evaluation is helpful in selecting the site of care and type of therapy. Physician should document their opinion of the likelihood of [[ACS]] in one of the three categories of low, intermediate or high likelihood. Patients with high risk score and/or hemodynamic instability should be managed in [[coronary care unit]] while those with intermediate to low risk score and hemodynamic stability can be managed in a [[step down unit]]. A continuous ECG monitoring([[telemetry]]) should be used to monitor for arrythmias.

	==Treatment==		==Treatment==
-		+	Immediate management is directed towards relief of chest pain. [[Nitrates]], [[ASA]] and morphine are recommended to control the symptoms from possible [[ACS]]. [[Beta blockers]], thienopyridines(like [[Clopidogrel]] and [[prasugrel]]) should be administered in the absence of contraindication to their use. Based on the suspicion for likelihood of [[ACS]], anticoagulants and gycoprotein IIb/IIIa inhibitors can be started early in the course of presentation. Two strategies in the treatment are early invasive or conservative strategies. Most trials have shown benefit of early invasive therapy with cardiac catheterization and revascularisation procedures. Early invasive therapy is now recommended for patients with [[UA]]/[[NSTEMI]] and ST segment changes at presentation and/or positive troponins during first 24hrs of presentation.

	==Discharge care==		==Discharge care==

Image:C michael gibson small.jpg

C Michael Gibson — Fri, 20 Nov 2009 14:36:38 GMT

uploaded a new version of "[[Image:C michael gibson small.jpg]]"

New page

User:C Michael Gibson

C Michael Gibson — Fri, 20 Nov 2009 14:26:46 GMT

←Older revision		Revision as of 14:26, 20 November 2009
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	'''Download This Brief Bio as a Word Document:''' Download this brief bio as a word document [[media:Brief bio.doc\|here]]		'''Download This Brief Bio as a Word Document:''' Download this brief bio as a word document [[media:Brief bio.doc\|here]]
-		+	__NOTOC__
	----		----
		+	C. Michael Gibson, M.S., M.D. is an interventional cardiologist, cardiovascular researcher and educator who pioneered our understanding of the "open artery hypothesis" as well our understanding of the importance of restoring flow downstream in the capillary bed in the "open microvasculature hypothesis". He has led his own Academic Research Organization ([http://www.perfuse.org PERFUSE]) for over 20 years now, and his work has been presented in over 1000 manuscripts, abstracts, trial summaries, textbooks and textbook chapters. He is Founder and Chairman of the Board of the non-profit WikiDoc foundation, the world's largest open source textbook of medicine.
		+
		+	==Education and Academic Positions==
	Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School.		Dr. Gibson received his B.S., M.S., and M.D. degrees from the University of Chicago. He was an Intern, Resident and Chief Resident at the Brigham and Women’s Hospital, Harvard Medical School. He received his training as an interventional cardiologist and served as the Director of the Coronary Care Unit at Beth Israel Hospital, Harvard Medical School. Dr. Gibson then served as the Chief of Cardiology and Director of Interventional Cardiology at the West Roxbury Veterans Affairs Medical Center, Harvard Medical School. While at the West Roxbury VA, he also served as an Associate Physician at the Brigham and Women’s Hospital. He then moved on to Allegheny General Hospital as Vice Chairman of Medicine for Clinical Research and Director of Invasive Cardiology. He subsequently relocated to the west coast and served as Associate Chief of Cardiology, Chief of Interventional Cardiology and Director of the Cardiac Catheterization Laboratory at University of California San Francisco (UCSF). In 2000, Gibson returned to Harvard Medical School in Boston. Until 2003, Dr. Gibson served as Chief Academic Officer and Director of Core Services at Harvard Clinical Research Institute (HCRI), until 2005 he served as Associate Chief of Cardiology and Director of Academic Affairs in the Cardiovascular Division at the Beth Israel Deaconess Medical Center. Until 2009 he served as the Director of the TIMI Data Coordinating Center at the Brigham and Women’s Hospital. He is currently a full time interventional cardiologist and Chief of Clinical Research in the Cardiovascular Division at Beth Israel Deaconess Medical Center, Harvard Medical School.

