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Biomedical subjects

Manesh R Patel

Publications and source records attributed to Manesh R Patel.

34 records · Page 2Linked to original sources
PubMed2005

Cardiac imaging impaired by a silicone breast implant.

The authors report a case of a left-sided silicone breast implant interfering with nuclear imaging of the myocardium. Cardiac SPECT imaging of a woman documented widespread infarct in the anterolateral, inferior, and posterolateral walls, as well as mixed ischemia/infarct in the anterior wall. Subsequent cardiac MRI revealed just anterolateral and inferolateral infarct. The anterior wall was completely viable. Also apparent on the MR images was a left breast implant overlying the anterior myocardial wall. This case of a left-sided silicone breast implant interfering with nuclear imaging of the myocardium highlights the importance of understanding the potential interference from silicone breast implants.

Aged↗
PubMed2005

Pexelizumab: a novel therapy for myocardial ischemia-reperfusion.

Despite significant advances in the study of myocardial reperfusion, patients with epicardial coronary reperfusion still have adverse clinical outcomes. This is in part due to an inflammatory reaction in the injured tissue. Inflamed myocardial tissue after ischemia and reperfusion releases several cytokines and toxic metabolites that lead to reperfusion injury and cellular apoptosis. Complement activation appears to mediate myocardial damage through both these pathways. Recently, pexelizumab, a novel C5 complement monoclonal antibody fragment, has been developed to prevent the complement-mediated myocardial damage from myocardial ischemia and reperfusion. In animal studies, pexelizumab decreased the amount of myocardial damage with ischemia and reperfusion. Pexelizumab has been studied in phase II and phase III clinical trials involving patients undergoing coronary artery bypass grafting and in patients with acute myocardial infarction as an adjunct to reperfusion therapy. Two large clinical trials are currently underway in coronary artery bypass surgery and acute myocardial infarction patients undergoing primary percutaneous revascularization. This review will cover the pathophysiological role of complement activation with regards to ischemia-reperfusion injury, the novel compound pexelizumab, and both the preclinical and clinical data for pexelizumab use in coronary artery bypass surgery and acute myocardial infarction patients.

Antibodies, Monoclonal↗
PubMed2004

State-mandated continuing medical education and the use of proven therapies in patients with an acute myocardial infarction.

OBJECTIVES: The purpose of this study was to determine whether state-mandated continuing medical education (CME) requirements affect the use of evidence-based therapies and outcomes in patients with acute myocardial infarction (AMI). BACKGROUND: The Institute of Medicine recommends that educational programs demonstrate their effect through process and outcome measures. METHODS: We analyzed 134,609 patients according to whether or not CME was mandated in the state of physician practice. A hierarchical multivariable model was developed that controlled for state, hospital, physician, and patient level characteristics to determine the association between state CME requirements and the use of evidence-based therapies. Primary outcome measures were admission aspirin use and reperfusion therapy, and discharge aspirin and beta-blocker prescription. Thirty-day and one-year mortality were secondary outcome measures. RESULTS: States with and without CME requirements had similar rates of aspirin use at admission and discharge (79.9% vs. 79.4% and 72.5% vs. 72.5%, respectively) and beta-blocker prescription at discharge (53.6% vs. 55.3%). The rate of reperfusion therapy at admission was significantly higher in states requiring CME (53.1%) compared with states without CME (47.9%) (p < 0.0001). After adjustment, patients admitted in CME-requiring states were significantly more likely to receive reperfusion therapy, mainly owing to "patented" thrombolytic therapy (odds ratio 1.15; p = 0.016). There was no association between CME requirements and one-year mortality. CONCLUSIONS: State-mandated CME had little association with AMI care or outcome, other than an increased use of patented thrombolytic therapy. Further research is needed to maximize the measurable effect of CME on the use of proven therapies irrespective of whether patented or generic medications are involved.

Adrenergic beta-Antagonists↗
PubMed2004

Hand-held echocardiographic examination of patients with symptoms of acute coronary syndromes in the emergency department: the 30-day outcome associated with normal left ventricular wall motion.

BACKGROUND: Acute chest pain is a common complaint for patients presenting to emergency departments. Electrocardiography (ECG) results and biochemical markers have strong positive predictive value, but an equally available, inexpensive, and non-invasive test with strong negative predictive value is needed. Hand-held echocardiography (HHE) might serve this purpose. The objective of this study was to test the hypothesis that in patients with symptoms suggestive of acute coronary syndrome, non-diagnostic ECG, and normal biochemical markers, HHE-documented normal left ventricular function is not associated with a clinical diagnosis of acute myocardial ischemia or infarction, nor an ischemic event within 30 days of follow-up. METHODS: Assessment of left ventricular systolic function was performed in 150 patients with the HHE device. The incidences of the clinical end points of death, myocardial infarction, and ischemia were determined during the 30-day follow-up period. Data analysis included evaluation of specificity, sensitivity, and positive and negative predictive values. RESULTS: The incidence of acute myocardial infarction was 2.5% (2/78) in the normal HHE group and 20% (6/30) in the abnormal HHE group (P = .002). The incidence of either acute myocardial infarction or ischemia was 7.6% (6/78) in the normal HHE group and 14.6% (6/30) in the abnormal HHE group (P = .11). The negative predictive value of HHE was 91%. CONCLUSIONS: These results suggest a possible role for HHE in providing additional diagnostic and prognostic information in the examination of patients with a low likelihood of myocardial ischemia or infarction and symptoms suggestive of acute coronary syndrome.

Angina, Unstable↗
PubMed2002

Pharmacological treatment of elderly patients with acute coronary syndromes without persistent ST segment elevation.

Evidence-based management of acute coronary syndromes (ACS) without persistent ST segment elevation involves a rational, stepwise approach to the selection of therapies with potential benefit for elderly patients. Specifically, in elderly patients with ACS without persistent ST segment elevation, therapy should be administered based on the likelihood of unstable angina or non-ST elevation myocardial infarction being present and the risks and benefits of each individual therapy. All elderly patients with suspected ACS should receive anti-ischaemic therapy consisting of beta-blockers and nitrates, and antiplatelet therapy with aspirin unless clear contraindications exist. For patients with a moderate likelihood of ACS being present, defined as prior coronary disease or recurrent pain despite the use of anti-ischaemic therapies, unfractionated heparin or enoxaparin should be added to aspirin for more intense anticoagulation. In patients with high-risk clinical features, defined as ischaemic electrocardiographic changes and positive cardiac markers such as troponins, therapy with clopidogrel or glycoprotein IIb/IIIa inhibitors should be considered in addition to aspirin and heparin. Furthermore, high-risk patients should be managed with an early invasive strategy that includes prompt cardiac catheterisation within 24 to 48 hours and appropriate use of revascularisation as determined by the findings of the catheterisation. An evidence-based approach to the treatment of elderly patients with ACS without persistent ST segment elevation will help to improve the use of beneficial therapies and interventions that are recommended by current practice guidelines.

Acute Disease↗