Emergency Unit

Montréal, Canada

Emergency Unit

Montréal, Canada
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Alvarez P.,Hospital Clinico Metropolitano la Florida | Alvarez P.,Finis Terrae University | Alvarez P.,University of Chile | Tapia L.,University of Chile | And 5 more authors.
Chemico-Biological Interactions | Year: 2014

Ischemia-reperfusion (IR) cycle in the myocardium is associated with activation of an injurious cascade, thus leading to new myocardial challenges, which account for up to 50% of infarct size. Some evidence implicates reactive oxygen species (ROS) as a probable cause of myocardial injury in prooxidant clinical settings. Damage occurs during both ischemia and post-ischemic reperfusion in animal and human models. The mechanisms that contribute to this damage include the increase in cellular calcium (Ca2+) concentration and induction of ROS sources during reperfusion. Pharmacological preconditioning, which includes pharmacological strategies that counteract the ROS burst and Ca2+ overload followed to IR cycle in the myocardium, could be effective in limiting injury. Currently widespread evidence supports the use of anesthetics agents as an important cardioprotective strategy that act at various levels such as metabotropic receptors, ion channels or mitochondrial level. Their administration before a prolonged ischemic episode is known as anesthetic preconditioning, whereas when given at the very onset of reperfusion, is termed anesthetic postconditioning. Both types of anesthetic conditioning reduce, albeit not to the same degree, the extent of myocardial injury. This review focuses on cellular and pathophysiological concepts on the myocardial damage induced by IR and how anesthetic pharmacological agents commonly used could attenuate the functional and structural effects induced by oxidative stress in cardiac tissue. © 2014 Elsevier Ireland Ltd. All rights reserved.

Laicini E.,Emergency Unit
International Journal of Food Sciences and Nutrition | Year: 2014

Recent findings suggest that an early exposure to dietary antigens may be more protective towards allergy than a later introduction even in high-risk infants. The consequent earlier introduction of food items such as egg yolk and oily fish, together with breastfeeding continuation through the first year, could contribute to reducing protein and increasing fat supply, respectively. These changes might have a role in the overall prevention of non-communicable disorders of adulthood. © 2014 Informa UK Ltd.

Shokri A.,Hamadan University of Medical Sciences | Mortazavi H.,Shahid Beheshti University of Medical Sciences | Salemi F.,Hamadan University of Medical Sciences | Javadian A.,Hamadan University of Medical Sciences | And 2 more authors.
Biomedical Journal | Year: 2013

Background: Diagnosis of external root resorption (ERR) cavities may be challenging, especially when no clinical signs are seen. Therefore, the aim of this study was to compare the efficacy of conventional intraoral film radiography, charge-coupled device (CCD) detector, photostimulable phosphor plate (PSP) detector, and cone beam computed tomography (CBCT) for the detection of ERR. Methods: The study sample comprised 54 maxillary first premolars. Cavities were created by using a low-speed handpiece with round diamond burs of 1 mm in diameter. Digital and conventional radiographs were taken from each tooth. Three observers examined all images for the presence of resorption cavities. Data were statistically analyzed with the χ2 test. The reliability and degrees of agreement were also determined by the mean of Cohen′s Kappa analysis. Results: The differences between the imaging methods in correct detection of root resorption for all sizes were not significant. For locations of root resorption, significant differences were found between CBCT and other methods in the apical regions. Conclusions: CBCT was only useful for detection of cavities located in the apical one-third of the root, compared to other digital or conventional methods.