-		+	==Research==
	Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in over 1000 manuscripts, abstracts, trial summaries, textbooks and textbook chapters.		Dr. Gibson’s work has largely focused on investigating the pathophysiology of coronary artery disease and the efficacy of pharmacologic and device based therapies. His work has been presented in over 1000 manuscripts, abstracts, trial summaries, textbooks and textbook chapters.

-		+	Over 20 years ago, Gibson founded [http://www.perfuse.org PERFUSE], an academic research organization which has served as the angiographic core laboratory and data coordinating center for a wide variety of studies including acute MI studies, unstable angina studies, interventional cardiology trials, peripheral interventional trials, venographic trials, angiogenesis trials (VEGF), imaging modality studies, managed care analyses for HCFA, and atherosclerosis regression trials such as the NIH-sponsored Harvard Atherosclerosis Reversibility Project (HARP). Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his reasearch have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open microvasculature hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 1800 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).
-	Over 20 years ago, Gibson founded [http://www.perfuse.org PERFUSE], an academic research organization which has served as the angiographic core laboratory and data coordinating center for a wide variety of studies including acute MI studies, unstable angina studies, interventional cardiology trials, peripheral interventional trials, venographic trials, angiogenesis trials (VEGF), imaging modality studies, managed care analyses for HCFA, and atherosclerosis regression trials such as the NIH-sponsored Harvard Atherosclerosis Reversibility Project (HARP). Gibson directed the TIMI angiographic core laboratory and invented the TIMI frame count (CTFC) in which the number of cineframes for dye to reach standardized distal landmarks is counted (an index of epicardial blood flow). Gibson also invented the TIMI myocardial perfusion grade (the blush, a measure of microvascular perfusion). The TIMI frame count and the TIMI myocardial perfusion grade are both multivariate predictors of 2 year mortality in acute MI, and are now widely used both clinically and in the assessment of new reperfusion strategies. The methods invented by Gibson and his reasearch have played a critical role in our understanding of "the open artery hypothesis" and more recently in what Gibson has termed "the open ~~muscle~~ hypothesis". On Google scholar, the TIMI Frame Count is listed as being cited in over 1800 articles ([http://scholar.google.com/scholar?hl=en&lr=&q=%22timi+frame+count%22&btnG=Search for updated numbers click here]) and the TIMI myocardial perfusion grade is listed as being cited in over 800 articles ([http://scholar.google.com/scholar?hl=en&q=%22timi+myocardial+perfusion+grade%22&btnG=Search for updated numbers click here]).	+
-		+

	Under Gibson's direction, [http://www.perfuse.org PERFUSE] created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center.		Under Gibson's direction, [http://www.perfuse.org PERFUSE] created the master database that unified data from over 25 years of TIMI studies (TIMI 1-50) in nearly 100,000 patients and coordinated data analyses for the TIMI study group and functioned as the TIMI Data Coordinating Center.
-

	Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.		Within the Thrombolysis In Myocardial Infarction (TIMI) Study Group, Dr. Gibson has served as a Principle Investigator of multiple international trials within the TIMI Study Chairman’s Office.

-		+	==Textbooks==
	Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. There are currently over 30,000 page views daily of over 70,000 chapters of content contributed and edited over 400,000 times by over 1,500 registered users.		Dr. Gibson is Founder and Chairman of the Board of WikiDoc Foundation (a 509 (a)(1) Charitable Organization). This is the world's largest medical textbook / encyclopedia. There are currently over 30,000 page views daily of over 70,000 chapters of content contributed and edited over 400,000 times by over 1,500 registered users.

		+	Dr. Gibson also edits a textbook entitled “Management Strategies in Interventional Cardiology” which is optimized for hand held devices. In the past, Gibson has authored the chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In the past he has co-authored the chapter “Recognition and Management of Patients with Stable Angina Pectoris in Braunwald and Goldman’s Primary Cardiology. He has served as lead author of the section on myocardial perfusion imaging in a imaging textbook which is a companion to Braunwald’s Heart Disease. Gibson has authored content in several editions of Grossman and Baim's Textbook of Interventional Cardiology.

