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  • 1
    Online Resource
    Online Resource
    Yersinia pseudotuberculosis bacteraemia with splenic abscesses: a case report
    Microbiology Society ; 2023
    In:  Access Microbiology Vol. 5, No. 9 ( 2023-09-01)
    Details
    In: Access Microbiology, Microbiology Society, Vol. 5, No. 9 ( 2023-09-01)
    Abstract: Introduction. Yersinia pseudotuberculosis has been known to cause a variety of clinical manifestations ranging from mild enteric illness to bacteraemia with septic shock and extraintestinal abscesses. Patients with liver disease and iron overload are at risk of more severe disease manifestations. Case Report. A middle-aged male with chronic alcohol use disorder presented with confusion and jaundice, with ascites and asterixis noted on examination. His blood work was remarkable for neutrophilic leukocytosis, elevated liver enzymes and lactate. An abdominal computed tomography scan revealed splenic microabscesses and a cirrhotic liver. Yersinia pseudotuberculosis was recovered from his blood cultures and he was treated with ceftriaxone following susceptibility results. Conclusion. Y. pseudotuberculosis should be considered in the differential diagnosis of splenic or other extraintestinal microabscesses particularly in patients with chronic liver disease.
    Type of Medium: Online Resource
    ISSN: 2516-8290
    URL: Article
    DOI: 10.1099/acmi.0.000525.v3
    Language: English
    Publisher: Microbiology Society
    Publication Date: 2023
    detail.hit.zdb_id: 2973602-X
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  • 2
    Online Resource
    Online Resource
    Abstract T P324: Prehospital Neurological Deterioration Predicts Intracerebral Hemorrhage
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Introduction: Elevated hospital admission blood pressure (BP) has been associated with early neurological deterioration (END) in acute stroke patients. We tested the hypothesis that higher prehospital BP is also associated with END. Methods: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP and GCS measurements, of all patients transported by Emergency Transport Services (EMS) to the Emergency Department (ED) of a single hospital during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging were utilized to determine final diagnosis of ischemic stroke (IS), intracerebral hemorrhage (ICH), and early death (prior to discharge). END was defined as ≥2 point drop in Glasgow Coma Scale (GCS) score prior to hospital arrival. Results: A total of 877 patients were transported by EMS to the ED with suspected stroke. Of these, 420 patients had a final diagnosis of acute stroke (360 IS, 60 ICH). Mean ± SD prehospital SBP was higher in ICH (172 ± 32 mmHg) than IS patients (155 ± 27 mmHg, p 〈 0.001). Initial median (IQR) GCS was lower in ICH (13(5)) than IS patients (15(2), p=0.001). Prehospital END was more common in ICH (9/60 (14.8%) than IS (2/360 (0.6%), p 〈 0.001). Univariate logistic regression indicated that prehospital END predicted the diagnosis of ICH (OR 5.6 (95% CI: 2.6-12.2)). Mean prehospital SBP was similar in patients with (171 ± 39 mmHg) and without END (158 ± 28 mmHg, p=0.29). SBP change during EMS transport was similar in patients with END (-5 (25) mmHg) than those without (-2 (23) mmHg, p=0.88). Prehospital END was more common in those who died (11.8%) than those who survived (0.8%, p=0.001). Mean prehospital SBP was higher in patients who died (166 ± 35 mmHg) than those who survived (157 ± 7 mmHg, p=0.04). Early death occurred more often in ICH (43%) than IS (12.5%, p 〈 0.001). Conclusion: Prehospital END is predictive of ICH. Although mean prehospital BP was not higher in patients with END in this retrospective study, it was associated with early death, which is supportive of the hypothesis that elevated prehospital BP may be an acute treatment target.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.tp324
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 3
    Online Resource
    Online Resource
    Abstract TP73: Lower Prehospital Blood Pressure Is Not Associated with Larger Infarct Volumes in Non-lacunar Ischemic Stroke Patients
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Stroke Vol. 47, No. suppl_1 ( 2016-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 47, No. suppl_1 ( 2016-02)
