811-1 Evolution of Left Ventricular Function, Myocardial Perfusion and Metabolism in Infarct Patients After Coronary Thrombolysis

Follow-up of regional myocardial blood flow, metabolism and function was studied in a population of thrombolysed patients. Fifty one patients with an acute myocardial infarction were prospectively enrolled. All patients received thrombolytic therapy within 6 hours after the onset of symptoms. Coronary angiography, 2D-echocardiography and 13NH3/18FDG PET were performed 5 days after the acute event. Three months after the infarction, 2D-echocardiography and 13NH3/18FDG PET studies were repeated.Thirty six patients (62% with TIMI III, 7% with TIMI II) revealed a concordant decrease of flow and metabolism in the infarct area (PET match). Fifteen patients (33% with TIMI III, 13% with TIMI II) revealed a decrease of flow with preservation of metabolism (PET mismatch). Twelve patients received further treatment (PTCA or CAGB) after the first PET scan. Myocardial blood flow improved significantly in both match (71±17ml/min/l00g at 3 months versus 60±17ml/min/100 g at 5 days, p<0.01) and mismatch groups (71±26ml/min/l00 g at 3 months versus 63 ±18ml/min/100 g at 5 days, p<0.05). Blood flow in remote areas did not change significantly (84±18mllmin/l 00 g at 3 months versus 82±19ml/min/l 00 gat 5 days, p=NS). In 4 patients with a match pattern at 5 days, a mismatch pattern had developed 3 months after the acute event.Functional follow-up was performed in 30 patients, 23 with a match pattern and 7 with a mismatch pattern. A variable outcome was observed: In 3 out of 7 mismatch areas contractility did not improve. On the contrary, 9 out of 23 match areas revealed functional improvement.It can be concluded that in this population of early thrombolysed patients, few mismatches were observed (29%). Flow values improved significantly in both match and mismatch groups 3 months after the acute event. In some patients, a mismatch pattern was found after 3 months, suggesting the need for further treatment. Functional outcome was variable, probably due to a variety of pathophysiologic processes such as stunning shortly after reperfusion with functional improvement after 3 months, reocclusion or progression of coronary artery disease resulting in reinfarction or hibernation

Disaster health education framework for short and intermediate training in Saudi Arabia: A scoping review

BackgroundSaudi Arabia has made extensive efforts to manage disasters using unique national approaches; however, challenges and obstacles concerning disaster health handling persist. The nation has a reactive strategy to disaster management with a need for increased involvement of health professionals in disaster management and improvement of healthcare facilities emergency preparedness including competency-based education training.ObjectiveA comprehensive and consistent approach of disaster education programs for short and intermediate training of health professionals involved in disaster responses in Saudi Arabia is still not evident. Therefore, it is vital to explore and map the current state of the disaster education framework in Saudi Arabia.MethodsThe Joanna Briggs Institute approach for scoping reviews was used to assess research articles and preprints between January 2000 and September 2021 from Saudi Digital Library; PubMed, CINAHL, and Google Scholar. Five experts identified key aspects of the disaster education approach and eligibility criteria to facilitate identification of relevant articles.ResultsOnly five articles met the specified criteria and described two short and three intermediate courses on disaster health management in Saudi Arabia. All courses involved competency-specific training aimed at basic or foundational level and involved a range of activities and learning types. None had refresher courses within 12 months.ConclusionThe review highlights the obvious scarcity of short and intermediate term evidence-based disaster health programs in Saudi Arabia. Adoption of the education framework proposed by the authors based on international frameworks could improve the quality and consistency of the disaster education curriculum in Saudi Arabia

Nuclear and chemical incidents in Holland: are we there yet?

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Evolution of regional performance after an acute anterior myocardial infarction in humans using magnetic resonance tagging

Regional remodelling after a left ventricular myocardial infarction is the first step in a cascade that may lead to heart failure and death. To understand better the mechanisms underlying this process, it is important to study not only the evolution in local deformation parameters but also the corresponding loading conditions. Using magnetic resonance (MR) myocardial tagging, we measured the regional contribution to ejection (regional ejection fraction) and loading (systolic blood pressure × radius of curvature (mean of short and long axes)/wall thickness) in 32 regions throughout the left ventricle (LV) in patients 1 week (1W) and 3 months (3M) after a first anterior infarction. Using positron emission tomography (PET), the LV was divided into infarct, adjacent and remote regions. In the remote regions the average deformation decreased between 1W and 3M (from 59.3 ± 5.6 to 57.9 ± 6.7 %, P < 0.05) due to an increase in loading conditions only (from 730 ± 290 to 837 ± 299 mmHg, P < 0.05). In the adjacent myocardium, no change in function was observed (49.0 ± 10.8 to 49.0 ± 6.5 %, P = n.s.), although loading increased (806 ± 297 to 978 ± 287 mmHg, P < 0.05). In the infarct region only, an increase in deformation was seen (30.7 ± 14.2 to 37 ± 6.9 %, P < 0.05), together with a higher loading level (1229 ± 422 to 1466 ± 284 mmHg, P < 0.05), which indicates a true improvement in function. The fact that MR tagging can identify both regional deformation and loading permits us to differentiate between changes due to alterations in regional loading conditions and true changes in function. After an acute myocardial infarction (MI), an improvement can be observed in the deformation-loading relation in the adjacent and infarct regions, but the improvement is mainly in the infarct region. Using this technique, types of intervention leading to even more functional gain could be evaluated

Effects of creatine supplementation with exercise training on physical fitness in coronary artery disease and chronic heart failure.

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Significant impact of transient deterioration of renal function on dosimetry in PRRT

Peptide receptor radionuclide therapy (PRRT), with (90)Y-DOTATOC and (177)Lu-DOTATATE as most clinically used radiopeptides, is widely used in the management of metastatic neuroendocrine tumors. With respect to radiation dosimetry, the kidneys are the critical organ for (90)Y-DOTATOC. Renal irradiation is significant because of reabsorption of the radiopeptide from the proximal tubuli and the resulting retention in the interstitium, mainly in the inner cortical zone. The high energy and consequently wide range in tissue of the yttrium-90 beta particle result in high absorbed doses to the kidney cortex and medulla. Accurate renal dosimetry can help minimizing radiation nephropathy. We report a case of a 69-year-old candidate for PRRT with an acceptable kidney function at the time of screening. When performing (111)In-octreotide pretreatment dosimetry 3 weeks later, we observed a drastic deterioration in kidney function, caused by undisclosed non-steroidal anti-inflammatory drug intake. The calculated kidney biological effective dose (BED) was 153 Gy after four projected cycles. PRRT was canceled as our full-course BED limit is 37 Gy and the patient was switched to morphine analgesics. Renal function normalized after 3 months and repeated dosimetry yielded an acceptable kidney BED of 28 Gy after four projected cycles (7 Gy/cycle). This case emphasizes that acute kidney insufficiency can yield toxic kidney doses in a single therapy cycle, with an inherent risk of persistent renal insufficiency. All clinical factors which might influence kidney function should be verified at screening and before PRRT administration.status: publishe