-	Dr. Gibson ~~also edited a textbook entitled “Management Strategies in Interventional Cardiology” which~~ is ~~optimized for hand held devices. In~~ the ~~past~~, ~~Gibson has authored~~ the ~~chapter on Primary Angioplasty in Randomized Trials in Cardiovascular Disease published as a companion to Braunwald's Heart Disease. In~~ the ~~past he has co-authored the chapter “Recognition and Management~~ of ~~Patients with Stable Angina Pectoris in Braunwald~~ and ~~Goldman’s Primary Cardiology. He has served as lead author of~~ the ~~section on myocardial perfusion imaging in a imaging textbook which is a companion to Braunwald’s~~ Heart ~~Disease~~.	+	==Editorial Boards==
		+	Dr. Gibson is on the editorial board of Circulation, the Journal of the American College of Cardiology Interventions, Cardiac Catheterization and Intervention and the American Heart Journal.

		+	==Internet Educational Sites==
		+	Dr. Gibson is Founder and Editor-in-Chief of [http://www.clinicaltrialresults.org Clinical Trial Results] where he created the first weekly TV show for Cardiologists "This Week in Cardiology" and has provided slides summarizing clinical trials since 1999. Gibson also created [http://www.timi.org TIMI.org], the website of the TIMI Study Group.

-	~~Dr.~~ Gibson ~~is on~~ the ~~editorial board~~ of ~~Circulation~~. Dr. ~~Gibson is Editor-~~in~~-Chief~~ of ~~[http://www~~.~~clinicaltrialresults.org Clinical Trial Results] where he created~~ the ~~first weekly TV show~~ for ~~Cardiologists "This Week~~ in ~~Cardiology"~~. ~~Gibson also created [http://www~~.~~timi~~.~~org TIMI~~.~~org]~~, the ~~website~~ of the ~~TIMI Study Group~~.	+	==Awards==
		+	Gibson graduated from college Phi Beta Kappa, and from medical school Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achievements in cardiovascular science. In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being Pope John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. In 2007 and 2009, Gibson was selected by Who's Who as the Clinical Researcher of the Year. In 2009, Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.

-		+	Gibson is an award winning fine art black and white photographer whose work has been exhibited in museums and one man gallery shows. In a juried competition, his work was selected as one of 50 artists from around the world for the 2009 Carmel Art and Film festival. His work can be viewed at [http://www.f64andmore.com f64 And More Gallery].
-	~~Dr.~~ Gibson ~~lectures internationally on the topics of interventional cardiology, antithrombotics, antiplatelet agents, acute coronary syndromes, atherosclerosis~~ and ~~lipid-lowering, the future of medical communication~~ and ~~the concept of "copyleft" as well as pay for performance~~.	+
-		+
-	~~==Awards==~~	+
-	~~Gibson graduated from college Phi Beta Kappa~~, ~~and from medical school as Alpha Omega Alpha, both from the University of Chicago. In 1993 he~~ was selected as ~~the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall~~ of ~~China Symposium in 2003, Gibson was awarded~~ the ~~Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China~~ for ~~his achivements in cardiovascular science. In 2005,~~ the ~~John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit,~~ and ~~a research laboratory was named there in his honor~~. ~~He was the 4th such awardee, the others being John Paul II and Dr~~. ~~Valentine Fuster~~. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. In 2007 and 2009, Gibson was selected by Who's Who as the Clinical Researcher of the Year. In 2009, Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.	+

	==Disclosures:==		==Disclosures:==

Unstable angina / non ST elevation myocardial infarction overview

Smitakohli — Fri, 20 Nov 2009 13:42:52 GMT

←Older revision		Revision as of 13:42, 20 November 2009
Line 48:		Line 48:
	*Increasing angina-previously diagnosed angina that has become distinctly more frequent, longer in duration, or lower in threshold (i.e., increased by 1 or more CCS class to at least CCS class III severity)		*Increasing angina-previously diagnosed angina that has become distinctly more frequent, longer in duration, or lower in threshold (i.e., increased by 1 or more CCS class to at least CCS class III severity)

