Evolution and Medicine. Dr. Peter J. Lin Director Primary Care Initiatives Canadian Heart Research Centre

Size: px

Start display at page:

Download "Evolution and Medicine. Dr. Peter J. Lin Director Primary Care Initiatives Canadian Heart Research Centre"

Alexander Jordan
6 years ago
Views:

1 Evolution and Medicine Dr. Peter J. Lin Director Primary Care Initiatives Canadian Heart Research Centre

2 Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form or by any means graphic, electronic, or mechanical, including photocopying, recording, or information storage and retrieval systems without prior written permission of Sea Courses Inc. except where permitted by law. Sea Courses is not responsible for any speaker or participant s statements, materials, acts or omissions.

3 Evolution

7 Platelet Red blood cell Fibrin

8 Fast Moving Platelets Sticks First Carotid Coronary PAD

12 BARE METAL (BMS) Drug Eluding Stent (DES)

13 Thromboxane A2 ASA ADP Clopidogrel

14 ASA + Clopidogrel

16 Slow moving Coag First DVT AFib

17 Clotting Cascade

22 Warfarin (Wisconsin Alumni Research Foundation) Warfarin is the most widely used coumarin derivative Originally found in sweet clover Sweet clover

26 Benefit : Stroke Prevention in Atrial Fibrillation INR below 2.0 results in a higher risk of stroke Hylek EM, et al. NEJM 1996;335:

27 Risk of Intracranial Hemorrhage in Outpatients Adapted from: Hylek EM, Singer DE, Ann Int Med 1994;120: Hylek, et al, studied the risk of intracranial hemorrhage in outpatients treated with warfarin. They determined that an intensity of anticoagulation expressed as a prothrombin time ratio (PTR) above 2.0 (roughly corresponding to an INR of 3.7 to 4.3) resulted in an increase in the risk of bleeding.

28 Adjusted odds ratios for ischemic stroke and intracranial bleeding in relation to intensity of anticoagulation INR 2-3 Warfarin Reduce Stroke Risk in AF 64% Fuster, V. et al. Circulation 2006;114:e257-e354 Copyright 2006 American Heart Association

29 Warfarin mechanism of action Vitamin K VII IX X II Synthesis of functional coagulation factors

30 Warfarin mechanism of action Vitamin K VII IX X II Synthesis of non-functional coagulation factors Warfarin

31 Warfarin mechanism of action

g: Cauliflower Green cabbage Seaweed (1350) Broccoli (270) Green

32 Food interactions Green leafy vegetables counteract effects of warfarin Vitamin K Foods with high amounts of vitamin K, e.g: Cauliflower Green cabbage Seaweed (1350) Broccoli (270) Green tea Turnip greens Soybean oil (often used to fry foods in restaurants) Raw spinach

34 Clotting Cascade

35 Clotting Cascade Factor Xa inhibitor Direct Thrombin Inhibitor (DTI)

37 Low B12 Low muscle Mass Low Vitamin D/Ca

40 Vibrating plate

41 We came out of water

42 The renin--angiotensin-- aldosterone system (RAAS) Angiotensinogen Angiotensin I Angiotensin II AT 1 AT 2 ACEI: Angiotensin--converting enzyme inhibitor ARB: Angiotensin II receptor blocker

43 Venom of the Brazilian Viper

Angiotensin II Bradykinin degradation products AT 1 AT 2

44 The renin--angiotensin-- aldosterone system (RAAS) Angiotensinogen Renin Bradykinin Angiotensin I ACE ARB Angiotensin II Bradykinin degradation products AT 1 AT 2 ACEI: Angiotensin--converting enzyme inhibitor ARB: Angiotensin II receptor blocker

45 Pressure Blood loss Adrenalin RAAS Salt retention

46 % Improving Survival in CHF 1 Year Mortality SOLVD-T (1991) 20 RRR 23% diuretic digoxin diuretic digoxin ACE-I

47 % Improving Survival in CHF 1 Year Mortality 20 SOLVD-T (1991) RRR 23% CIBIS-2 (1999) RRR 33% diuretic diuretic diuretic diuretic digoxin digoxin digoxin digoxin ACE-I ACE-I ACE-I blocker

48 % Improving Survival in CHF 1 Year Mortality 20 SOLVD-T (1991) RRR 23% CIBIS-2 (1999) RRR 33% CHARM-Added (2003) ( blocker subgroup) RRR 30% diuretic diuretic diuretic diuretic diuretic diuretic digoxin digoxin digoxin digoxin digoxin digoxin ACE-I ACE-I ACE-I ACE-I ACE-I blocker blocker blocker ARB

50 % incidence of stroke BP (mmhg) Effect of candesartan cilexetil on BP and stroke in SP-SHR* Time (weeks) SP-SHR* control candesartan cilexetil 0.1 mg/kg candesartan cilexetil 10 mg/kg *SP-SHR = stroke-prone spontaneously hypertensive rats Inada Y, et al. Clin Exper Hypertens 1997;19:

53 Missing Cells

54 Cytokine Storm

55 Seasonal Affective Disorder

57 Hibernation

60 We asked women about MEN.....

62 Quadruple ByPass Burger

63 The Gut Microbiota - Complex community of microbes estimated to contain 200 trillion cells - > 1000 diverse microbial species - 10 x the number of human cells in our body - Gut microbiome is 150 x larger than the human genome

64 Gut Microbiota

65 Gut Microbiota Colonization of the gastrointestinal tract begins immediately after birth Initial bacterial colonization (normal) starts from a Germ free intrauterine environment and is populated through maternal vaginal/fecal flora and oral feeding (breast milk vs formula) Complete adult colonization : by 3 yrs of life

66 Factors affecting Gut Microbiome

67 Gut Microbiota - IBD

a protease found in S. epidermidis, but if left to grow out of control, S. aureus can become pathogenic and cause infection http://commons.wikimedia.

68 Nose The interior lining of the nose contains mucous secreting glands. A wide variety of microbes are normally found there. Here s a few: Staphylococcus epidermidis bacteria forms a biofilm that coats the mucosal lining Staphylococcus aureus bacteria is fine when kept under control by a protease found in S. epidermidis, but if left to grow out of control, S. aureus can become pathogenic and cause infection Summer 2012 Workshop in Biology and Multimedia for High School Teachers

Use of Antimicrobial Products How many do we really need?

that can barely survive these treatments to grow and become more

wikimedia.org/wiki/file:afwasmiddel.jpg http://commons.wikimedia.org/wiki/file:tissue.

jpg http://commons.wikimedia.org/wiki/file:toothpaste.

69 Use of Antimicrobial Products How many do we really need? But do we need some natural exposure to germs to keep our normal flora around? Products kill germs to reduce infection Will this allow superbugs that can barely survive these treatments to grow and become more prevalent causing problems for the future? Summer 2012 Workshop in Biology and Multimedia for High School Teachers

70 This was you!

Prepared by Pfizer-BMS alliance in response to an unsolicited request Not for further distribution

Prepared by Pfizer-BMS alliance in response to an unsolicited request Not for further distribution AF review Petr Polasek Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document