Pharmacodynamic and clinical implications of switching between P2Y12 receptor antagonists: considerations for practice.

Dual antiplatelet therapy with aspirin and a P2Y12 receptor antagonist, either clopidogrel or the newer more potent agents prasugrel or ticagrelor, is standard therapy in patients receiving a coronary stent and those with a recent acute coronary syndrome. Switching antiplatelet drug regimen may be required in some patients for efficacy, safety, adherence, and cost considerations. However, there are potential concerns when switching from one agent to another that gaps in effective antiplatelet inhibition could lead to thrombotic events, and overlap of agents might cause excessive platelet inhibition thereby increasing the risk of bleeding.

X-Linked dominant chondrodysplasia punctata: prenatal diagnosis and autopsy findings.

Objective: To report our experience of the prenatal diagnosis of X-linked dominant chondrodysplasia punctata (CDPX2) and highlight its variable phenotypic presentation.

Methods: We report the sonographic features of three female fetuses affected with CDPX2. The ultrasound, radiographic and pathological findings were compared.

The effectiveness of unannounced standardised patients in the clinical setting as a teaching intervention.

Purpose: Teaching medical students to spontaneously identify biopsychosocial issues (e.g. family violence) remains a challenge.

Evaluating paramedic comfort with field pronouncement: development and validation of an outcome measure.

Objectives: Interventions designed to improve cardiac resuscitation and the quality of field pronouncement need to consider outcomes on paramedic providers. The authors developed and evaluated the reliability and validity of a survey instrument measuring paramedic comfort with field pronouncement.

Methods: A mail survey of 120 paramedics (EMT-Ps) was performed using the Modified Dillman survey methodology.

Environmental constraints on foot trajectory reveal the capacity for modulation of anticipatory postural adjustments during rapid triggered stepping reactions.

This study used environmental restrictions on foot movement to challenge the capacity of the central nervous system (CNS) to counter the lateral instability that arises after foot-lift during rapid triggered stepping reactions evoked by unpredictable postural perturbation. The objective was to determine the extent to which lateral stability could be regulated via modulation of the mediolateral (m-l) anticipatory postural adjustment (APA) that precedes foot-lift. A high frontal obstacle was used to double the required swing duration, and thereby increase the potential for the center of mass (COM) to fall laterally toward the unsupported side, during forward-step reactions.

Outcome of neck dissection for node-positive melanoma.

Objective: To determine the rates of regional recurrence for node-positive melanoma after neck dissection alone.

Design: Retrospective review from a single tertiary care institution.

Methods: Data were obtained for all patients receiving neck dissection from 1990 to 1997 at Sunnybrook and Women's Health Sciences Center.

Tumor necrosis factor-alpha and transforming growth factor-beta reflect severity of liver damage in primary biliary cirrhosis.

Background And Aims: The pathogenesis of primary biliary cirrhosis (PBC) is unknown. The role of cytokines such as tumor necrosis factor-alpha (TNF-alpha) and transforming growth factor-beta (TGF-beta), and the effect of ursodeoxycholic acid (UDCA) in modifying the cytokine environment in patients with PBC has remained largely unstudied. Our aims were to determine: (i) the relationship between serum levels of TNF-alpha and TGF-beta and the severity of PBC; and (ii) the effects of UDCA therapy on TNF-alpha and TGF-beta levels in patients with PBC.

Recognition memory and verbal fluency differentiate probable Alzheimer disease from subcortical ischemic vascular dementia.

Background: Alzheimer disease (AD) and vascular dementia are among the most frequently occurring causes of dementia in the world, and their accurate differentiation is important because different pharmaceutical strategies may modify the course of each disease.

Objective: To determine which of 10 neuropsychological test scores can accurately differentiate patients with probable AD from those with subcortical ischemic vascular dementia (SIVD) for use in evidence-based clinical practice.

Design: Patients with suspected dementia were referred to the study by family physicians, geriatricians, and neurologists.

A risk-benefit assessment of the newer oral antifungal agents used to treat onychomycosis.

The newer antifungal agents itraconazole, terbinafine and fluconazole have become available to treat onychomycosis over the last 10 years. During this time period these agents have superseded griseofulvin as the agent of choice for onychomycosis. Unlike griseofulvin, the new agents have a broad spectrum of action that includes dermatophytes, Candida species and nondermatophyte moulds.