-	[[NSTEMI]] generally presents as prolonged, more intense rest angina or angina equivalent. Patients with suspected ACS must be evaluated rapidly. Evaluation should not be done over the phone but in person and in a place where a 12 lead ECG can be obtained. A focused history, examination ~~and~~ ECG are helpful to determine where the patient will be managed and whether the patient needs to be transferred or referred to a different hospital/setting. Physical examination should focus on identifying the precipitating factors, comorbid conditions, rule out alternative diagnosis and assess hemodynamic status of the patient.	+	[[NSTEMI]] generally presents as prolonged, more intense rest angina or angina equivalent. Patients with suspected ACS must be evaluated rapidly. Evaluation should not be done over the phone but in person and in a place where a 12 lead ECG can be obtained. A focused history, examination, ECG and cardiac biomarkers are helpful to determine where the patient will be managed and whether the patient needs to be transferred or referred to a different hospital/setting. Physical examination should focus on identifying the precipitating factors, comorbid conditions, rule out alternative diagnosis and assess hemodynamic status of the patient. Unstable angina is associated with negative cardiac biomarkers whereas NSTEMI is associated with elevated cardiac biomarkers.

	==Risk stratification==		==Risk stratification==
Line 54:		Line 54:

	==Treatment==		==Treatment==
		+
		+
	==Discharge care==		==Discharge care==

User:C Michael Gibson

C Michael Gibson — Fri, 20 Nov 2009 13:41:39 GMT

Awards

←Older revision		Revision as of 13:41, 20 November 2009
Line 39:		Line 39:
	Dr. Gibson lectures internationally on the topics of interventional cardiology, antithrombotics, antiplatelet agents, acute coronary syndromes, atherosclerosis and lipid-lowering, the future of medical communication and the concept of "copyleft" as well as pay for performance.		Dr. Gibson lectures internationally on the topics of interventional cardiology, antithrombotics, antiplatelet agents, acute coronary syndromes, atherosclerosis and lipid-lowering, the future of medical communication and the concept of "copyleft" as well as pay for performance.

-		+	==Awards==
-	In 2007 and 2009, Gibson was selected by Who's Who as the Clinical Researcher of the Year.	+	Gibson graduated from college Phi Beta Kappa, and from medical school as Alpha Omega Alpha, both from the University of Chicago. In 1993 he was selected as the Julian and Eunice Cohen Scholar in Medicine at the Brigham and Women's Hospital. In conjunction with delivering the opening plenary lecture at the 10th annual Great Wall of China Symposium in 2003, Gibson was awarded the Gold Medal by the Institute of Geriatric Cardiology, Chinese Peoples Liberation Army General Hospital, Beijing China for his achivements in cardiovascular science. In 2005, the John Paul II Hospital in Krakow, Poland awarded Gibson the Pro Bono Curantium Gold Medal for Merit, and a research laboratory was named there in his honor. He was the 4th such awardee, the others being John Paul II and Dr. Valentine Fuster. In that same year, Gibson was awarded the Medal of the Jagiellonian University for his outstanding achievements in education and research in cardiovascular science. In 2007 and 2009, Gibson was selected by Who's Who as the Clinical Researcher of the Year. In 2009, Gibson was chosen by his peers as one of Boston's Top Doctors in Boston Magazine.

	==Disclosures:==		==Disclosures:==

Sprained ankle

C Michael Gibson — Fri, 20 Nov 2009 00:20:02 GMT

←Older revision		Revision as of 00:20, 20 November 2009
Line 13:		Line 13:
	MeshID = \|		MeshID = \|
	}}		}}
		+
		+	{{CMG}}
		+
	A '''sprained ankle''', also known as a '''ankle sprain''', '''ankle injury''' or '''ankle ligament injury''', is a common medical condition where one or more of the [[ligaments]] of the [[ankle]] is torn or partially torn. The [[anterior talofibular ligament]] is one of the most commonly involved ligaments. Sprains to the lateral aspect of the ankle account for 85% of ankle sprains.		A '''sprained ankle''', also known as a '''ankle sprain''', '''ankle injury''' or '''ankle ligament injury''', is a common medical condition where one or more of the [[ligaments]] of the [[ankle]] is torn or partially torn. The [[anterior talofibular ligament]] is one of the most commonly involved ligaments. Sprains to the lateral aspect of the ankle account for 85% of ankle sprains.

