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Choperena-Aguilar D, Ramirez-Santiago A, Díaz MCA. Measuring geospatial healthcare access to primary level facilities in Mexico: a GIS-based diagnosis analysis. CIENCIA & SAUDE COLETIVA 2021; 26:2471-2482. [PMID: 34133627 DOI: 10.1590/1413-81232021266.1.40872020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/07/2020] [Indexed: 11/22/2022] Open
Abstract
To describe a general overview of health services delivery in Mexico and geospatially analyze the current distribution and accessibility of Primary Health Care (PHC) facilities to contribute to new approaches to improve healthcare planning in Mexico. We performed a spatial analysis of official data to analyze current distances from health facilities to population, to determine the underserved areas of health services delivery in three selected states using a ranking of indicators. We estimated service area coverage of PHC facilities with road networks of three Mexican states (Chiapas, Guerrero, and Oaxaca). Our estimations provide an overview of spatial access to healthcare of the Mexican population in Mexico's three most impoverished states. We did not consider social security nor private providers. Geospatial access to health facilities is critical to achieving PHC and adequate coverage. Countries like Mexico must measure this to identify underserved areas with a lack of geospatial access to healthcare to solve it. This type of analysis provides critical information to help decision-makers decide where to build new health facilities to increase effective geospatial access to care and to achieve Universal Health Coverage.
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Affiliation(s)
- Daniel Choperena-Aguilar
- Facultad de Ciencias Políticas y Sociales. Circuito Mario de la Cueva S/N, Ciudad Universitaria. 04510 Alcaldía Coyoacán Ciudad de México México.
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Szarpak L, Rafique Z, Gasecka A, Jaguszewski MJ, Filipiak KJ. Tirofiban in emergency conditions: Systematic review. Am J Emerg Med 2021; 51:422-423. [PMID: 33824023 DOI: 10.1016/j.ajem.2021.03.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Lukasz Szarpak
- Institute of Outcomes Research, Maria Sklodowska-Curie Medical Academy in Warsaw, Warsaw, Poland; Maria Sklodowska-Curie Białystok Oncology Centre, Białystok, Poland; Polish Society of Disaster Medicine, Warsaw, Poland.
| | - Zubaid Rafique
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Aleksandra Gasecka
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Krzysztof J Filipiak
- 1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Feng Q, Li X, Qin X, Yu C, Jin Y, Qian X. PTEN inhibitor improves vascular remodeling and cardiac function after myocardial infarction through PI3k/Akt/VEGF signaling pathway. Mol Med 2020; 26:111. [PMID: 33213359 PMCID: PMC7678076 DOI: 10.1186/s10020-020-00241-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/11/2020] [Indexed: 01/14/2023] Open
Abstract
Background Myocardial infarction (MI) is the leading cause of death from cardiovascular disease (CVD). Currently, the efficacy for MI treatment remains unsatisfactory. Therefore, it is urgent to develop a novel therapeutic strategy. Methods Left anterior descending arteries (LAD) of mice were ligated to induce MI. Another set of mice were intravenously injected with PTEN inhibitor BPV (1 mg/kg) 1 h after LAD ligation and continued to receive BPV injection daily for the following 6 days. Mice were performed echocardiography 14 days after surgery. Results Mice in MI group displayed an increased expression of PTEN with impaired cardiac function, enhanced cardiomyocyte apoptosis and decreased angiogenesis. BPV treatment significantly improved cardiac function, with reduced cardiomyocyte apoptosis, promoted angiogenesis, and activated PI3K/Akt/vascular endothelial growth factor (VEGF) signaling pathway. Conclusion PTEN inhibitor BPV could effectively prevent myocardial infarction in mice, highlighting its potential as a candidate therapeutic drug.
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Affiliation(s)
- Qiuting Feng
- Department of Cardiovascular, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No.68, Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Xing Li
- Department of Cardiovascular, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No.68, Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Xian Qin
- Department of Cardiovascular, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No.68, Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Cheng Yu
- Department of Cardiovascular, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No.68, Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Yan Jin
- Department of Cardiovascular, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No.68, Zhongshan Road, Wuxi, 214002, Jiangsu, China
| | - Xiaojun Qian
- Department of Respiratory, the Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, No.68, Zhongshan Road, Wuxi, 214002, Jiangsu, China.
