956-114 The Use of Invasive Coronary Procedures Have Increased and Prognosis Improved in Patients Ineligible for Thrombolysis in Israel

Patients (pts) with acute myocardial infarction (AMI) ineligible for thrombolytic therapy (TTX) are at increased risk. Invasive coronary procedures (ICP) have been recommended for these pts. In 3 surveys performed in the CCU's of Israel during 1990, ‘92 and ‘94 the use of TTX was 35, 46 and 43% respectively. The characteristics and management of excluded pts from TTX in the respective surveys were as follows:Characteristics (%)1990 (n=267)1992 (n=546)1992 (n=567)Men687569Age (mean + SD)65±11 yrs65±12 yrs65±12 yrs>75 yrs212522First MI666360ICP(%)Coronaro-angiography151827PTCA<1611CABG<125Mortality (%) (17days)13108Conclusions1) ICP use is steadily increasing in MI pts ineligible for TTX in Israel; 2) increased ICP rates are associated with decrease of early death among MI patients ineligible for TTX

Spatiotemporal Gait Parameters as Predictors of Lower-Limb Overuse Injuries in Military Training

The study objective was to determine whether spatiotemporal gait parameters could predict lower-limb overuse injuries in cohort of combat soldiers during first year of military service. Newly recruited infantry soldiers walked on a treadmill at a 15 ∘ incline with a fixed speed of 1.67 m/sec while wearing a standard military vest with a 10 kg load. Stride time variability, stride length variability, step length asymmetry, and the duration of the loading response phase of the gait cycle were measured. Injury data on 76 soldiers who did not report musculoskeletal complaints at initial screening were collected one year after recruitment. Multiple logistic regression analyses were conducted to determine the predictive effect of the gait parameters on lower-limb injuries. Twenty-four soldiers (31.6%) had overuse injuries during the first year after recruitment. Duration of the loading response was a significant predictor of general lower-limb injury ( < 0.05), as well as of foot/ankle and knee injuries ( < 0.05, < 0.01, resp.). A cutoff value of less than 12.15% for loading response duration predicted knee injuries with 83% sensitivity and 67% specificity. This study demonstrates the utility of spatiotemporal gait evaluation, a simple screening tool before military training, which may help to identify individuals at risk of lower-limb overuse injuries

Spatiotemporal Gait Parameters as Predictors of Lower-Limb Overuse Injuries in Military Training

The study objective was to determine whether spatiotemporal gait parameters could predict lower-limb overuse injuries in cohort of combat soldiers during first year of military service. Newly recruited infantry soldiers walked on a treadmill at a 15° incline with a fixed speed of 1.67 m/sec while wearing a standard military vest with a 10 kg load. Stride time variability, stride length variability, step length asymmetry, and the duration of the loading response phase of the gait cycle were measured. Injury data on 76 soldiers who did not report musculoskeletal complaints at initial screening were collected one year after recruitment. Multiple logistic regression analyses were conducted to determine the predictive effect of the gait parameters on lower-limb injuries. Twenty-four soldiers (31.6%) had overuse injuries during the first year after recruitment. Duration of the loading response was a significant predictor of general lower-limb injury (p<0.05), as well as of foot/ankle and knee injuries (p<0.05, p<0.01, resp.). A cutoff value of less than 12.15% for loading response duration predicted knee injuries with 83% sensitivity and 67% specificity. This study demonstrates the utility of spatiotemporal gait evaluation, a simple screening tool before military training, which may help to identify individuals at risk of lower-limb overuse injuries

Prasugrel versus Clopidogrel for Acute Coronary Syndromes without Revascularization

peer reviewedBACKGROUND: The effect of intensified platelet inhibition for patients with unstable angina or myocardial infarction without ST-segment elevation who do not undergo revascularization has not been delineated. METHODS: In this double-blind, randomized trial, in a primary analysis involving 7243 patients under the age of 75 years receiving aspirin, we evaluated up to 30 months of treatment with prasugrel (10 mg daily) versus clopidogrel (75 mg daily). In a secondary analysis involving 2083 patients 75 years of age or older, we evaluated 5 mg of prasugrel versus 75 mg of clopidogrel. RESULTS: At a median follow-up of 17 months, the primary end point of death from cardiovascular causes, myocardial infarction, or stroke among patients under the age of 75 years occurred in 13.9% of the prasugrel group and 16.0% of the clopidogrel group (hazard ratio in the prasugre

The Role of Hand-Held Cardiac Ultrasound in Patients with COVID-19

The role of point-of-care ultrasound (POCUS) in patient management has been established in recent years as an important tool. It is increasingly used by multiple medical disciplines in numerous clinical settings, for different applications and diagnostic purposes and in the guidance of procedures. The introduction of small-sized and inexpensive hand-held ultrasound devices (HUDs) has addressed some of the POCUS-related challenges and has thus extended POCUS’ applicability. HUD utilization is even more relevant in the COVID-19 setting given the operators’ infection risk, excessive workload concerns and general equipment contamination. This review focuses on the available technology, usefulness, feasibility and clinical applications of HUD for echocardiogram assessment in patients with COVID-19