8 Burst results for "Pattro"
"pattro" Discussed on Cardionerds
"Louis University. She has since been at Johns Hopkins for Residency Cardiology Fellowship and advanced heart failure fellowship. Her early research search pursuits were in heart failure with preserved ejection fraction from this and former advanced heart failure training she developed a strong clinical interest and research interest in in the early diagnosis and treatment of cardiac amyloidosis which is why she makes such a perfect person to continue our discussion on amyloid. Absolutely absolutely totally Great Jovan has been a mentor to me. She's been a year ahead of me in residency and then fellowship and has been guided me along the way we used to share clinic together and when she left to pursue her heart streams in advanced heart failure. I it was a real loss so I used to send her snap chats every clinic day which she ignored and threw it into the trash so jovan thanks so much for joining. Think for having so. We're real excited to have you. We are going to get started with in some questions that we are dying to get your take on first. We'd like to talk a little bit more about heart failure therapy in cardiac amyloid so so we wanted to get your opinion from a practical standpoint on the management of these patients in terms of medical therapy that traditional medical Michael therapy that we use for cardiomyopathy patients. What are sort of the do's and don'ts that are specific to cardiac amyloid yeah? I think that's great to discuss. fess up front with cardiac amyloidosis actually like many aspects of heart failure understanding the human dynamic. Derangement is probably the best way to understand why we do do. And why we don't treat cardiac amyloid with certain quote Unquote Standard Heart. Failure Therapies Cardiac amyloidosis as we may now as an infiltrative restrictive of cardiomyopathy the amyloid fiber deposition leads to buy ventricular hypertrophy and the LV is generally thick non dilated needed and non defensible. So this really does limit the heart's ability to various stroke volume and there is actually kind of a fixed stroke volume advanced restrictive disease so even though the major symptom manifestation of Obama light is congestion there is also this propensity for hypo dialing. HEP Of Alenia. Nia with over dire recess and importantly the hypothermia from diary says may manifest dizziness lightheadedness precinct. syncope does often to need to be distinguished from dizziness. For example from neuropathy interesting over that that can be seen in. What as one of the manifestations of amyloid correct performer apathy is mean another major manifestation of teacher Emelin so the humidity Amex are also? You know why eighth Feb is very sensitive in credit cardiac amyloid. There is a loss of atrial kick or reduction in stroke volume and this could be really consequential and then lastly there's also a heart rate dependency to to maintain your cardiac output and a need to avoid certain drugs. which will talk about a little bit like Betablockers that may lower your heart rate depending on the patient most patients chance do develop congestion though an require? Initiation of loop diuretics on which is a mainstay of therapy and often times pretty high doses are needed to achieve symptom relief. As I mentioned the caveat with diabetic titrate has just to be on the lookout for over diary system. hypoglycemia symptoms that patients will report court. If they are experiencing this are lightheadedness dizziness precinct. Piece syncope they may have an AK I in their labs or have a lower them baseline blood pressure. There is in this case. What may be tricky distinguishing the symptoms of lightheadedness and dizziness from another common carmody amyloid patients? which is autonomic neuropathy? With the which can also manifest as lightheadedness and dizziness precinct opinion syncope Visayas diabetics in particular Matola zone is sometimes needed as a booster and manifestation has is good enough renal function and especially with hypoglycemia. I do try to add ons for locked him. I think one important lesson I've learned just owing to the restrictive nature of the Aziz and one of my clinical humid enact mentors docker Wittstein. taught me early on is you may never actually normalize the JV P or you know have normal filling pressures in patients with cardiac amyloidosis patients are dependent on filling pressures to maintain their stroke volume so with diabetic tight. Ration- what I'm really assuming for is symptom relief and decongestion more than anything. That's really interesting job. What I'm hearing from you is that Dia? Radic's are really the mainstay of therapy in treating treating cardiac amyloid really to get to decrease in congestion and symptom management which is counter to what were traditionally thought with cardiomyopathy where our mainstay mainstay is really trying to get them on goal. Directed therapy are really pushing Beta blockers. Ace inhibitors year. You're really reaching for diabetics. I and so coronal acting on for example is not necessarily from the guideline directed therapy perspective. But more