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Archive for February, 2022

A path-breaking research is coming up from Jhon Paulson school of engineering, Harvard.

It is all about a tiny lab-made bio-hybrid fish that is mechanically engineered with cardiac stem cells. It can generate enough mechanical force that can transform into a biological organ (or assistance)to the heart. Early lab experiments are exciting. We will soon see a stem cell-enriched bio-fish that will dance to the tunes of the cardiac cycle.

(See the video below) 

Final message

Will it become real? or a just a grandeur thought?

We have just done Xeno heart transplantation and the mechanistic possibility of a fully functional total artificial heart is always there. Now, let us look forward to this bio-hybrid organism*  that will break the ultimate barrier in the biomechanical support for failing hearts.

Reference

*Biohybrid organisms, are devices containing biological components.

KEEL YONG LEE ,SUNG-JIN PARK , DAVID G. MATTHEWS et al  An autonomously swimming biohybrid fish designed with human cardiac biophysics SCIENCE • 10 Feb 2022 • Vol 375Issue 6581 • pp. 639-647 

 

 

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Spanish flu battered our planet in 1918. How did we overcome that? (Did we really do anything ?) About fifty million lives were lost. At that time, we didn’t even know, cells had a fully functional nucleus, forget about the DNA & RNAs. Spanish flu was tackled only with our primitive understanding of microbes, cells, and immunity. Masks and common sense were the weapons.

Now, one century later the next pandemic is In. It is an advanced medical world out there.100 Noble prizes have been won for medicine since then. We do the whole-genome map of not only human cellular DNA but also for the viral particles.

A recent paper on this topic. 

How effective is modern science in controlling the current pandemic ? 

We did wonders saving thousand of life with the help of critical care units. Some precious (elite)lives were saved by ECMO, Even lung transplants saved a few lives. We mastered the art of creating RNA interrupting biologicals. Even as we reap the benefits of stunning discoveries of science, we have equally misbehaved with it and largely undid whatever we should have achieved. We lost more lives due to a lack of simple measures. excess of futile measures, manic dependence on diagnostics.

Where did we collectively lose our sense and decide to chase multiple variants with a full genome mapping on a global scale? Who decided to call the viral variants attractive names and give larger-than-life images to amplify the panic? Even after getting a final vaccine solution, why the World is denied sharing the benefits in an equitable manner. 

There is no meaningful evidence that extensive  RTPCR,  antigen, or antibody testing has impacted this pandemic in a significant way. Testing is meant before the onset of community spread or if there is a specific treatment for the disease. How do we explain countries with maximum testing, maximum vaccine coverage, maximum booster dose had a maximum recurrence and damage?

Final message 

Science is sacred & Godly if only, its creator’s Intentions are pure. The risk-benefit ratio of modern science, (Rather, the way we understand and assimilate it ) in tackling this pandemic is threatening to tilt in an adverse fashion. Definitely, WHO must realize this. Let us go back and read the foundational lessons of clinical epidemiology and pandemic handling. I felt awkward to write this post but truths are rarely sweet.

This article  by Dr. Anand Krishnan, Professor of  community medicine, AIIMS New Delhi, has some enlightening content

https://timesofindia.indiatimes.com/india/whys-pandemic-policymaking-still-short-of-science/articleshow/88650912.cms

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“We have a 24/7 cath lab with an open door policy. Our cardiologist arrives at 15 minutes’ notice. Door to balloon time is less than 60-90 minutes”, 

“Great, so, you can always offer a successful treatment for STEMI”

“No, that we can never guarantee.” 

 “Oh, It Is not the answer, I  expected”

“I agree, it sounds disappointing, but. truths are less pleasing. What I am trying to say is, there are a number of factors other than the availability of a grand cath lab and agile and effortless hands, that try to reperfuse the myocardium in distress.  I agree, we do save lives occasionally in a dramatic fashion. Recently we resuscitated an almost dead man with CPR and ECMO-guided PCI. But, most times it turns out to be just a customary ritual that takes us to the legal and therapeutic  endpoint* of STEMI management”

*Both salvage & non-salvage

“I didn’t get you, Can you explain further?

See this curve and try to understand it yourself. (I would say, this is the ultimate curve to understand in the entire field of coronary care)

Can you guess what will be the outcome for C to B, or B to A ?  In the real world, a substantial number of interventions take place at an Invisible point E beyond A  Source: Gersh BJ, Stone GW, White HD, Holmes DR Jr. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future? JAMA. 2005;293:979–86

Slippery slopes and edgy Interventions

At what point the patient lands up in the curve & at what point the interventional cardiologist intervenes (or does not intervene) matters the most. 

The gaps between benefit and harm can change in a few strokes of time. The reperfusion tamasha can get more curious if we realize both the slope of the curve & its absolute position are dynamic. It can shift to the right or left with reference to the patient’s Initial medications, MVo2 confounders, the quantum of collateral circulation, myocardial hypoxia threshold,  previous ischemic episodes, conditioning, etc. So, basically, we are reacting to events and trying to rush up things. Don’t worry about all this. Cardiologists have every expertise and equipment to tackle untoward events.

STEMI is not always myocardium under fire

Finally, and most importantly STEMI, though a cardiac emergency. all should not be equated with the house(myocardium) on fire analogy. It can also be a spontaneously aborting, settling, or evolving, self-extinguished controlled fire, and the myocardium may take it easy. All that it requires is some deep ischemic slumber. Don’t try to poke it with all our violent hardware at one go in the name of salvaging. What is required is proper CCU care to take care of potential arrhythmia, angina, or failure. One may create more damage if trying to dowse non-existing flames furiously, which expresses in the form of reperfusion Injury and no-reflow to the myocardium. (Which might have reperfused at leisure without experiencing the injury.)

It is worth pondering over this question.

Why does even an apparently well-timed primary PCI of IRA leave behind a significant LV dysfunction or even a  scar? This is a clear case of “successful PCI failed reperfusion syndrome”. It is better cardiology community defines successful primary PCI with reference to predischarge  LV function, not on the IRA patency and mystery endpoint called TIMI 3 flow.

Final message

Cath lab doors that are open 24/7,  with experienced cardiologists may matter little if we are double-blinded against multiple scientific and non-scientific factors that are visible as well as invisible. 

Counterpoint

How good is late PCI? Are you not aware benefits of the open artery hypothesis?

You need to learn a lot man, before posting such posts.

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