Unstable angina / non ST elevation myocardial infarction

Smitakohli — Thu, 19 Nov 2009 21:37:19 GMT

←Older revision		Revision as of 21:37, 19 November 2009
Line 19:		Line 19:
	{{CMG}}		{{CMG}}
	__NOTOC__		__NOTOC__
-	'''Associate Editor-In-Chief:''' {{CZ}}	+	'''Associate Editor-In-Chief:''' {{CZ}}; Smita Kohli, M.D.

	'''Associate Editor-In-Chief:''' {{NMG}}		'''Associate Editor-In-Chief:''' {{NMG}}

ST elevation myocardial infarction glucose control

Smitakohli — Thu, 19 Nov 2009 21:33:46 GMT

←Older revision		Revision as of 21:33, 19 November 2009
Line 22:		Line 22:
	: There are currently trials underway that are addressing whether aggressive glucose control with insulin in STEMI patients (particularly anterior STEMI) improves infarct size and cardiovascular outcomes.		: There are currently trials underway that are addressing whether aggressive glucose control with insulin in STEMI patients (particularly anterior STEMI) improves infarct size and cardiovascular outcomes.

-	==ACC / AHA Guidelines (DO NOT EDIT)<ref name="pmid15339869">{{cite journal \|author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK \|title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) \|journal=Circulation \|volume=110 \|issue=9 \|pages=e82–292 \|year=2004 \|month=August \|pmid=15339869 \|doi= \|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>==	+	==ACC / AHA Guidelines (DO NOT EDIT)<ref name="pmid15339869">{{cite journal \|author=Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK \|title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction) \|journal=Circulation \|volume=110 \|issue=9 \|pages=e82–292 \|year=2004 \|month=August \|pmid=15339869 \|doi= \|url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref><ref name="2009 STEMI guidelines">[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>==

	{{cquote\|		{{cquote\|
-	~~===Class I===~~
-	~~1. An [[insulin]] infusion to normalize [[blood glucose]] is recommended for patients with [[STEMI]] and complicated courses. ''(Level of Evidence: B)''~~

	===Class IIa===		===Class IIa===
-	1. During the acute phase (first 24 to 48 hours) of the management of [[STEMI]] in patients with [[hyperglycemia]], it is reasonable to administer an [[insulin]] infusion to normalize [[blood glucose]] even in patients with an uncomplicated course. ''(Level of Evidence: B)''

-	2. ~~After the acute phase of [[STEMI]], it~~ is reasonable to ~~individualize treatment of [[diabetic]]s, selecting from a combination of [[~~insulin~~]], [[insulin analog]]s, and oral [[hypoglycemic agent]]s that~~ achieve ~~the best [[glycemic control]]~~ and ~~are well tolerated~~. ''(Level of Evidence: C)''	+	1. It is reasonable to use an insulin-based regimen to achieve and maintain glucose levels less than 180 mg/dL while avoiding hypoglycemia for patients with STEMI with either a complicated or uncomplicated course. ''(Level of Evidence: B)''}}
-	}}	+

	==Sources==		==Sources==

ST elevation myocardial infarction anticoagulant and antithrombotic therapy

Smitakohli — Thu, 19 Nov 2009 21:24:34 GMT

←Older revision		Revision as of 21:24, 19 November 2009
Line 146:		Line 146:
	While the addition of [[warfarin]] to aspirin is efficacious, there is a 20% rate of discontinuation for both [[warfarin]] monotherapy, and the combination of warfarin plus aspirin. <ref name="pmid12126819">{{cite journal \|author=van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE \|title=Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial \|journal=Lancet \|volume=360 \|issue=9327 \|pages=109–13 \|year=2002 \|month=July \|pmid=12126819 \|doi=10.1016/S0140-6736(02)09409-6 \|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(02)09409-6}}</ref> This high rate of discontinuation is critical in so far as only those patients who are compliant with warfarin over 70% of the time derived a clinical benefit. <ref name="pmid11216966">{{cite journal \|author= \|title=Effects of long-term, moderate-intensity oral anticoagulation in addition to aspirin in unstable angina. The Organization to Assess Strategies for Ischemic Syndromes (OASIS) Investigators \|journal=J. Am. Coll. Cardiol. \|volume=37 \|issue=2 \|pages=475–84 \|year=2001 \|month=February \|pmid=11216966 \|doi= \|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109700011189}}</ref>		While the addition of [[warfarin]] to aspirin is efficacious, there is a 20% rate of discontinuation for both [[warfarin]] monotherapy, and the combination of warfarin plus aspirin. <ref name="pmid12126819">{{cite journal \|author=van Es RF, Jonker JJ, Verheugt FW, Deckers JW, Grobbee DE \|title=Aspirin and coumadin after acute coronary syndromes (the ASPECT-2 study): a randomised controlled trial \|journal=Lancet \|volume=360 \|issue=9327 \|pages=109–13 \|year=2002 \|month=July \|pmid=12126819 \|doi=10.1016/S0140-6736(02)09409-6 \|url=http://linkinghub.elsevier.com/retrieve/pii/S0140-6736(02)09409-6}}</ref> This high rate of discontinuation is critical in so far as only those patients who are compliant with warfarin over 70% of the time derived a clinical benefit. <ref name="pmid11216966">{{cite journal \|author= \|title=Effects of long-term, moderate-intensity oral anticoagulation in addition to aspirin in unstable angina. The Organization to Assess Strategies for Ischemic Syndromes (OASIS) Investigators \|journal=J. Am. Coll. Cardiol. \|volume=37 \|issue=2 \|pages=475–84 \|year=2001 \|month=February \|pmid=11216966 \|doi= \|url=http://linkinghub.elsevier.com/retrieve/pii/S0735109700011189}}</ref>

-	==ACC/AHA Guidelines- Recommendations for Anticoagulants (DO NOT EDIT) <ref name="pmid18071078">{{cite journal \|author=Antman EM, Hand M, Armstrong PW, ''et al'' \|title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee \|journal=Circulation \|volume=117 \|issue=2 \|pages=296–329 \|year=2008 \|month=January \|pmid=18071078 \|doi=10.1161/CIRCULATIONAHA.107.188209 \|url=}}</ref>==	+	==ACC/AHA Guidelines- Recommendations for Parenteral Anticoagulants (DO NOT EDIT) <ref name="pmid18071078">{{cite journal \|author=Antman EM, Hand M, Armstrong PW, ''et al'' \|title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee \|journal=Circulation \|volume=117 \|issue=2 \|pages=296–329 \|year=2008 \|month=January \|pmid=18071078 \|doi=10.1161/CIRCULATIONAHA.107.188209 \|url=}}</ref><ref name="2009 STEMI guidelines">[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>==

	{{cquote\|		{{cquote\|
		+	===Class I===
		+
		+	1. 1. For patients proceeding to primary [[PCI]] who have been treated with [[ASA]] and a [[thienopyridine]], recommended supportive anticoagulant regimens include the following:
		+
		+	:a. For prior treatment with [[UFH]], additional boluses of [[UFH]] should be administered as needed to maintain therapeutic activated clotting time levels, taking into account whether GP IIb/IIIa receptor antagonists have been administered. ''(Level of Evidence: C)''
		+	:b. [[Bivalirudin]] is useful as a supportive measure for primary [[PCI]] with or without prior treatment with [[UFH]]. ''(Level of Evidence: B)''
		+
	===Class IIa===		===Class IIa===