    Abstract: Background: Although prehospital blood pressure (BP)-lowering trials in acute stroke have begun, concerns persist that hypotension may exacerbate hypoperfusion and increase infarct volumes, particularly in non-lacunar stroke. We tested the hypothesis that lower prehospital BP is associated with larger infarct volumes in non-lacunar ischemic stroke. Methods: We conducted a retrospective study of consecutive patients with suspected stroke transported by Emergency Medical Services (EMS) during an 18-month period. Serial prehospital BP data were obtained from a centralized EMS database. Hospital charts and neuroimaging were reviewed. Stroke etiology was classified using TOAST criteria. Infarct volumes were measured on follow-up MRI or CT using semi-automated thresholding planimetric techniques by two independent raters, blinded to prehospital BP. Results: Of a total 960 patients transported by EMS, 367 had a final diagnosis of ischemic stroke. Stroke etiology was large artery disease in 51 patients, cardioembolic in 140, lacunar in 44, other determined etiology in 22, and cryptogenic in 110 patients. Follow-up imaging was available in 315 patients (163 MR, 152 CT) at a median (IQR) 1(1) days. The overall median non-lacunar infarct volume was 16.5 (49.6) ml, median NIHSS was 7(10), and mean prehospital SBP was 153 ± 25 mmHg. Mean prehospital SBP was lower in patients with other determined etiology (133.2 ± 26.1 mmHg, p 〈 0.01) than cardioembolic (150.9 ± 25.5 mmHg), large artery disease (157.1 ± 26.1 mmHg) and cryptogenic stroke (157.7 ± 22.9 mmHg). Median infarct volume was similar across categories of stroke etiology (large artery disease (16.3 (60.3) ml), cardioembolic (19.9 (76.2) ml), other determined etiology (23.9 (33.6) ml), and cryptogenic stroke (11.5 (35.9) ml), p=0.12). There was no correlation between mean prehospital SBP and mean infarct volume (r =-0.06, p=0.33). NIHSS score was correlated with mean infarct volume (r=0.6, p 〈 0.001), but not mean prehospital SBP (r=-0.07, p=0.24). Conclusion: These data provide no evidence to suggest that lower prehospital BP is associated with larger infarct volumes in patients with non-lacunar ischemic stroke. The effect of BP reduction on infarct volumes should be assessed as part of randomized trials.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.47.suppl_1.tp73
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
    detail.hit.zdb_id: 1467823-8
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  • 4
    Online Resource
    Online Resource
    Critical race theory in medicine
    CMA Impact Inc. ; 2021
    In:  Canadian Medical Association Journal Vol. 193, No. 20 ( 2021-05-17), p. E739-E741
    Details
    In: Canadian Medical Association Journal, CMA Impact Inc., Vol. 193, No. 20 ( 2021-05-17), p. E739-E741
    Type of Medium: Online Resource
    ISSN: 0820-3946 , 1488-2329
    URL: Article
    DOI: 10.1503/cmaj.210178
    Language: English
    Publisher: CMA Impact Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2028772-0
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  • 5
    Online Resource
    Online Resource
    Prehospital systolic blood pressure is higher in acute stroke compared with stroke mimics
    Ovid Technologies (Wolters Kluwer Health) ; 2016
    In:  Neurology Vol. 86, No. 23 ( 2016-06-07), p. 2146-2153
    Details
    In: Neurology, Ovid Technologies (Wolters Kluwer Health), Vol. 86, No. 23 ( 2016-06-07), p. 2146-2153
    Abstract: To assess the natural history of prehospital blood pressure (BP) during emergency medical services (EMS) transport of suspected stroke and determine whether prehospital BP differs among types of patients with suspected stroke (ischemic stroke, TIA, intracerebral hemorrhage [ICH], or stroke mimic). Methods: A retrospective, cross-sectional, observational analysis of a centralized EMS database containing electronic records of patients transported by EMS to the emergency department (ED) with suspected stroke during an 18-month period was conducted. Hospital charts and neuroimaging were utilized to determine the final diagnosis (ischemic stroke, TIA, ICH, or stroke mimic). Results: A total of 960 patients were transported by EMS to ED with suspected stroke. Stroke was diagnosed in 544 patients (56.7%) (38.2% ischemic stroke, 12.2% TIA, 5.3% ICH) and 416 (43.2%) were considered mimics. Age-adjusted mean prehospital systolic BP (SBP) was higher in acute stroke patients (155.6 mm Hg; 95% confidence interval [CI]: 153.4–157.9 mm Hg) compared to mimics (146.1 mm Hg; 95% CI: 142.5–148.6 mm Hg; p 〈 0.001). Age-adjusted mean prehospital SBP was higher in ICH (172.3 mm Hg; 95% CI: 165.1–179.7 mm Hg) than in either ischemic stroke or TIA (154.7 mm Hg; 95% CI: 152.3–157.0 mm Hg; p 〈 0.001). Median (interquartile range) SBP drop from initial prehospital SBP to ED SBP was 4 mm Hg (−6 to 17 mm Hg). Mean prehospital SBP was strongly correlated with ED SBP ( r = 0.82, p 〈 0.001). Conclusions: Prehospital SBP is higher in acute stroke relative to stroke mimics and highest in ICH. Given the stability of BP between initial EMS and ED measurements, it may be reasonable to test the feasibility and safety of prehospital antihypertensive therapy in patients with suspected acute stroke.
