Are iso-osmolar, as compared to low-osmolar, contrast media cost-effective in patients undergoing cardiac catheterization? An economic analysis.

Purpose: Contrast-induced acute kidney injury is a prominent complication following cardiac catheterization, though the risk has progressively decreased in recent times with appropriate risk stratification and use of safer contrast agents. Despite data supporting further lowering of risk with the iso-osmolar agent, iodixanol, uptake has lagged, perhaps due to increased upfront cost of this agent. We undertook an economic analysis to estimate the cost-effectiveness of a strategy utilizing iodixanol compared to using a low-osmolar contrast agent.

Thiazide diuretic-caused hyponatremia in the elderly hypertensive: will a bottle of Nepro a day keep hyponatremia and the doctor away? Study protocol for a proof-of-concept feasibility trial.

Background: Hypertension is the most common modifiable risk factor for cardiovascular disease, with an increasing prevalence with age, but with easily available medications to control it. Adverse effects of these medications do limit their use, in particular hyponatremia due to thiazide and thiazide-like diuretics. This is more common in the elderly patients due to a combination of inadequate protein intake and impaired urinary dilution capability, made worse by additional thiazide use.

Implementation and evaluation of structured nephrology morbidity and mortality conferences: a quality education report.

Background: Morbidity and Mortality Conferences (M&MCs) have for generations been part of the education of physicians, yet their effectiveness remains questionable. The Ottawa M&M Model (OM3) was developed to provide a structured approach to M&MCs in order to maximize the quality improvement impact of such rounds.

Study Design: We conducted a retrospective assessment of the impact of implementing nephrology-specific M&MCs using the OM3.

Vascular Access Practice Patterns in Canada: A National Survey.

Background: One of the mandates of the Canadian Society of Nephrology's (CSN) Vascular Access Working Group (VAWG) is to inform the nephrology community of the current status of vascular access (VA) practice within Canada. To better understand VA practice patterns across Canada, the CSN VAWG conducted a national survey.

Objectives: (1) To inform on VA practice patterns, including fistula creation and maintenance, within Canada.

Association between Duration of Predialysis Care and Mortality after Dialysis Start.

Background And Objectives: Early nephrology referral is recommended for people with CKD on the basis of observational studies showing that longer nephrology care before dialysis start (predialysis care) is associated with lower mortality after dialysis start. This association may be observed because predialysis care truly reduces mortality or because healthier people with an uncomplicated course of disease will have both longer predialysis care and lower risk for death. We examined whether the survival benefit of longer predialysis care exists after accounting for the potential confounding effect of disease course that may also be affected by predialysis care.

Drug discontinuation before contrast procedures and the effect on acute kidney injury and other clinical outcomes: a systematic review protocol.

Background: Contrast-induced acute kidney injury (CI-AKI) is defined as worsening of renal function after the administration of iodinated contrast material. In patients with cardiovascular disease, kidney disease, and/or diabetes, renin-angiotensin system blockers, non-steroidal anti-inflammatory drugs, diuretics, and metformin can increase the risk of CI-AKI when undergoing contrast imaging. Despite CI-AKI being the leading iatrogenic cause of acute kidney injury, there is a lack of sufficient scientific evidence supporting which drugs should be stopped, when they should be stopped, and when they should be resumed.

Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review.

Background: Hemodynamic instability related to renal replacement therapy (HIRRT) may increase the risk of death and limit renal recovery. Studies in end-stage renal disease populations on maintenance hemodialysis suggest that some renal replacement therapy (RRT)-related interventions (e.g.

Confronting system barriers for ST- elevation MI in low and middle income countries with a focus on India.

Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays.

Remapping cortical modulation for electrocorticographic brain-computer interfaces: a somatotopy-based approach in individuals with upper-limb paralysis.

Objective: Brain-computer interface (BCI) technology aims to provide individuals with paralysis a means to restore function. Electrocorticography (ECoG) uses disc electrodes placed on either the surface of the dura or the cortex to record field potential activity. ECoG has been proposed as a viable neural recording modality for BCI systems, potentially providing stable, long-term recordings of cortical activity with high spatial and temporal resolution.

Spironolactone is effective in treating hypokalemia among peritoneal dialysis patients.

Background: Hypokalemia is common in peritoneal dialysis (PD) patients and is associated with increased cardiovascular and all-cause mortality. The management approach for such patients routinely includes spironolactone at our centre. We undertook this study to assess the efficacy of spironolactone for the treatment of hypokalemia in PD patients.

Longitudinal Blood Pressure in Late-Stage Chronic Kidney Disease and the Risk of End-Stage Kidney Disease or Mortality (Best Blood Pressure in Chronic Kidney Disease Study).

Whether different methods of quantitating blood pressure (BP) in late chronic kidney disease better mimic pathophysiological processes and clinical outcomes remains unclear. In a retrospective study, we determined the association of BP with end-stage kidney disease (ESKD) and all-cause mortality with BP modeled at baseline versus longitudinally with time-varying Cox models as (1) current (most recent) clinic visit, (2) lag (visit immediately preceding the current), (3) cumulative (average of previous measurements), and (4) change from baseline to the most recent. Among 1203 (6913 visits) study patients, the mean age and baseline estimated glomerular filtration rate were 66 and 18 mL·min·1.