for to help normalize the potassium so patients don't have to take you know just like bucket. Tuck it loads of potassium. Yeah that's correct so the other standard therapies that you mention Rasa Habituation Beta blockade. That you know we are really trying to push on our dilated cardiomyopathy map. The patients have not shown similar efficacy in cardiac amyloidosis patients and again this really goes back to the underlying he amex and the concept of having a relatively fixed stroke volume so online dilated cardiomyopathy. Were you Vasil dilate in reducing increase your cardiac output. There's really but not this ability in amyloid and instead you just kinda potentiate hypertension a lot of time. Betablockers can do the same You know again related related to the negative Aina Trophy and current trophy nonetheless. There are definitely patients. Who've Kinda me on clinic there hypertensive with cardiac amyloid there on ace inhibitor? Or they're on Beta blocker because of a history of a fifth and tolerating these medications. Fine so in these cases I usually don't stop the drug but definitely regularly monitor symptoms inches. Have a low threshold to discontinue and related to this. I think one useful clinical pro to throw out there in the diagnosis of cardiac amyloidosis. Is You you know you have a heart failure patient diagnosis in the hospital. Of course everyone wants to start guideline directed medical therapy and you may not have diagnosed amyloidosis at this point will a clue that this may be. AMYLOID is patient tanks when you start. Logos Beta blocker or ace. Inhibitor on initiatives prompted. Think about if that is what's going on in the ideology aetiology so that was a great summary of traditional cardiac medications and how they defer in the in the treatment of cardiac amyloid. But what's really exciting about this particular disease entity it has been. I think the advent of novel therapies particularly for tr which is why there is now such a greater push to diagnose this disease at an earlier time now that we have a therapy. We'd love to hear more from you about the drugs that have been developed that are sort of in the pipeline Particularly the attract trial that came out at New England Journal in two thousand eighteen eighteen looking at two feminists. Yeah I think this is What's incredibly exciting about diagnosing and treating amyloid in this era? I'm there's just been a large surge of disease modifying therapy before we kind of dive into two families and attract in. I think it's important to review so what we're targeting here. which is the translate written? Protein translate written at transport. Protein is synthesized in the liver and it comes together to form a Just kind of like a four leaf clover in its natural state. So with T. T. R.. Cardiac transplant written the issue. Is it destabilizes in dissociates associates in the monomers missiles and then deposited as amyloid fibers In various organs but as we talked about particularly the heart and the peripheral nervous the system so this can happen either due to a pathogenic mutation such as in variant teacher amyloid or not do genetic mutation in its natural state which is called wild type T to our amyloid so all the different therapies that have emerged in the past few years target. Different parts of this pathogen pathway by either suppressing teacher reformation in the case of Thomas and others stabilizing the TR trimmer or by degrading the amyloid fibers that have already deposited moving onto damnedest. So it's a stabiliser and as of two thousand nineteen you know after I tracked. It was kind of fast tracked. It's the only FDA approved therapy for the treatment of cardiac amyloidosis. The attract trial was a phase three clinical trial it looked at famine EST versus placebo in both variant and and wild type teacher. Cardiac patients It's a once a day Peo- medication and mechanistically it works by binding. Tr Tetra with very high affinity and so basically inhibits a step. Where the Touch Moore dissociates into monomers which is the rate limiting step of that cascade so attract international placebo controlled like I mentioned and patients enrolled either had near accreditation class. One two three heart heart failure so the trial did exclude classes for her failure. Patients the primary endpoint was mortality credit vascular hospitalizations but he's a secondary endpoints were improvement in the KC Q.. And six minute walk test. Q- It's the Kansas City Cardi Mafi questionnaire basically focused on quality of life really commonly used in all heart failure trials. Thank you guys. Okay I was asking for the audience. It was so stupid people So commonly talked about what the ATTRAC- Trial Zero really unique statistical method for analysis. So I thought we should mention here. It's the Finkelstein show. I love this. It calculates a win ratio But really I think this method capitalizes on rare disease and a small cohort it really increase the sensitivity in power of the trial points. Eh prioritize the importance of mortality and morbidity so and you know usually composite end points you look at all of them together Finkelstein gene show and fell this hierarchical so it'll prioritize death and then then you it's like a ladder that you go up for endpoint so it allows you to sort of say say this endpoint is more important than this employment cetera crushing your stats class. No we didn't learn this incessant is that I love this method over. I'm not putting that up a real nerd so in terms of trial implants to feminist was shown to reduce mortality by thirty percents compared to placebo that generative number needed to treat of about seven point. Five just to prevent one death hospitalizations cardiovascular hospitalizations positions were reduced by thirty two percent number needed to treat correlating faddis. Four one hospitalization. I think one important lesson we can take home. I'm from attract. Is that earlier. Diagnosis in earlier. Treatment is way better. A subgroup analysis showed much more benefit in the class. One to two you near Kurt. Association patients compared to clashes three in mortality an cardiovascular hospitalizations and again class for patients weren't even enrolled and also kind of related to this notion of earlier treatment and earlier diagnosis is that It did take a little while for the benefit to be seen so the survival survival curve split at about eighteen months And in terms of hurtful layer hospitalizations occur of divergent about nine months. So you can't have a super sick a patient that you're starting on because they need to live a while to see the benefit from this drug Jovan that was a really great overview of the attract trial and it will be really exciting to see how the use of FAMAS hands out in day to day clinical practice. What has been your experience thus far with this drug? I think it's great to be able to offer therapy to my patients with chronic amyloidosis. So I'm in general very excited about it. I think besides being able to offer Therapy another major advantage is that it's really safe. And well tolerated. The trial itself had very few adverse events in clinical practice. I haven't had a patient. Don't need to come off drug. Because intolerance or side effect the big disadvantage which has been extensively discussed you know in nationwide international. Aw on an international level is the cost because amyloid was classified as a rare disease. The drug was costed as such. It can cost on average of two hundred thousand dollars per year. And it's by far the most expensive cardiovascular drug on the market. I think they're really needs to be headway. Made in this front especially if we diagnose amyloid in more and more patients as we expect to do so it will no longer be the rare disease that we have classified it as absolutely and so I know to famas sort of at this. Point is the coolest kid on the block. The one that we probably hear about the most. But tell us about the other. T. T. R. stabilisers. Yeah there are other stabilisers. That are Hopefully coming down the pipeline. Aj Ten was was recently published about in phase two clinical trial and there's an ongoing phase three clinical trial and the mechanism is interesting it mimics so mutation that has been found to be super stabiliser. Tr in the phase two clinical trial it was deemed safe and did reduce the rate of that Tetra. America Association Association. That we talked about was kind of this integral step in the cascade in both mutant. Wild type Emily so it'll be exciting to see what comes of further another trial data. It's an oral drug as well which is another advantage and I flew his. Al Is kind of the old kid on the block. I guess it's an end set in a a nonselective Stabiliser it's shown modest benefit in crop than has been shown to slow progression of neurologic impairment in those affected by neuropathy. I think they use in cardiac amyloid is a bit controversial. Because of the long term side effects events that use we tell all of our patients avoid end said all our patients with heart failure to avoid and says and has been shown with. I flew Reduction Gfr in volume retention so it has to be a select cohort that That gets this drug. That's pretty important to know so to fabulous. Aj Ten and a flu nestle as you mentioned. Our T. T. R. stabilisers Sir. But what about agents that are particularly working to suppress t t our production. Yeah this has been an exciting time for amyloid as well. There have been two drugs. Approved relatively recently for. At our peripheral neuropathy and that are actively being studied for cardiomyopathy in both aim to suppress. I teach our production. First of those participants are on Pattro and it was studied furniture up at the end. The Apollo trial the mechanism impetus rand so it is a small Paul interfering molecule in targets a sequence of the Amarna within tr and that sequences preserved in in those with the mutant and of course. It's impacting those with wild type. So in Apollo there was a significant improvement pollen or a decrease teach your levels overall improve quality of life. They did a pre specified subgroup analysis with cardiac involvement which led to the little talk about but that showed improvement in credit structure and function so decrease..