    Type of Medium: Online Resource
    ISSN: 0028-3878 , 1526-632X
    URL: Article
    DOI: 10.1212/WNL.0000000000002747
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2016
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  • 6
    Online Resource
    Online Resource
    Abstract 91: Prehospital Blood Pressure Differentiates Acute Stroke From Mimics
    Ovid Technologies (Wolters Kluwer Health) ; 2015
    In:  Stroke Vol. 46, No. suppl_1 ( 2015-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 46, No. suppl_1 ( 2015-02)
    Abstract: Introduction: Elevated hospital admission blood pressure (BP) in acute stroke is common and associated with poor outcomes. The natural history of BP in suspected stroke patients in the prehospital setting is unknown. We tested the hypothesis that prehospital BP values are higher in acute stroke patients, relative to stroke mimics. Methods: We conducted a retrospective analysis of a prospectively-maintained centralized database of electronic patient health care reports (ePCR), including serial BP measurements, of all patients transported by Emergency Medical Services (EMS) to the Emergency Department (ED) of a single hospital with acute stroke symptoms during an 18-month period. All patients with an EMS dispatch code for suspected stroke were included. Hospital charts and neuroimaging review were utilized to determine final diagnosis of ischemic stroke, transient ischemic attack (TIA), intracerebral hemorrhage (ICH) or stroke mimic. BP data was analyzed by one-way ANOVA followed by Tukey’s test for independent comparisons. Results: A total of 877 patients were transported by EMS to the ED with suspected stroke. Median (IQR) time from symptom onset to first BP measurement was 70.5 (204) minutes. The final diagnosis was stroke in 524 (59.7%) patients (41.0% ischemic stroke, 11.7% TIA, 7.0% ICH) and 354 (40.4%) were considered mimics. Mean ± SD prehospital SBP was higher in acute stroke patients (155 ± 31 mmHg) compared to stroke mimics (143 ± 32 mmHg), p 〈 0.001). Mean prehospital SBP was higher in ICH (171 ±33 mmHg, p=0.001) than both ischemic stroke (155 ± 27 mmHg) and TIA (153 ± 23 mmHg). SBP remained stable during EMS transport in all patients (median -3 (22) mmHg), p=0.16). Mean prehospital SBP was correlated with ED SBP (R=0.85, p 〈 0.001). Mean SBP at ED arrival was higher in acute stroke patients (ICH: 170 ± 34 mmHg, ischemic stroke: 154 ± 30 mmHg, TIA: 153 ± 26 mmHg) than stroke mimics (142 ± 28 mmHg), p 〈 0.001). Conclusion: Higher prehospital SBP differentiates acute stroke from stroke mimics. Blood pressures are highest in ICH patients. Prehospital BP remains stable until ED arrival. Elevated prehospital BP may help identify patients with acute stroke. Acute BP elevation may also represent an acute prehospital treatment target.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.46.suppl_1.91
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2015
    detail.hit.zdb_id: 1467823-8
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  • 7
    Online Resource
    Online Resource
    SURG-22. QUALITY BASED ASSESSMENT OF THE COST-EFFECTIVENESS OF 5-ALA IN HIGH GRADE GLIOMA SURGERY: A SYSTEMATIC REVIEW
    Oxford University Press (OUP) ; 2017
    In:  Neuro-Oncology Vol. 19, No. suppl_6 ( 2017-11-06), p. vi240-vi240
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 19, No. suppl_6 ( 2017-11-06), p. vi240-vi240
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/nox168.978
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2017
    detail.hit.zdb_id: 2094060-9
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  • 8
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    Online Resource
    La théorie critique de la race en médecine
    CMA Impact Inc. ; 2021
    In:  Canadian Medical Association Journal Vol. 193, No. 32 ( 2021-08-16), p. E1286-E1288
    Details
    In: Canadian Medical Association Journal, CMA Impact Inc., Vol. 193, No. 32 ( 2021-08-16), p. E1286-E1288
    Type of Medium: Online Resource
    ISSN: 0820-3946 , 1488-2329
    URL: Article
    DOI: 10.1503/cmaj.210178-f
    Language: English
    Publisher: CMA Impact Inc.