Thus Far and No Further: Should Diastolic Hypotension Limit Intensive Blood Pressure Lowering?

Intensive blood pressure lowering to systolic blood pressure thresholds of less than 120 mmHg is making a slow comeback with the publication of trials supporting its benefit, especially in lowering stroke and congestive heart failure. At the same time, there is an increasing awareness of the prevalence and risk of diastolic hypotension, especially at levels of less than 60 mmHg, with support for the existence of a J-curve coming from post hoc analyses of trials and epidemiological data from large cohort studies. Hence, intensive lowering of systolic blood pressure should be done cautiously in those patients who have pre-existing coronary artery disease, and a diastolic blood pressure between 60 and 70 mmHg.

Hemodialysis Access Choice: Impact of Health Literacy.

Background: Hemodialysis patients need to make decisions about vascular access and diet that they may not fully understand. In this study, we hypothesized that patients with low health literacy are likely to choose a central venous catheter (CVC) and have higher serum potassium (K), serum phosphate (P), and inter-dialysis weight gains (IDWG).

Objective: Primarily, the study sought to describe the health literacy of patients treated with hemodialysis in a Canadian tertiary care center.

Proton Pump Inhibitors: More Indigestion than Relief?

Proton pump inhibitors (PPIs) are widely prescribed to treat a number of gastrointestinal (GI) disorders due to excessive acid production. While effective and safe, adverse renal effects have been increasingly described in epidemiological literature. The most well-documented adverse renal outcome is acute interstitial nephritis; however, association with overall acute kidney injury has also been recently reported.

Longitudinal Prediction of Quality-of-Life Scores and Locomotion in Individuals With Traumatic Spinal Cord Injury.

Objectives: To examine (1) differences in quality-of-life scores for groups based on transitions in locomotion status at 1, 5, and 10 years postdischarge in a sample of people with spinal cord injury (SCI); and (2) whether demographic factors and transitions in locomotion status can predict quality-of-life measures at these time points.

Design: Retrospective case study of the National SCI Database.

Setting: Model SCI Systems Centers.

Interventions to prevent hemodynamic instability during renal replacement therapy for acute kidney injury: a systematic review protocol.

Background: Hemodynamic instability during renal replacement therapy (HIRRT) in the form of intradialytic hypotension (IDH) is a frequent complication of hemodialysis in end-stage kidney disease (ESKD), and most studies have focused on this chronic population. However, HIRRT is also an important concern for critically ill ICU patients with acute kidney injury (AKI), complicating an estimated 30% of dialysis treatments in this population. HIRRT can exacerbate organ hypoperfusion in the setting of critical illness and may negatively impact renal recovery in the AKI population.

Mid-Esophageal Diverticulum Mimicking an Aortic Aneurysm on Chest Radiography.

Background: Mid-esophageal region is an uncommon location of esophageal diverticula, a condition usually diagnosed in elderly individuals.

Case Report: We report a case of an elderly male with incidental finding of mediastinal lesion, which was initially thought to be an aortic aneurysm. Further evaluation demonstrated a mid-esophageal diverticulum at the level of the carina.

Susceptibility-weighted angiography and diffusion-weighted imaging in posterior reversible encephalopathy syndrome - Is there an association between hemorrhage, cytotoxic edema, blood pressure and imaging severity?

Purpose: To assess the significance of association and possible correlation between hemorrhage, cytotoxic edema, blood pressure and imaging severity in posterior reversible encephalopathy syndrome (PRES).

Materials And Methods: This retrospective study included the medical and imaging records of 35 consecutive patients with PRES. The clinical data analysis included the highest recorded blood pressure (BP) on the day of the ictus, MRI including spin-echo echo planar diffusion-weighted imaging (DWI), susceptibility weighted angiography (SWAN) and conventional sequences.

Microparticle Formation in Peritoneal Dialysis: A Proof of Concept Study.

Background: Injury to the mesothelial layer of the peritoneal membrane during peritoneal dialysis (PD) is implicated in loss of ultrafiltration capacity, but there are no validated biomarkers for mesothelial cell injury. Microparticles (MPs) are 0.1 to 1.

Cu-sil Denture- A Space Maintainer for Function- In Paediatric Patients.

The purpose of this report is to introduce Cu-sil like denture as a functional space maintainer. Here, we report two paediatric cases treated with Cu-sil like denture with multiple edentulous spaces and partially erupted/compromised permanent teeth. Cu-sil like denture not only serves as removable partial functional space maintainer, but also restores the vertical dimension of occlusion, mastication and aesthetics in children.

Assessment of maternal risk indicators for the development of caries in their children: A comparative, cross-sectional study.

Introduction: Certain factors in mothers could be risk indicators for certain diseases in their children. Hence, this study was undertaken to assess maternal risk indicators for the development of early childhood caries in their children.

Methodology: A comparative, cross-sectional study was designed among 180 mother-child pairs attending various Anganwadi centers.

Human perception of electrical stimulation on the surface of somatosensory cortex.

Recent advancement in electrocorticography (ECoG)-based brain-computer interface technology has sparked a new interest in providing somatosensory feedback using ECoG electrodes, i.e., cortical surface electrodes.