Delayed clamping of the umbilical cord after delivery and implications for public cord blood banking.

Background: Public banking of umbilical cord blood units (CBUs) containing higher numbers of cells ensures timely engraftment after transplantation for increasing numbers of patients. Delayed clamping of the umbilical cord after birth may benefit some infants by preventing iron deficiency. Implications of delayed cord clamping for public cord blood banking remains unclear.

Comparison of standard and accelerated initiation of renal replacement therapy in acute kidney injury.

In patients with severe acute kidney injury (AKI) but no urgent indication for renal replacement therapy (RRT), the optimal time to initiate RRT remains controversial. While starting RRT preemptively may have benefits, this may expose patients to unnecessary RRT. To study this, we conducted a 12-center open-label pilot trial of critically ill adults with volume replete severe AKI.

Does pragmatically structured outpatient dietary counselling reduce sodium intake in hypertensive patients? Study protocol for a randomized controlled trial.

Background: Hypertension is highly prevalent among adults, and is the most important modifiable risk factor for cardiovascular events, in particular stroke. Decreasing sodium intake has the potential to prevent or delay the development of hypertension and improve blood pressure control, independently of blood pressure lowering drugs, among hypertensive patients. Despite guidelines recommending a low sodium diet, especially for hypertensive individuals, sodium intake remains higher than recommended.

Obesity and the challenges of noninvasive imaging for the detection of coronary artery disease.

Obesity is a significant health problem that could potentially lead to increased cardiovascular risk. Noninvasive imaging plays an important role in the evaluation of cardiovascular symptoms and risk of these patients. Selection of the appropriate test in the diagnosis of obstructive coronary artery disease in this unique population is important.

Myocardial viability: it is still alive.

Heart failure presents a significant problem in industrialized countries, with a high prevalence, morbidity, and mortality, where it is most frequently caused by coronary artery disease. Revascularization in patients with symptomatic heart failure has been associated with improved cardiovascular outcomes. Predictors of outcome benefit from revascularization include the presence and extent of hibernating myocardium, ischemia, scar, left ventricular ejection fraction, and renal function.

Preeclampsia is a biomarker for vascular disease in both mother and child: the need for a medical alert system.

This paper reviews the literature pertaining to the impact of preeclampsia not only on the mother but particularly on the children. The review points to the higher blood pressure in children born to preeclamptic mothers compared to controls, their increased tendency to suffer strokes, the reduction in their cognitive ability, and their vulnerability to depression. Mechanisms that may induce these changes are emphasized, particularly the placental vascular insufficiency and the resulting hypoxic and proinflammatory environments in which the fetus develops.

Direct mecA polymerase chain reaction testing of blood culture bottles growing Gram-positive cocci and the clinical potential in optimizing antibiotic therapy for staphylococcal bacteremia.

This study evaluated the performance of direct mecA polymerase chain reaction (PCR) from blood culture bottles growing Gram-positive cocci in clusters and its role in optimization of antibiotic therapy. A total of 266 blood cultures including 121 methicillin-resistant and 122 methicillin-susceptible Staphylococci were tested for mecA. Compared to phenotypic testing, the overall performance of direct mecA PCR was 99% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively.

Trends in the utilization of endovascular therapy for elective and ruptured abdominal aortic aneurysm procedures in Canada.

Objective: While randomized trials have shown improved operative mortality with endovascular aneurysm repair (EVAR) but similar long-term mortality rates, enthusiasm for EVAR persists, and rates of EVAR use continue to increase. Currently, knowledge of utilization rates of EVAR in Canada is limited.

Methods: Patients who underwent nonruptured abdominal aortic aneurysm (AAA) and ruptured AAA (RAAA) repair, by either open surgical repair (OSR) or EVAR, in Canada were identified from hospital discharge abstract data.

Histochemical analysis and immunohistochemical profile of mucoepidermoid carcinoma of the conjunctiva.

Purpose: To elucidate the distinct histochemical and immunohistochemical profile of mucoepidermoid carcinoma of the conjunctiva (MECC) and to determine which combination of stains is most useful in diagnosing MECC and differentiating it from squamous cell carcinoma of the conjunctiva (SCC) in cases where the clinical or cytological findings are not definitive.

Methods: Eight specimen of MECC from 4 patients and 4 specimens of SCC from 4 patients were examined using a variety of special stains and immunohistochemical markers. The results were then analyzed for usefulness in diagnosing MECC.

Diagnosis: use of clinical probability algorithms.

Evidence suggests that patients with suspected pulmonary embolism are managed better with a diagnostic strategy that includes clinical pretest probability assessment, D-dimer test, and/or imaging. Several clinical prediction rules have been described in the literature during the last decade. This review focuses on the role of clinical prediction rules in the diagnostic process and their clinical application into diagnostic algorithms.

Cytologic features of benign solitary pulmonary nodules with radiologic correlation and diagnostic pitfalls: a report of six cases.

Background: The solitary pulmonary nodule (SPN) is a common radiologic abnormality often detected incidentally. The majority of SPNs represent benign processes, including granulotmatous inflammation, bronchogenic cysts and hamartomata. However, a solitary nodule may also potentially represent an early stage of lung cancer or a metastasis.

No evidence for decreased incidence of aspiration after rapid sequence induction.

Purpose: The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management.

Source: In June 2006 a structured search of MEDLINE from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed.

Defining parkinsonism in the Canadian Study of Health and Aging.

This study sought an operational definition of parkinsonism in elderly people (n = 2,914) who underwent a clinical examination in the Canadian Study of Health and Aging (CSHA). Parkinsonism was defined as having two of the following features: (1) bradykinesia of face or limbs, (2) resting tremor, (3) rigidity, and (4) abnormality of gait and posture. The association of parkinsonism with other parkinsonian-related features (prior diagnosis of Parkinson's disease, use of drugs with extrapyramidal side effects, and use of antiparkinsonian medications) and variables not expected to be related to parkinsonism (stroke and Hachinski score > 5) was determined.

Folic acid.

Folic acid is an essential nutrient from the B complex group of vitamins. Folate, as a cofactor, is involved in numerous intracellular reactions, and this is reflected in the various derivatives that have been isolated from biological sources. Folic acid is involved in single carbon transfer reactions and serves as a source of single carbon units in different oxidative states.

The association between antiulcer medication and initiation of cobalamin replacement in older persons.

As chronic use of antiulcer medications might predispose older persons to cobalamin deficiency, we studied participants (> 65 years) in the clinical examination of the Canadian Study of Health and Aging to test the association between the use of an antiulcer medication (histamine-2 blocker or proton pump inhibitor) at baseline with initiation of cobalamin replacement during the 5 year follow-up period. Of 1054 eligible subjects, 125 (11.7%) were taking an antiulcer medication at baseline.

The association between parkinsonism, Alzheimer's disease, and mortality: a comprehensive approach.

Background: The impact of parkinsonism on survival in older persons independent of dementia is not well understood.

Methods: Participants in the clinical examination of the Canadian Study of Health and Aging who had parkinsonism and were older than age 65 were identified. The impact of parkinsonism on 5-year survival was determined for a combined cohort with and without dementia, and a stratified analysis was then conducted for the subgroups with Alzheimer's disease (AD) and those without dementia.

Measurement of gluconeogenesis and mass isotopomer analysis based on [U-(13)C]glucose.

Two methods of measuring rates of gluconeogenesis based on label redistribution after the introduction of [U-(13)C]glucose into the whole body are examined. These methods are compared with methods previously derived for carbon-14 tracers. It is shown that the three approaches (stoichiometric, dilution, and combinatorial) are equivalent, provided the same set of assumptions are used.