PubMed | Emergency Unit, University of Pavia, Molecular Virology Unit and University of Milan
Type: Journal Article | Journal: PloS one | Year: 2015

In order to investigate the genetic diversity and patterns of the co-circulating genotypes of respiratory syncytial virus (RSV) and their possible relationships with the severity of RSV infection, we studied all of the RSV-positive nasopharyngeal samples collected from children during five consecutive winters (2009-2010, 2010-2011, 2011-2012, 2012-2013 and 2013-2014). The RSVs were detected using the respiratory virus panel fast assay and single-tube RT-PCR, their nucleotides were sequenced, and they were tested for positive selection. Of the 165 positive samples, 131 (79.4%) carried RSV-A and 34 (20.6%) RSV-B; both groups co-circulated in all of the study periods, with RSV-A predominating in all the seasons except for winter 2010-2011, which had a predominance of RSV-B. Phylogenetic analysis of the RSV-A sequences identified genotypes NA1 and ON1, the second replacing the first during the last two years of the study period. The RSV-B belonged to genotypes BA9 and BA10. BA9 was detected in all the years of the study whereas BA only desultorily. Comparison of the subjects infected by RSV-A and RSV-B types did not reveal any significant differences, but the children infected by genotype A/NA1 more frequently had lower respiratory tract infections (p<0.0001) and required hospitalisation (p = 0.007) more often than those infected by genotype A/ON1. These findings show that RSV has complex patterns of circulation characterised by the periodical replacement of the predominant genotypes, and indicate that the circulation and pathogenic role of the different RSV strains should be investigated as each may have a different impact on the host. A knowledge of the correlations between types, genotypes and disease severity may also be important in order to be able to include the more virulent strains in future vaccines.

PubMed | Emergency Unit, University of Pavia, Molecular Virology Unit and University of Milan
Type: Journal Article | Journal: PloS one | Year: 2015

To evaluate the role of human bocavirus (hBoV) as a causative agent of respiratory disease, the importance of the viral load in respiratory disease type and severity and the pathogenicity of the different hBoV species, we studied all hBoV-positive nasopharyngeal samples collected from children who attended an emergency room for a respiratory tract infection during three winters (2009-2010, 2011-2012, and 2013-2014). Human bocavirus was detected using the respiratory virus panel fast assay and real-time PCR. Of the 1,823 nasopharyngeal samples, 104 (5.7%) were positive for hBoV; a similar prevalence was observed in all three periods studied. Among hBoV-infected children, 53.8% were between 1-2 years old, and hBoV was detected alone in 57/104 (54.8%) cases. All of the detected hBoV strains belonged to genotype 1. The median hBoV load was significantly higher in samples containing strains with both the N546H and T590S mutations compared to other samples (p<0.05). Children with a single hBoV-1 infection more frequently had upper respiratory tract infections (URTIs) than those who were co-infected (37.0% vs 17.8%, respectively, p = 0.04). The duration of hospitalization was longer among children with high viral loads than that observed among children with low viral loads (8.0 2.2 days vs 5.0 1.5 days, respectively, p = 0.03), and the use of aerosol therapy was more frequent among children with high viral loads than among those with low viral loads (77.1% vs 55.7%, respectively, p = 0.04). This study shows that hBoV is a relatively uncommon but stable infectious agent in children and that hBoV1 seems to be the only strain detected in Italy in respiratory samples. From a clinical point of view, hBoV1 seems to have in the majority of healthy children relatively low clinical relevance. Moreover, the viral load influences only the duration of hospitalization and the use of aerosol therapy without any association with the site of the respiratory disease.

Milani G.P.,Emergency Unit | Mazzoni M.B.M.,Emergency Unit | Burdick L.,Foundation Medicine | Bianchetti M.G.,Emergency Unit | Fossali E.F.,Emergency Unit
American Journal of Kidney Diseases | Year: 2010

Imaging studies show entrapment of the left renal vein in the fork between the aorta and proximal superior mesenteric artery in most cases of isolated postural proteinuria. Therefore, it has been postulated that partial obstruction to the flow in the left renal vein in the upright position is a cause of this form of proteinuria. In a girl with isolated postural proteinuria, kidney ultrasonic imaging and Doppler flow scanning showed left renal vein entrapment. Seven years later, a new evaluation showed resolution of both postural proteinuria and left renal vein entrapment. The longitudinal observation provides substantial additional support for entrapment of the left renal vein by the aorta and superior mesenteric artery as a cause of isolated postural proteinuria. © 2010 National Kidney Foundation, Inc.

PubMed | Emergency Unit, Rega Institute for Medical Research and University Hospitals Leuven
Type: Journal Article | Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology | