Aims To assess the safety and efficacy of pump therapy (continuous subcutaneous insulin infusion;... more Aims To assess the safety and efficacy of pump therapy (continuous subcutaneous insulin infusion; CSII) during labour and delivery in women with Type 1 diabetes.
Introduction: Vitamin D has been identified as a hormone that acts on bone health and calcium hom... more Introduction: Vitamin D has been identified as a hormone that acts on bone health and calcium homeostasis. It is also an important hormone that regulates cardiac myocytes. It has been implicated in the immune system and the inflammatory cascade led by B and T cells. Deficient levels of vitamin D have also been found to correlate with sepsis. Patients undergoing left ventricular assist device (LVAD) implantation are at increased risk of driveline infection. It is considered one of the major adverse events after LVAD implantation. Hypothesis: Vitamin D levels are associated with increased risk of driveline infection after LVAD implantation. Methods: We retrospectively reviewed the charts of 212 consecutive LVAD patients between Jan 1, 2010 and Jan 1, 2015. A total of 29 patients on ECMO and biventricular assist devices were excluded. Demographics showed a mean age of 59.7 years, 76.8% male and 52% Caucasian. We measured 25-OH vitamin D levels within one week prior to LVAD implantation and investigated its association with driveline infection during 1 year follow up. Vitamin D level was classified into 3 categories listed as Normal (>30 ng/ml), Insufficient (20-30 ng/ml) and Deficient ( Results: Lower vitamin D levels were independently associated with a significant increase in the rate of driveline infection (Table 1). Conclusions: In conclusion, these findings reflect the clinical impact of vitamin D levels on patients undergoing LVAD implantation. Patients with decreased vitamin D levels had a significant increase in driveline infection. This can result in increased readmissions and morbidity. Further studies are needed to determine if vitamin D repletion regimens could decrease driveline infections.
Background: Vitamin D is an important hormone that regulates cardiac myocyte function. Low levels... more Background: Vitamin D is an important hormone that regulates cardiac myocyte function. Low levels contribute to the development of cardiovascular disease and have been implicated in immune function and the inflammatory cascade. Patients who undergo left ventricular assist device (LVAD) implantation are at risk for driveline infection, stroke, and gastrointestinal (GI) bleeding. We investigated whether serum 25-hydroxy (25-OH) vitamin D levels affect clinical outcomes after LVAD. Methods: 212 patients who underwent LVAD implantation between 2010 and 2015 were included. We measured preoperative 25-OH vitamin D level and postoperative adverse events during the first year. Vitamin D level was classified into 3 categories: normal (>30 ng/mL), insufficient (20-30 ng/mL), and deficient (<20 ng/mL). Clinical outcomes in both insufficient and deficient categories were compared with the normal category. Results: The odds ratio (OR) of being admitted ࣙ2 times was 2.46 (95% confidence interval [CI]: 1.067-5.769) for deficiency and 2.5 (95% CI: 0.970-6.443) for insufficiency. The OR of driveline infection was 6.185 (95% CI: 0.80-49.2; P = .07) for insufficiency and 11.467 (95% CI: 1.204-109.26; P = .03) for deficiency. Vitamin D levels were not associated with GI bleeding, length of stay, or stroke. Conclusions: In patients with LVAD, both deficiency and insufficiency of 25-OH vitamin D levels are independently associated with increased postoperative driveline infection risk and higher rate of readmission. Further trials are needed to confirm whether a repletion regimen could be a promising means of decreasing the risk for these postoperative adverse events.
Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical ... more Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical emergency with a high mortality rate. The clinical manifestations of a severely thyrotoxic state can be devastating, and its most significant effects occur in the cardiovascular system. Cardiac involvement is the leading cause of death in patients with thyroid storm. We report a unique case of thyroid storm precipitated by viral myopericarditis in the setting of exogenous thyroid hormone supplementation. Methods: Case report and review of the literature. Results: We report a case of a previously healthy 26-year-old male with a history of bodybuilding who developed thyroid storm with multi-organ failure, including acute-onset congestive heart failure, leading to cardiogenic shock. Investigations revealed ingestion of exogenous thyroid hormone as the source of his thyrotoxicosis. Initial labs revealed serum thyroid-stimulating hormone 0.015 mU/L, free thyroxine 2.3 ng/dL, free triiodothyronine 8.8 pg/mL, total triiodothyronine of 2.22 ng/ mL, and thyroglobulin 4.4 ng/mL. There was also evidence of viral myopericarditis, as demonstrated on cardiac imaging and multiple elevated Coxsackie virus B titer levels. Conclusion: Given the patient's underlying thyrotoxic state from exogenous thyroid hormone ingestion, we believe that his acute myopericarditis was the catalyst that precipitated his thyroid storm. The combination of acute myopericarditis and thyroid storm ultimately led to cardiogenic shock. He showed rapid improvement with cardiopulmonary supportive efforts and treatment for thyroid storm. In considering the etiology of thyroid storm, it is important to exclude the possibility of exogenous thyroid hormone ingestion, especially in the setting of nonregulated, over-the-counter, bodybuilding, or weight-loss supplement use. (AACE Clinical Case Rep. 2017;3:e74-e78) Abbreviations: MRI = magnetic resonance imaging; SSKI = supersaturated potassium iodide; T3 = triiodothyronine; T4 = thyroxine e78 Thyroid Storm and Myopericarditis, AACE Clinical Case Rep. 2017;3(No. 1)
Pregnancy in the setting of type 1 diabetes is associated with an increased risk of adverse outco... more Pregnancy in the setting of type 1 diabetes is associated with an increased risk of adverse outcomes for both mother and fetus. Adequate glycaemic control has been shown to result in improved outcomes, but the strict glycaemic targets required in pregnancy are often difficult to achieve. The development of novel technologies for insulin delivery aim to assist in achieving excellent glycaemic control, while attempting to minimize the significant risk of hypoglycaemia that exists in pregnancy. This review will discuss the use of insulin pump therapy, continuous glucose monitoring and closed loop insulin delivery in the setting of pregestational diabetes, highlighting some of the potential advantages of these technologies. Novel insulin delivery devices have been shown to be safe in the setting of pregnancy, but proper randomized controlled trials are still needed to determine if they are superior to traditional insulin delivery mechanisms.