"pattro" Discussed on Mornings with Keyshawn, Jorge & LZ
"Perimeter. He was. Was there? Probably there is there last year for sure. Yeah. I'm sure you're listen to k SPN loss asthma. Some of the radio makes sense. Yeah. Braiding makes sense. Because I mean, these guys make this makes sense to but some not really buying it to their fashion. If that's what this is about if it's a an art gallery for fashion and all this from buying them today fashion. I mean saquon Barkley was there. Thank mark. I handle his look was dated though. Yeah. That was what's gonna? Tuxedo? The I well I actually wore well, you're not him. Well, I'm just letting you know, my people we've been for rail we've been doing this for a minute. So I wore the the short and blazer outfit push like three years ago at the SP channel for in the Bron followed after me. Beat you to it. When he do he did it several years ago at ask like the suit but with the test. Okay. Was saying so you see for rail did in an outside thin. It was like come on, man. Does anybody just roll in regularly? Or is that not how you go to the met? I mean, you weird when you do there was a picture of a black tux pitcher Trevor Noah, and he was dressed like normal normal like glue Pattro, she say yellow looks like a bright yellow something like a down would nice. I was like you lost. Gala which gonna maitre d. About of Drake's valet parking janitor like a valid. What do you have a red jacket? You just had all like a Keith look like a Dicky's, Dicky's or members only co essay. But right. He did. I get a members only I come home. Maroon I had a plaque. Now there were a couple lady Gaga she like a big red splash. There's Katie Peres, Katie paparazzi. Good Morning, America. I also really like dressed as Cinderella. That was a was diet than Donna ninety era. Boy who Iran will be there. You know, he's. Yeah. He was. Yeah. But his pairs were cut. Right. The break was too big. If you look at it. Yeah. You gotta that's that's played that big break who was the one. I showed up in chair the when you send us. Dalley Billy hill. Billy order that was a lot really weren't Oscars. Yeah. Yeah. Attention. I mean, he. Let us also consistent with what who'll eat only who he who is he he's a Broadway. Go ahead. So, you know. That's no, I'm not saying, no, I'm done done, Billy. Go ahead is a he's a he's a legendary Broadway performer, but he's also the star of FX show called pose which is really what drag culture, and so he's supposed to represent all of that. When he starts to you know, when you step it out. He's rolling. He's gotta keep that going going big. He's going back. Many got did you see today? Dea no Sheila McCann ice ice witch like from. Did not though I was looking at us for the bath Elsa. I was like many go. What's going on narnia? Keys headline of today gala here job keep like one day. We just get dressed vote against that. You'd be one. Look it up record. What are you gonna wear Janice? Dominic is sue is still on the street last year. The Rams signed him for one year, fourteen and a half million dollars, and he was somewhere between okay?.
"pattro" Discussed on WMAL 630AM
"The hearing is going on Capitol Hill were keeping one ear on that. I'll update you on that as we go, so far, no fireworks. But I'll update you right now. Let's go to the phones. Let's go to Donna in Frederick done. You're on the Chris Plante show. Right. Chris. I wanted to you that you know, you've often said the most of power is power to ignore. And we're seeing that with propaganda designed this guy journalism, but the burning question in the minds on sure sixty three million Americans voted for Trump is there. Obstruction of where Moeller deliberately omitted information in that report. And that question is what they don't bomb and Hillary Clinton. And when did they know it? You know, I gotta say that is a very important question. Donna, and because this whole thing beats the plan Pattro door. We played the audio of Ben Rhodes deputy national security advisor to Obama yesterday who was squirming like a toad and and couldn't answer. Well, no, we know that we've owned about in the newspaper, and he was just jumping out of his skin trying to get away from these questions. It was obvious that this was a very uncomfortable question for him. And obviously, I mean, I think it's obvious that the FBI the Justice department don't launch a a surveillance operation against the opposing parties presidential campaign and leave the president out of it. You just don't know that's not plausible deniability. This is not area fifty one. This is not some Hollywood movie. The president is in the loop when his intelligence and law enforcement apparatus are targeting the opposing parties political campaign, and Donna. Why would we believe they weren't also spying on other Republicans on.
"pattro" Discussed on 860AM The Answer
"Washington county sheriff's office says deputy discover the menacing appliance after entering the bathroom with guns. Drawn jerem sergeant Danny de Pattro says isn't countering was his first roomba. Burglar and thirteen years on the job. More on these stories at townhall dot com. In nineteen fifty-six is father is scape from prison and hungry when he was facing life in jail for fighting against communism and the Soviet invasion is mother escaped at the same time. They fled to the UK. He learned from an early age fight the war against fascist communists, and Nazis became a world expert in fighting terrorists. The book why we joined the Trump team on the White House staff in twenty seventeen now in twenty nine hundred takes this battle to a national radio platform. This is America first with some best in Gorkha. Welcome to the new age..