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Kumar V, Sharma AK, Kumar T, Nath RK. Large intracoronary thrombus and its management during primary PCI. Indian Heart J 2020; 72:508-516. [PMID: 33357638 PMCID: PMC7772595 DOI: 10.1016/j.ihj.2020.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/22/2020] [Accepted: 11/07/2020] [Indexed: 11/07/2022] Open
Abstract
Large intracoronary thrombus has been reported in significant number of patients with STEMI. Primary PCI is the current standard of care in patients of STEMI. Despite the availability of dual antiplatelets, GP IIb/IIIa inhibitor and effective anticoagulation regimens, large intracoronary thrombus remains one of the biggest challenge to interventional cardiologists during primary PCI. Large intracoronary thrombus may lead to distal embolization, no/slow reflow or embolization into a non-culprit vessel and is associated with adverse cardiovascular outcome. There is no ideal management strategy. We hereby discuss the current available methods/strategies to deal with large thrombus burden encountered during primary PCI, in the current manuscript.
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Affiliation(s)
- Vinod Kumar
- Department of Cardiology, Dr Ram Manohar Lohia Hospital & PGIMER, New Delhi, 110001, India.
| | - Ajay Kumar Sharma
- Department of Cardiology, Dr Ram Manohar Lohia Hospital & PGIMER, New Delhi, 110001, India.
| | - Tarun Kumar
- Department of Cardiology, Dr Ram Manohar Lohia Hospital & PGIMER, New Delhi, 110001, India.
| | - Ranjit Kumar Nath
- Department of Cardiology, Dr Ram Manohar Lohia Hospital & PGIMER, New Delhi, 110001, India.
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Lichota A, Szewczyk EM, Gwozdzinski K. Factors Affecting the Formation and Treatment of Thrombosis by Natural and Synthetic Compounds. Int J Mol Sci 2020; 21:E7975. [PMID: 33121005 PMCID: PMC7663413 DOI: 10.3390/ijms21217975] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 12/13/2022] Open
Abstract
Venous thromboembolism (VTE) refers to deep vein thrombosis (DVT), whose consequence may be a pulmonary embolism (PE). Thrombosis is associated with significant morbidity and mortality and is the third most common cardiovascular disease after myocardial infarction and stroke. DVT is associated with the formation of a blood clot in a deep vein in the body. Thrombosis promotes slowed blood flow, hypoxia, cell activation, and the associated release of many active substances involved in blood clot formation. All thrombi which adhere to endothelium consist of fibrin, platelets, and trapped red and white blood cells. In this review, we summarise the impact of various factors affecting haemostatic disorders leading to blood clot formation. The paper discusses the causes of thrombosis, the mechanism of blood clot formation, and factors such as hypoxia, the involvement of endothelial cells (ECs), and the activation of platelets and neutrophils along with the effects of bacteria and reactive oxygen species (ROS). Mechanisms related to the action of anticoagulants affecting coagulation factors including antiplatelet drugs have also been discussed. However, many aspects related to the pathogenesis of thrombosis still need to be clarified. A review of the drugs used to treat and prevent thrombosis and natural anticoagulants that occur in the plant world and are traditionally used in Far Eastern medicine has also been carried out.
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Affiliation(s)
- Anna Lichota
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Eligia M. Szewczyk
- Department of Pharmaceutical Microbiology and Microbiological Diagnostic, Faculty of Pharmacy, Medical University of Lodz, 90-235 Lodz, Poland; (A.L.); (E.M.S.)
| | - Krzysztof Gwozdzinski
- Department of Molecular Biophysics, Faculty of Biology and Environmental Protection, University of Lodz, 90-236 Lodz, Poland
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Wang H, Feng M. Influences of different dose of tirofiban for acute ST elevation myocardial infarction patients underwent percutaneous coronary intervention. Medicine (Baltimore) 2020; 99:e20402. [PMID: 32501985 PMCID: PMC7306376 DOI: 10.1097/md.0000000000020402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tirofiban is widely used in patients with acute ST elevation myocardial infarction (STEMI) underwent percutaneous coronary intervention (PCI). This drug can efficiently improve myocardial perfusion and cardiac function, but its dose still remains controversial. We here investigated the effects of different dose of tirofiban on myocardial reperfusion and heart function in patients with STEMI. A total of 312 STEMI patients who underwent PCI in our hospital from March 2017 to March 2018 were enrolled and randomly divided into control group (75 cases, 0 μg/kg), low-dose group (79 cases, 5 μg/kg), medium-dose group (81 cases, 10 μg/kg) and high-dose group (77 cases, 20 μg/kg). The infarction-targeted artery flow grade evaluated by thrombolysis in myocardial infarction (TIMI), corrected TIMI frame count (CTFC) and sum-ST-segment resolution were recorded. At Day 7 and Day 30 after PCI, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, left ventricular end systolic diameter, major adverse cardiovascular events and the hemorrhage and thrombocytopenia were also evaluated. After PCI, the rate of TIMI grade 3, CTFC and incidence of sum-ST-segment resolution > 50% of high-dose group were significantly higher than those of control group, low-dose group and medium-dose group (P < .05), and the CTFC of medium -dose group were significantly higher than that of control group, low-dose group (P < .05). Moreover, the LVEF, left ventricular end diastolic diameter and left ventricular end systolic diameter of high-dose group were significantly improved than those of other groups, and the LVEF of medium-dose group was significantly superior to that of low-dose group (P < .05). However, the incidence of major adverse cardiac events in high-dose group was significantly decreased, while the hemorrhage and incidence of thrombocytopenia of high-dose group were significantly higher than those of other 3 groups (P < .05). The tirofiban can effectively alleviate the myocardial ischemia-reperfusion injury and promote the recovery of cardiac function in STEMI patients underwent PCI. Although the high-dose can enhance the clinical effects, it also increased the hemorrhagic risk. Therefore, the rational dosage application of tirofiban become much indispensable in view of patient's conditions and hemorrhagic risk, and a medium dose of 10 μg/kg may be appropriate for patients without high hemorrhagic risk.