Canadian Family Physician Medecin De Famille Canadien, 2009
OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influe... more OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influence on medical students. DESIGN Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. SETTING Ontario, Canada. PARTICIPANTS All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study.
OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influe... more OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influence on medical students. DESIGN Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. SETTING Ontario, Canada. PARTICIPANTS All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study.
Canadian family physician Médecin de famille canadien, 2009
To explore the strategies used by rural recruitment programs and their perceived influence on med... more To explore the strategies used by rural recruitment programs and their perceived influence on medical students. Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. Ontario, Canada. All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study. The factors that influence medical students to consider rural practice, strategies used by recruiters, and student perceptions of the ethical appropriateness of both. The questionnaire was completed by 42.1% of medical students. Lifestyle considerations were an important influence for 93.1% of students. Themes from the qualitative analysis included the ethical appropriateness of financial considerations, economic forces, perceived disadvantages of rural practice, competition between communities, a...
Aims To assess the safety and efficacy of pump therapy (continuous subcutaneous insulin infusion;... more Aims To assess the safety and efficacy of pump therapy (continuous subcutaneous insulin infusion; CSII) during labour and delivery in women with Type 1 diabetes.
Introduction: Vitamin D has been identified as a hormone that acts on bone health and calcium hom... more Introduction: Vitamin D has been identified as a hormone that acts on bone health and calcium homeostasis. It is also an important hormone that regulates cardiac myocytes. It has been implicated in the immune system and the inflammatory cascade led by B and T cells. Deficient levels of vitamin D have also been found to correlate with sepsis. Patients undergoing left ventricular assist device (LVAD) implantation are at increased risk of driveline infection. It is considered one of the major adverse events after LVAD implantation. Hypothesis: Vitamin D levels are associated with increased risk of driveline infection after LVAD implantation. Methods: We retrospectively reviewed the charts of 212 consecutive LVAD patients between Jan 1, 2010 and Jan 1, 2015. A total of 29 patients on ECMO and biventricular assist devices were excluded. Demographics showed a mean age of 59.7 years, 76.8% male and 52% Caucasian. We measured 25-OH vitamin D levels within one week prior to LVAD implantation and investigated its association with driveline infection during 1 year follow up. Vitamin D level was classified into 3 categories listed as Normal (>30 ng/ml), Insufficient (20-30 ng/ml) and Deficient ( Results: Lower vitamin D levels were independently associated with a significant increase in the rate of driveline infection (Table 1). Conclusions: In conclusion, these findings reflect the clinical impact of vitamin D levels on patients undergoing LVAD implantation. Patients with decreased vitamin D levels had a significant increase in driveline infection. This can result in increased readmissions and morbidity. Further studies are needed to determine if vitamin D repletion regimens could decrease driveline infections.
Background: Vitamin D is an important hormone that regulates cardiac myocyte function. Low levels... more Background: Vitamin D is an important hormone that regulates cardiac myocyte function. Low levels contribute to the development of cardiovascular disease and have been implicated in immune function and the inflammatory cascade. Patients who undergo left ventricular assist device (LVAD) implantation are at risk for driveline infection, stroke, and gastrointestinal (GI) bleeding. We investigated whether serum 25-hydroxy (25-OH) vitamin D levels affect clinical outcomes after LVAD. Methods: 212 patients who underwent LVAD implantation between 2010 and 2015 were included. We measured preoperative 25-OH vitamin D level and postoperative adverse events during the first year. Vitamin D level was classified into 3 categories: normal (>30 ng/mL), insufficient (20-30 ng/mL), and deficient (<20 ng/mL). Clinical outcomes in both insufficient and deficient categories were compared with the normal category. Results: The odds ratio (OR) of being admitted ࣙ2 times was 2.46 (95% confidence interval [CI]: 1.067-5.769) for deficiency and 2.5 (95% CI: 0.970-6.443) for insufficiency. The OR of driveline infection was 6.185 (95% CI: 0.80-49.2; P = .07) for insufficiency and 11.467 (95% CI: 1.204-109.26; P = .03) for deficiency. Vitamin D levels were not associated with GI bleeding, length of stay, or stroke. Conclusions: In patients with LVAD, both deficiency and insufficiency of 25-OH vitamin D levels are independently associated with increased postoperative driveline infection risk and higher rate of readmission. Further trials are needed to confirm whether a repletion regimen could be a promising means of decreasing the risk for these postoperative adverse events.
Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical ... more Objective: Thyroid storm represents the extreme manifestation of thyrotoxicosis and is a medical emergency with a high mortality rate. The clinical manifestations of a severely thyrotoxic state can be devastating, and its most significant effects occur in the cardiovascular system. Cardiac involvement is the leading cause of death in patients with thyroid storm. We report a unique case of thyroid storm precipitated by viral myopericarditis in the setting of exogenous thyroid hormone supplementation. Methods: Case report and review of the literature. Results: We report a case of a previously healthy 26-year-old male with a history of bodybuilding who developed thyroid storm with multi-organ failure, including acute-onset congestive heart failure, leading to cardiogenic shock. Investigations revealed ingestion of exogenous thyroid hormone as the source of his thyrotoxicosis. Initial labs revealed serum thyroid-stimulating hormone 0.015 mU/L, free thyroxine 2.3 ng/dL, free triiodothyronine 8.8 pg/mL, total triiodothyronine of 2.22 ng/ mL, and thyroglobulin 4.4 ng/mL. There was also evidence of viral myopericarditis, as demonstrated on cardiac imaging and multiple elevated Coxsackie virus B titer levels. Conclusion: Given the patient's underlying thyrotoxic state from exogenous thyroid hormone ingestion, we believe that his acute myopericarditis was the catalyst that precipitated his thyroid storm. The combination of acute myopericarditis and thyroid storm ultimately led to cardiogenic shock. He showed rapid improvement with cardiopulmonary supportive efforts and treatment for thyroid storm. In considering the etiology of thyroid storm, it is important to exclude the possibility of exogenous thyroid hormone ingestion, especially in the setting of nonregulated, over-the-counter, bodybuilding, or weight-loss supplement use. (AACE Clinical Case Rep. 2017;3:e74-e78) Abbreviations: MRI = magnetic resonance imaging; SSKI = supersaturated potassium iodide; T3 = triiodothyronine; T4 = thyroxine e78 Thyroid Storm and Myopericarditis, AACE Clinical Case Rep. 2017;3(No. 1)
Pregnancy in the setting of type 1 diabetes is associated with an increased risk of adverse outco... more Pregnancy in the setting of type 1 diabetes is associated with an increased risk of adverse outcomes for both mother and fetus. Adequate glycaemic control has been shown to result in improved outcomes, but the strict glycaemic targets required in pregnancy are often difficult to achieve. The development of novel technologies for insulin delivery aim to assist in achieving excellent glycaemic control, while attempting to minimize the significant risk of hypoglycaemia that exists in pregnancy. This review will discuss the use of insulin pump therapy, continuous glucose monitoring and closed loop insulin delivery in the setting of pregestational diabetes, highlighting some of the potential advantages of these technologies. Novel insulin delivery devices have been shown to be safe in the setting of pregnancy, but proper randomized controlled trials are still needed to determine if they are superior to traditional insulin delivery mechanisms.
Canadian Family Physician Medecin De Famille Canadien, 2009
OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influe... more OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influence on medical students. DESIGN Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. SETTING Ontario, Canada. PARTICIPANTS All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study.
OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influe... more OBJECTIVE To explore the strategies used by rural recruitment programs and their perceived influence on medical students. DESIGN Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. SETTING Ontario, Canada. PARTICIPANTS All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study.
Canadian family physician Médecin de famille canadien, 2009
To explore the strategies used by rural recruitment programs and their perceived influence on med... more To explore the strategies used by rural recruitment programs and their perceived influence on medical students. Two original questionnaires delivered electronically, one to medical students and the other to recruiters in rural Ontario communities. Ontario, Canada. All 525 medical students enrolled in the Schulich School of Medicine & Dentistry at the University of Western Ontario in London and physician recruiters in 71 rural communities in Ontario were invited to participate in the study. The factors that influence medical students to consider rural practice, strategies used by recruiters, and student perceptions of the ethical appropriateness of both. The questionnaire was completed by 42.1% of medical students. Lifestyle considerations were an important influence for 93.1% of students. Themes from the qualitative analysis included the ethical appropriateness of financial considerations, economic forces, perceived disadvantages of rural practice, competition between communities, a...
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