"pattro" Discussed on 77WABC Radio
"The right breast with lymph nodes on the right and left armpit and thou disease of the lungs. So she has stage for cancer, she's continued to refuse all treatment. Her wettest dropped from one hundred and forty pounds two hundred seventeen pounds. She's lost twenty five pounds. She's six feet tall tall woman. She had a CAT scan one of the big hospitals a few months ago and showed cancer in the lymph nodes and under the breasts of sub Pattro women have pectoral muscles. Dislike men there were cancer spread down to the sub pectoral area journal memory nodes lung, and she generally believe it or not is feeling pretty good. Her Esther receptors were positive and she came to me, she's married. I should tell you one more thing about her her mother and two ram mothers had breast cancer. So there's three direct relatives. All with breast cancer. I examined her and she had bilateral lemons, right and left lymph nodes in the armpit up to three centimeters. And there was in the right breast massive distortion of the breasts. The breast was about sixteen centimeters distorted the breast was hired discolored in all consistent with cancer infiltrating through at my fist. My fist size fourteen shoes and big hands. My fist is eight. Centimetres? Her cancer was sixteen seven meters in that breast rock-hard, and I met with her. We spoke about all the options and she now after five years understands more about her breast cancer and wants to start treatment to try to get these symptoms in this cancer reversed. mrS the work that we do every day every day at thirty four Broadway. We take care of women with early breast cancers late breast cancers massive breast cancers and tiny breast cancers, we have the ability to do that we have the understanding experience. And we have a team of doctors physicists though of technician. Nurses and staff here for you. And you can call and get information even now call two one two choices to and two choices. It's two and two choices because two and two means New York City, and choices means we've truly believe you have choices for medical care. I want to talk about a woman who is seventy eight years old. She has one son shade comes to us with a history of heart disease, diabetes and high blood pressure and congestive heart failure who had abdominal pain and had colonoscopy for years ago had called Oscar said to be negative and the Levada half a year ago or three quarters of a year ago. She had called Oscar p and a cat scan just found heaven obstructing mass. In the signaled colon amass in the signaled call and the doctors tried to call NAS Coppee colonoscopy is to look inside the colon intestines, and the mass was so big the doctors were unable to pass the scope through this or beyond this mess. The cat scan showed a five centimeter mass of the signaled colon which is next next to the rectum. She was seen by doctors at one of the super pooper, big hospitals. They wanted to do surgery can imagine this the doctors told her they wanted to do surgery, but they told her that most likely she wouldn't survive the surgery. Wow, reminds me almost of like the supreme court judge who gets surgery then you don't hear from her again. Well, we hope to hear from her. We hope she has a speedy recovery. But imagine the doctors at one of these super pooper big hospitals are recommending colon cancer surgery for this woman, the seventy eight year old woman, but telling your most likely, she wouldn't survive it. Wow. She's lost wake two years ago. She was one hundred forty five pounds should now. Dow tottered and twenty why do people with cancer lose weight? Well, often the cancers this eating through the body needs nutrition to grow to the cancer to grows eating away at her body. And so I saw her and we evaluated her. She had a scandal of her body. There was nothing else beyond this five centimeter mass in the signal. Eight colon should atrophy of a kidney inch it assist. And I saw her examined her and she came to me last year and wanted to be treated. You wanted non invasive treatment because she understood that surgery could be complicated. She may not survive the surgeon, some south's, this time told her that she probably wouldn't survive the surgery, and she came here for non.
