Impact of paramedic education on door-to-balloon times and appropriate use of the primary PCI pathway in ST-elevation myocardial infarction.

Objective: Evidence supports improved outcomes and reduced mortality with rapid reperfusion through primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). UK national audit data (Myocardial Ischaemia National Audit Project [MINAP]) demonstrates minor improvements in door-to-balloon times (DTB) of <90 min but increasing call-to-balloon times (CTB). We evaluate the effect of a regional Cardiologist delivered paramedic education programme (PEP) on DTB times and appropriate use of the PPCI pathway.

COVID-19 disease identification from chest CT images using empirical wavelet transformation and transfer learning.

In the current scenario, novel coronavirus disease (COVID-19) spread is increasing day-by-day. It is very important to control and cure this disease. Reverse transcription-polymerase chain reaction (RT-PCR), chest computerized tomography (CT) imaging options are available as a significantly useful and more truthful tool to classify COVID-19 within the epidemic region.

Human-Computer Agreement of Electrocardiogram Interpretation for Patients Referred to and Declined for Primary Percutaneous Coronary Intervention: Retrospective Data Analysis Study.

Background: When a patient is suspected of having an acute myocardial infarction, they are accepted or declined for primary percutaneous coronary intervention partly based on clinical assessment of their 12-lead electrocardiogram (ECG) and ST-elevation myocardial infarction criteria.

Objective: We retrospectively determined the agreement rate between human (specialists called activator nurses) and computer interpretations of ECGs of patients who were declined for primary percutaneous coronary intervention.

Methods: Various features of patients who were referred for primary percutaneous coronary intervention were analyzed.

Percutaneous coronary intervention to left anterior descending artery/right coronary artery bifurcation: this is not a typo! A case report.

Background: Anomalous origin of the right coronary artery (RCA) is a rare congenital anomaly. A single coronary artery arising from the left sinus of Valsalva, with the RCA originating from the left anterior descending artery (LAD), is extremely rare. We report the case of an anomalous origin of the RCA from the mid LAD with a significant bifurcation lesion, in the setting of an acute coronary syndrome, endangering both the RCA and LAD territories.

Antiplatelet agents in uncertain clinical scenarios-a bleeding nightmare.

Despite over 40 years since the first percutaneous coronary intervention (PCI) was performed, the optimal dual antiplatelet therapy (DAPT) regime poses a significant challenge for clinicians, especially in certain scenarios. DAPT is the standard of care in PCI following an acute coronary syndrome (ACS) or for elective patients with obstructive coronary artery disease (CAD). There remains significant uncertainty regarding DAPT in patients at high risk of bleeding, such as the elderly and patients requiring anticoagulation.

Characteristics and outcomes of patients undergoing percutaneous coronary intervention within 1 year of coronary artery bypass graft surgery.

Objectives: The aim of this study was to examine the clinical and procedural outcomes of patients undergoing percutaneous coronary intervention (PCI) within 1 year of coronary artery bypass graft surgery (CABG).

Background: CABG is the preferred revascularization strategy for patients with complex coronary artery disease due to a lower rate of repeat revascularization. Despite advances in surgical technique and medical therapy, >5% of patients require repeat revascularization within 1 year of CABG.

Efficacy and Safety of the GuideLiner Mother-in-Child Guide Catheter Extension in Percutaneous Coronary Intervention.

Background: Percutaneous coronary intervention (PCI) procedures are increasingly performed on complex tortuous and heavily calcified coronary lesions. The GuideLiner® catheter (Vascular Solutions, Inc. Minneapolis, MN) is a rapid exchange guide catheter extension system.

Myocardial blush and microvascular reperfusion following manual thrombectomy during percutaneous coronary intervention for ST elevation myocardial infarction: insights from the TOTAL trial.

Aims: Thrombectomy during primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) has been thought to be an effective therapy to prevent distal embolization and improve microvascular perfusion. The TOTAL trial (N = 10 732), a randomized trial of routine manual thrombectomy vs. PCI alone in STEMI, showed no difference in the primary efficacy outcome.

Efficacy of RADPAD® protection drape in reducing radiation exposure to the primary operator during Transcatheter Aortic Valve Implantation (TAVI).