-	1. ~~It is reasonable for patients with~~ [[STEMI]] ~~who do not undergo~~ [[~~reperfusion therapy~~]] ~~to be treated with [[anticoagulant therapy]] (non-[[UFH]] regimen) for the duration~~ of ~~the index hospitalization~~, ~~up to 8 days. ''(Level of Evidence: B)'' Convenient strategies that can be used include those with~~ [[~~LMWH]] ''(Level of Evidence: C)'' or [[fondaparinux~~]] ''(Level of Evidence: B)'' ~~using the same dosing regimens as for patients who receive [[fibrinolytic therapy]]. See Section 6.3.1.6.8.1 [of the 2007 Guidelines update]~~}}	+	1. In [[STEMI]] patients undergoing [[PCI]] who are at high risk of bleeding, [[bivalirudin]] anticoagulation is reasonable. ''(Level of Evidence: B)''}}
		+

	==ACC/AHA Guidelines- Recommendations for Anticoagulants as Ancillary Therapy to Reperfusion Therapy (DO NOT EDIT) <ref name="pmid18071078">{{cite journal \|author=Antman EM, Hand M, Armstrong PW, ''et al'' \|title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee \|journal=Circulation \|volume=117 \|issue=2 \|pages=296–329 \|year=2008 \|month=January \|pmid=18071078 \|doi=10.1161/CIRCULATIONAHA.107.188209 \|url=}}</ref>==		==ACC/AHA Guidelines- Recommendations for Anticoagulants as Ancillary Therapy to Reperfusion Therapy (DO NOT EDIT) <ref name="pmid18071078">{{cite journal \|author=Antman EM, Hand M, Armstrong PW, ''et al'' \|title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee \|journal=Circulation \|volume=117 \|issue=2 \|pages=296–329 \|year=2008 \|month=January \|pmid=18071078 \|doi=10.1161/CIRCULATIONAHA.107.188209 \|url=}}</ref>==

ST elevation myocardial infarction glycoprotein IIbIIIa inhibition

Smitakohli — Thu, 19 Nov 2009 21:09:54 GMT

←Older revision		Revision as of 21:09, 19 November 2009
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	==Side Effects==		==Side Effects==

-	==ACC / AHA Guidelines- Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)<ref name="pmid15289388">{{cite journal \|author=Antman EM, Anbe DT, Armstrong PW, ''et al'' \|title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) \|journal=Circulation \|volume=110 \|issue=5 \|pages=588–636 \|year=2004 \|month=August \|pmid=15289388 \|doi=10.1161/01.CIR.0000134791.68010.FA \|url=}}</ref>==	+	==ACC / AHA Guidelines- Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)<ref name="pmid15289388">{{cite journal \|author=Antman EM, Anbe DT, Armstrong PW, ''et al'' \|title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) \|journal=Circulation \|volume=110 \|issue=5 \|pages=588–636 \|year=2004 \|month=August \|pmid=15289388 \|doi=10.1161/01.CIR.0000134791.68010.FA \|url=}}</ref><ref name="2009 STEMI guidelines">{{[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]}}</ref>==

	===Class IIa===		===Class IIa===
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	1. The usefulness of glycoprotein IIb/IIIa receptor antagonists (as part of a preparatory pharmacological strategy for patients with STEMI before their arrival in the cardiac catheterization laboratory for angiography and PCI) is uncertain. ''(Level of Evidence: B)''		1. The usefulness of glycoprotein IIb/IIIa receptor antagonists (as part of a preparatory pharmacological strategy for patients with STEMI before their arrival in the cardiac catheterization laboratory for angiography and PCI) is uncertain. ''(Level of Evidence: B)''

-	==ACC / AHA Guidelines- Combination Therapy With Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)<ref name="pmid15289388">{{cite journal \|author=Antman EM, Anbe DT, Armstrong PW, ''et al'' \|title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) \|journal=Circulation \|volume=110 \|issue=5 \|pages=588–636 \|year=2004 \|month=August \|pmid=15289388 \|doi=10.1161/01.CIR.0000134791.68010.FA \|url=}}</ref>==	+	==ACC / AHA Guidelines- Combination Therapy With Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)<ref name="pmid15289388">{{cite journal \|author=Antman EM, Anbe DT, Armstrong PW, ''et al'' \|title=ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) \|journal=Circulation \|volume=110 \|issue=5 \|pages=588–636 \|year=2004 \|month=August \|pmid=15289388 \|doi=10.1161/01.CIR.0000134791.68010.FA \|url=}}</ref><ref name="2009 STEMI guidelines"/>==