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Affiliation(s)
- Haixia Wang
- Department Pharmacy, the Second Clinical Hospital of Shanxi Medical University, Taiyuan, Shanxi
| | - Meiqin Feng
- AstraZeneca (Wuxi) trading co. LTD, Wuxi, Jiangsu, China
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Cao B, Qu F, Liu X, Gao C, Fu Q, Jiang C, Wei P, Ma Q. Short-term efficacy of ticagrelor in acute ST-segment elevation myocardial infarction patients undergoing an emergency percutaneous coronary intervention. Aging (Albany NY) 2019; 11:8925-8936. [PMID: 31665124 PMCID: PMC6834424 DOI: 10.18632/aging.102353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/27/2019] [Indexed: 12/12/2022]
Abstract
In total, 97 acute ST-segment elevation myocardial infarction (STEMI) patients who received an emergency percutaneous coronary intervention (PCI) were enrolled and divided into a ticagrelor group and a clopidogrel group. Thrombolysis in myocardial infarction (TIMI) blood flow and the corrected TIMI frame count (CTFC) were used to assess the blood perfusion of culprit vessels. Thromboelastography (TEG) was used to evaluate the antiplatelet effect of drugs. The results showed that the incidence of TIMI grade III blood flow in the ticagrelor group was significantly higher than that in the clopidogrel group. The CTFC in the anterior descending, circumflex, and right coronary arteries was statistically significantly lower in the ticagrelor group as compared with that in the clopidogrel group. At 2 h and 7 d postdrug treatment, the adenosine diphosphate-induced platelet inhibition rate (ADP%) in the ticagrelor group increased significantly as compared with that in the clopidogrel group, and the platelet aggregation rate of the ADP pathway (MAADP) decreased significantly in the ticagrelor group versus that in the clopidogrel group. In conclusion, ticagrelor significantly improved TIMI blood flow and had a better antiplatelet effect than clopidogrel in STEMI patients undergoing an emergency PCI.
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Affiliation(s)
- Bangming Cao
- Department of Cardiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong, China
| | - Fuzheng Qu
- Department of Cardiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong, China
| | - Xianliang Liu
- Department of Cardiology, Yantai Affiliated Hospital of Binzhou Medical University, Yantai 264100, Shandong, China
| | - Changzheng Gao
- Department of Cardiology, Affiliated Hospital of Jiangnan University, Wuxi 214062, China
| | - Qiang Fu
- Department of Cardiology, Xuzhou Central Hospital, The Affiliated Hospital of Southeast University, Xuzhou 221009, Jiangsu, China
| | - Chunying Jiang
- Department of Cardiology, Xuzhou Central Hospital, The Affiliated Hospital of Southeast University, Xuzhou 221009, Jiangsu, China
| | - Peng Wei
- Department of Cardiology, Xuzhou Central Hospital, The Affiliated Hospital of Southeast University, Xuzhou 221009, Jiangsu, China.,XuZhou Clinical School of Xuzhou Medical University, Xuzhou 221009, Jiangsu, China
| | - Qianqian Ma
- Department of Rheumatology, Xuzhou Central Hospital, The Affiliated Hospital of Southeast University, Xuzhou 221009, Jiangsu, China
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de Winter RJ. Anticoagulation and antiplatelet therapy in acute coronary syndromes: choosing between the Scylla of bleeding and the Charybdis of ischaemic events. Neth Heart J 2018; 26:287-288. [PMID: 29797236 PMCID: PMC5968008 DOI: 10.1007/s12471-018-1121-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- R J de Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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