Background: The efficacy of RADPAD® (a sterile, lead-free drape) has been demonstrated to reduce the scatter radiation to the primary operator during fluoroscopic procedures. However, the use of the RADPAD® during TAVI procedures has not been studied. Transcatheter aortic valve implantation (TAVI) is now an established treatment for patients with symptomatic severe aortic stenosis who are deemed inoperable or at high risk for conventional surgical aortic valve replacement (AVR).

Use of fetal echocardiography for characterization of fetal cardiac structure in women with normal pregnancies and gestational diabetes mellitus.

Objectives: To assess fetal cardiac structure and function and to evaluate the efficacy of routine fetal echocardiography for detection of fetal cardiac abnormalities in women with normal pregnancies and those with gestational diabetes mellitus.

Methods: In this prospective study, we studied fetal cardiac structure and function in 294 uncomplicated singleton pregnancies and 302 pregnancies complicated by gestational diabetes. Fetal echocardiography (2-dimensional sonography and pulsed wave Doppler imaging) was used to assess functional parameters and to detect any cardiac structural abnormality.

Aspergillus infection in pulmonary cavitating lesions with right atrial myxoma.

Cardiac myxomas are rare primary tumors with varied clinical presentations that may pose a diagnostic challenge. Here, we describe the case of a 21-year-old man with multiple cavitating lung lesions with aspergillosis and underlying right atrial myxoma, who presented with hemoptysis and weight loss. He was successfully treated with right atrial myxoma resection and antifungal agents, with no recurrence or complications after one year of follow-up.

Double patch repair for a double ventricular rupture.

We describe the case of a 77-year-old woman with recent acute myocardial infarction complicated by ventricular septal defect and formation of a pseudoaneurysm, which were successfully treated surgically with a double patch repair. This case highlights the importance of early recognition of this serious complication, using clinical and echocardiographic examinations, and the various challenges encountered in surgical repair.

Reducing radiation exposure during transcatheter aortic valve implantation (TAVI).

Objectives: To establish radiation dose and determine the effect of changes in cine-fluoroscopic image acquisition settings on radiation dose and procedural outcomes in consecutive patients undergoing transcatheter aortic valve implantation (TAVI).

Background: The radiation dose during TAVI has not been extensively investigated. Methods to keep doses as low as reasonably achievable should be established for the safety of both the patient and the interventional team involved.

A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery.

Objectives: To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS.

Background: There is no prospective data examining the need, feasibility, and safety of over-expansion of current generation DES beyond nominal diameter.

Methods: Patients with flow-limiting coronary atheroma requiring IVUS assessment of the LMS were recruited.

Are accelerated infliximab infusions safe in patients with inflammatory bowel disease?

Background: Infliximab is a monoclonal antibody used in the treatment of inflammatory bowel disease (IBD). The manufacturer-recommended administration is over 2 hours followed by 2 hours of patient observation. The data relating to adverse outcomes in patients receiving accelerated infusions for IBD are limited.

Thomas Willis of the "circle of Willis".

Thomas Willis is best known for the circle of Willis. The life story of this 17th- century medical genius, who remains an inspiration for all neuroscientists 300 years later, is summarized in this article. We outline his academic achievements, including his description of the famous basal arterial circle, and we attempt to obtain insight into his visionary thought process through this historical review.

An overview of head lice infestation in neurosurgical patients.

Head lice or pediculosis is recognized as an increasing problem in medical practice (Down et al, 1999). Secondary bacterial infections can occur in patients with infestation. In neurosurgical patients, head lice infestation may be a potential risk factor for peri-operative complications.

Evaluation of a fiberoptic-based system for measurement of optical properties in highly attenuating turbid media.

Background: Accurate measurements of the optical properties of biological tissue in the ultraviolet A and short visible wavelengths are needed to achieve a quantitative understanding of novel optical diagnostic devices. Currently, there is minimal information on optical property measurement approaches that are appropriate for in vivo measurements in highly absorbing and scattering tissues. We describe a novel fiberoptic-based reflectance system for measurement of optical properties in highly attenuating turbid media and provide an extensive in vitro evaluation of its accuracy.