    Publication Date: 2021
    detail.hit.zdb_id: 2028772-0
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  • 9
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    Online Resource
    Enhanced postoperative surveillance versus standard of care to reduce mortality among adult surgical patients in Africa (ASOS-2): a cluster-randomised controlled trial
    Elsevier BV ; 2021
    In:  The Lancet Global Health Vol. 9, No. 10 ( 2021-10), p. e1391-e1401
    Details
    In: The Lancet Global Health, Elsevier BV, Vol. 9, No. 10 ( 2021-10), p. e1391-e1401
    Type of Medium: Online Resource
    ISSN: 2214-109X
    URL: Article
    DOI: 10.1016/S2214-109X(21)00291-6
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
    detail.hit.zdb_id: 2723488-5
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  • 10
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    The Cost-Effectiveness of 5-ALA in High-Grade Glioma Surgery: A Quality-Based Systematic Review
    Cambridge University Press (CUP) ; 2020
    In:  Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques Vol. 47, No. 6 ( 2020-11), p. 793-799
    Details
    In: Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, Cambridge University Press (CUP), Vol. 47, No. 6 ( 2020-11), p. 793-799
    Abstract: Le rapport coût-efficacité de l’utilisation de l’acide delta-aminolévulinique dans le cas d’interventions chirurgicales visant des gliomes de grades élevés : un examen systématique fondé sur la qualité . Contexte: Les gliomes de grades élevés (GGE) sont des tumeurs agressives qui vont inévitablement se reproduite en raison de leur nature diffuse et invasive. Des compléments peropératoires comme l’acide delta-aminolévulinique (ALA-5) ont par ailleurs montré des promesses intéressantes en permettant d’augmenter l’étendue de la résection. Étant donné que la perspective d’une utilisation accrue de l’ALA-5 est à la hausse, il nous semble qu’un examen systématique de ses aspects économiques demeure essentiel. Méthodes: Au moyen de mots clés se rapportant à « gliome », « rapport coût-efficacité » et « ALA-5 », nous avons tout d’abord interrogé les bases de données suivantes : Medline, EMBASE, Centre for Reviews and Dissemination (CRD), EconPapers et Cochrane. À ce sujet, nous avons inclus des études principales faisant état des aspects économiques ou du rapport coût-efficacité de l’ALA-5 en comparaison avec une intervention chirurgicale à la lumière blanche ( white-light surgery) dans le cas de GGE. Signalons que l’aspect qualitatif de notre examen a été évalué à l’aide des lignes directrices du British Medical Journal (BMJ). Résultats: Au total, nous avons pu identifier trois études, toutes d’origine européenne, menées dans le cadre de systèmes de soins de santé nationaux. Deux d’entre elles ont démontré un meilleur rapport coût-utilité en ce qui regarde l’ALA-5 si on le compare à la lumière blanche (12 817 $ CA et 13 508 $ / AVAQ). Ces deux montants se sont révélés en dessous des seuils nationaux de rentabilité pour chacune de ces études respectives. Une autre étude s’est aussi penchée sur le rapport coût-utilité par résection totale brute (6 813 $ CA). Elle n’a démontré aucune différence notable en ce qui a trait au coût de l’ALA-5 dans la résection des GGE (14 732 $ CA) si on la compare à une utilisation antérieure de routine (15 936 $ CA). Enfin, rappelons que la qualité de ces études variait de modérée à moyenne ; de plus, aucune d’entre elles n’a tenu compte dans son analyse de la perspective des patients ou des coûts indirects. Conclusions: Dans les cas de résection de GGE, il existe des preuves de plus en plus nombreuses quant aux avantages économiques de l’ALA-5 à titre de complément peropératoire. Cela dit, des études additionnelles menées dans le contexte canadien et mettant l’accent sur l’utilisation de l’ALA-5, études qui incluraient spécifiquement des perspectives sociétales ainsi que celles de patients dans des analyses coût-utilité, demeurent nécessaires pour renforcer ces preuves.
    Type of Medium: Online Resource
    ISSN: 0317-1671 , 2057-0155
    URL: Article
    DOI: 10.1017/cjn.2020.78
    RVK:
    XA 10000
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2577275-2
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