	===Class IIb===		===Class IIb===

ST elevation myocardial infarction thienopyridine therapy

Smitakohli — Thu, 19 Nov 2009 21:01:02 GMT

←Older revision		Revision as of 21:01, 19 November 2009
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	[[Ticlopidine]] administration has been associated with [[neutropenia]] and [[thrombotic thrombocytopenia]] ([[TTP]]). It is as a result of these potential side effects that [[clopidogrel]] is often prescribed instead. [[Clopidogrel]] may also be preferred because of the lack of need for laboratory monitoring, and once-daily dosing. It should be noted, however, that approximately one third to one quarter of patients may be resistant to clopidogrel, which is a pro-drug. For those patients who develop stent thrombosis while on clopidogrel, ticlopidine may be an optimal substitution because it is not a pro-drug and is not metabolized by the same pathway as clopidogrel.		[[Ticlopidine]] administration has been associated with [[neutropenia]] and [[thrombotic thrombocytopenia]] ([[TTP]]). It is as a result of these potential side effects that [[clopidogrel]] is often prescribed instead. [[Clopidogrel]] may also be preferred because of the lack of need for laboratory monitoring, and once-daily dosing. It should be noted, however, that approximately one third to one quarter of patients may be resistant to clopidogrel, which is a pro-drug. For those patients who develop stent thrombosis while on clopidogrel, ticlopidine may be an optimal substitution because it is not a pro-drug and is not metabolized by the same pathway as clopidogrel.

-	==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid18071078">{{cite journal \|author=Antman EM, Hand M, Armstrong PW, ''et al'' \|title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee \|journal=Circulation \|volume=117 \|issue=2 \|pages=296–329 \|year=2008 \|month=January \|pmid=18071078 \|doi=10.1161/CIRCULATIONAHA.107.188209 \|url=}}</ref>==	+	==ACC / AHA Guidelines (DO NOT EDIT) <ref name="pmid18071078">{{cite journal \|author=Antman EM, Hand M, Armstrong PW, ''et al'' \|title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee \|journal=Circulation \|volume=117 \|issue=2 \|pages=296–329 \|year=2008 \|month=January \|pmid=18071078 \|doi=10.1161/CIRCULATIONAHA.107.188209 \|url=}}</ref><ref>[http://content.onlinejacc.org/cgi/content/full/j.jacc.2009.10.015]</ref>==

	{{cquote\|		{{cquote\|

Zollinger-Ellison syndrome (patient information)

Jinhui Wu — Thu, 19 Nov 2009 20:51:05 GMT

Prevention of Zollinger-Ellison syndrome:

←Older revision		Revision as of 20:51, 19 November 2009
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	==Prevention of Zollinger-Ellison syndrome==		==Prevention of Zollinger-Ellison syndrome==
-	As a rare disease, the cause of Zollinger-Ellison syndrome is not clear. ~~And~~ the preventive measure is not known.	+	As a rare disease, the cause of Zollinger-Ellison syndrome is not clear. So the preventive measure is not known.

	==What to expect (Outook/Prognosis)?==		==What to expect (Outook/Prognosis)?==

5-alpha-reductase deficiency (patient information)

Jinhui Wu — Thu, 19 Nov 2009 20:48:07 GMT

Copyleft Sources:

←Older revision		Revision as of 20:48, 19 November 2009
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	==Copyleft Sources==		==Copyleft Sources==
		+	http://ghr.nlm.nih.gov/condition=5alphareductasedeficiency
		+
		+	http://emedicine.medscape.com/article/924291-overview

	{{WH}}		{{WH}}
	{{WS}}		{{WS}}
	[[Category:Patient Information]]		[[Category:Patient Information]]