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Chili Pepper Consumption And Cardiovascular Mortality, J. David Spence

Department of Medicine Publications

No abstract provided.

Trimethylamine N-Oxide: Not Just Red Meat - Egg Yolk And Renal Function Are Also Important, J. David Spence

Department of Medicine Publications

No abstract provided.

Registration Of Amiloride In South Africa: Cutting The Gordian Knot, B. L. Rayner, J. D. Spence, A. Bryer, M. T. Mpe

Department of Medicine Publications

Amiloride is an antagonist of the renal tubular epithelial sodium channel (ENaC). As such, it is a diuretic that is both potassium and magnesium sparing. It is used for the treatment of potassium depletion and hypertension, and is the specific therapy for hypertension due to overactivity of the ENaC (Liddle syndrome and several additional genetic causes of the Liddle phenotype - low renin and low aldosterone). It is listed as a World Health Organization essential drug, but has never been registered in South Africa (SA) and can therefore only be prescribed under a Section 21 application to the SA Health …

Perioperative Venous Thromboembolism Prophylaxis In Prostate Cancer Surgery, Zachary Klaasson, Christopher J.D. Wallis, Luke T. Lavallee, Philippe D. Violette

Department of Medicine Publications

Purpose

To describe a patient and procedure specific approach to selecting Venous thromboembolism (VTE) prophylaxis for men who undergo radical prostatectomy.

Methods

We performed a literature search and narrative review of VTE after radical prostatectomy. We describe the current paradigm of perioperative thromboprophylaxis and underlying rationale. Relevant findings from the European Association of Urology thromboprophylaxis guidelines are interpreted and summarized.

Results

The use of extended post-operative thromboprophylaxis for patients who undergo radical prostatectomy is appropriate when the risk of symptomatic VTE outweighs the risk of major bleeding. Patient and procedure factors impact VTE risk. Patient risk can be stratified as …

Antiplatelet Therapy In Ischemic Stroke And Transient Ischemic Attack: An Overview Of Major Trials And Meta-Analyses, Daniel G. Hackam, J. David Spence

Department of Medicine Publications

No abstract provided.

Nutrition And Risk Of Stroke, J. David Spence

Department of Medicine Publications

Nutrition is far more important in stroke risk than most physcians suppose. Healthy lifestyle choices reduce the risk of stroke by ~80%, and of the factors that increase the risk of stroke, the worst is diet: only ~0.1% of Americans consume a healthy diet, and only 8.3% consume a somewhat healthy diet. The situation is probably not much better in most other countries. A Cretan Mediterranean diet, high in olive oil, whole grains, fruits, vegetables and legumes, and low in cholesterol and saturated fat, can reduce stroke by 40% or more in high-risk patients. The role of the intestinal microbiome …

Assessment Of A Novel 32-Channel Phased Array For Cardiovascular Hybrid Pet/Mri Imaging: Mri Performance., Adam Farag, R Terry Thompson, Jonathan D Thiessen, John Butler, Frank S Prato, Jean Theberge

Department of Medicine Publications

BACKGROUND: Cardiovascular imaging using hybrid positron emission tomography (PET) and magnetic resonance imaging (MRI) requires a radio frequency phased array resonator capable of high acceleration factors in order to achieve the shortest breath-holds while maintaining optimal MRI signal-to-noise ratio (SNR) and minimum PET photon attenuation. To our knowledge, the only two arrays used today for hybrid PET/MRI cardiovascular imaging are either incapable of achieving high acceleration or affect the PET photon count greatly.

PURPOSE: This study is focused on the evaluation of the MRI performance of a novel third-party prototype 32-channel phased array designed for simultaneous PET/MRI cardiovascular imaging. The …

Overlapping Frontoparietal Networks In Response To Oculomotion And Traumatic Autobiographical Memory Retrieval: Implications For Eye Movement Desensitization And Reprocessing., Sherain Harricharan, Margaret C Mckinnon, Mischa Tursich, Maria Densmore, Paul Frewen, Jean Theberge, Bessel Van Der Kolk, Ruth A Lanius

Department of Medicine Publications

Background: Oculomotor movements have been shown to aid in the retrieval of episodic memories, serving as sensory cues that engage frontoparietal brain regions to reconstruct visuospatial details of a memory. Frontoparietal brain regions not only are involved in oculomotion, but also mediate, in part, the retrieval of autobiographical episodic memories and assist in emotion regulation. Objective: We sought to investigate how oculomotion influences retrieval of traumatic memories by examining patterns of frontoparietal brain activation during autobiographical memory retrieval in post-traumatic stress disorder (PTSD) and in healthy controls. Method: Thirty-nine participants (controls, n = 19; PTSD, n = 20) recollected both …

Vitamin B12 Deficiency And Hyperhomocysteinemia In Outpatients With Stroke Or Transient Ischemic Attack: A Cohort Study At An Academic Medical Centre, Shamon Ahmed, Chrysi Bogiatzi, Daniel G. Hackam, Angela C. Rutledge, Luciano A. Sposato, Alexander Khaw, Jennifer Mandzia, Mahmoud Reza Azarpazhoo, Vladimir Hachinski, J. David Spence

Department of Medicine Publications

Objective We sought to assess the current magnitude of the opportunity for secondary stroke prevention with B vitamins. Design A cohort study. Setting The Urgent TIA (Transient Ischaemic Attack) Clinic at an academic medical centre. Main outcome measures We assessed the prevalence of biochemical vitamin B 12 deficiency (B 12 Def, serum B 12 <156 pmol/L), hyperhomocysteinaemia (HHcy; plasma total homocysteine [tHcy] >14 μmol/L) and metabolic B 12 deficiency (MetB 12 Def, serum B 12 <258 pmol/L and HHcy) between 2002 and 2017, by age group and by stroke subtype. Results Data were available in 4055 patients. B 12 Def was present in 8.2% of patients overall; it declined from 10.9% of patients referred before 2009 to 5.4% thereafter (p=0.0001). MetB 12 Def was present in 10.6% of patients, and HHcy was present in 19.1% of patients. Among the patients aged ≥80 years, MetB 12 Def was present in 18.1% and HHcy in 35%. Among the 3410 patients whose stroke subtype was determined, HHcy was present in 18.4% of patients: 23.3% of large artery atherosclerosis, 18.1% of cardioembolic, 16.3% of small vessel disease, 10.8% of other unusual aetiologies and 13.6% of undetermined subtypes (p=0.0001). Conclusions Despite a decline in our referral area since 2009, B 12 Def, MetB 12 Def and HHcy remain common in patients with stroke/TIA. Because these conditions are easily treated and have serious consequences, all patients with stroke/TIA should have their serum B 12 and tHcy measured.

Blood Pressure Gradients In The Brain: Their Importance To Understanding Pathogenesis Of Cerebral Small Vessel Disease, J. David Spence

Department of Medicine Publications

The term “lacunar infarction” referred to small infarctions in the basal ganglia, internal capsule, thalamus, and brainstem, due to hypertensive small vessel disease. However, it has become common to refer to all small infarctions as “vascular centrencephalon”, where short straight arteries with few branches transmit high blood pressure straight through to end-arterioles. The cortex is supplied by long arteries with many branches, so there is a very large blood pressure gradient in the brain. When blood pressure in the brachial artery is 117/75 mmHg, the pressure in the lenticulostriate artery would be 113/73, and the pressure in small parietal arterioles …

Harm With High Levels Of Serum B12 In Elderly Persons, J. David Spence

Department of Medicine Publications

No abstract provided.