"pattro" Discussed on The Rich Eisen Show
"No. No, no, no. She's long gone yet. No, I'm not. I'm not quite sure which is doing hopefully, she's doing good good. My my lovely lady. Miss Kaelin coal is is actually over. There. Filming me writing really Kelsey has been caught own say hi Sweety own on a second. Let's make sure that she's on camera right here for catching Kelsey. So she. I'm glad I was actually yelling her the entire time. Yesterday's you're all that's definitely not the case. Let's definitely not the case. Okay. Everybody there. She is right here right there on the rich Eisen show. Okay. So you have been officially caught. Yes. Okay. No, no, no ring or anything like that. But well, okay. I enjoy her. Okay. She joys me. And we live and we live here. Cheers. Cheers. Travis calcining. What's what's what's your lovely girlfriend's name Caleb? I am killing Michael. Okay. Very good, man. Oh Instagram is that how you guys met. Yes. It is. Instagram, Instagram, business, pleasure. You name it. Okay. The got it on their man. Post pictures of food in the backs of the heads of my children because I don't want anybody to see their faces got everything and the rich Eisen show you and I use Instagram differently. I mean, again different people what is Patrick Mahomes, his nickname in the locker room because everybody's like calling them Showtime you to call them Showtime. Right. I didn't call them Showtime till everyone else brought to to light. And he said, I think is father had been calling him Showtime. Right. Make sense, but the school I called a paddock until his entire body. Baker's, man. Okay. Bake me cake fast, as you k- know, look the cake. Roland it handed. Do you like it has that does he like it? No. You keep because he's his pops actually told me that he just like to just like, Patty cake. You know, he's come home with the Patty cakes, right? Did you know what I've been trying to call him? I told I told him this, and he has politely refused. The patch will. It's not it's not bad. Now, you're not just giving that just as a friendly know thought, it was going to be something way worse. Like, I don't know. I asked for more clever than your the patron, and he text because I would texting text buddies in the same vein, Bella check, or you know, so I texted him. Hey, how about the patch was a hot don't think like that one? I tried again when he called into the show, and he totally politely shined. It off a very nice guy. But what do you say you give just next time? You see him Pattro petrol and see how it looked in. You text me how he took will without about that Patty cakes. Good. Good to see you Travis Kelsey who do you think wins? This look. I think it will end up being a coin flip and the New England Patriots win. Figurative coin flip or will there? Be overtime coin flip. Call your shot right away team. I don't even think the nature of the away team. I mean, they going to call a heads or tails, are you are you guess they're gonna call heads. Yes. Going to be heads. Tom. Brady's gonna take about four minutes to go down field. They're gonna get what an what an interesting. Like what an interestingly detailed. Okay, Travis Kelsey here on the rich Eisen show. You can follow him on Twitter at t Kelsey or on Instagram Killa trav-, but do not slide into any DM's because that Kelsey is already been cautioned. No, that's correct right here on the rich, Joe round of applause for. All right. In sports trade can make or break your team, a good one can mean a championship, but bad one can set your franchise back.
"pattro" Discussed on WBZ NewsRadio 1030
"Bad news. Let's get the forecast with John Feerick. Joining us with the four day WBZ AccuWeather rows ruling this evening. We'll see snow begin late tonight. Mix with rain along the south coast and Cape. An early low of twenty one to twenty seven temperatures do rise late tonight. We'll see that wintry. Mix of snow even some freezing rain and playing rain going over to all rain tomorrow morning slippery travel conditions tomorrow morning. North west of four ninety five for the most part. That's where we'll see the worst slippery travel, then rain tomorrow afternoon, high forty to forty five more rain tomorrow night, then increasingly windy dryer Wednesday. I forty eight blustering cold for Thursday. I'm AccuWeather John Feerick. WBZ Boston's NewsRadio. And right now in Boston down to thirty degrees. As that sun goes down into WBZ at seven oh, five AM, twelve thirty five and five thirty five pm for tomorrow's technology today. Brought to you by Toyota. Learn the latest news from leading experts on cutting edge innovations hybrid and safety technology. Toyota. Let's go places. The forecast was brought to us by Toyota's official website for deals by a Toyota dot com. Checking New England business news at Cambridge biotech is riding high on sales of a treatment for an inherited disease often impacting the liver nerves heart and kidneys alum alal-, analyze thermos. Suitable says global. Sales for on Pattro exceeded eleven million dollars the first quarter of the company says it has more than a billion dollars in cash and investments and also today a Wilburn company developing drugs.
Alnylam's gene silencing drug wins FDA approval
"Brown FDA makes. History as it grants approval to the first ever drug. Made by l. nylon pharmaceuticals and it's the first ever gene silencing drug to. Be okayed the Cambridge company will. Now move forward marketing on Pattro which treats a rare and deadly disease that attacks the nerves liver and, heart l. nylon, has been working on this drug for more than, a decade has spent billions to get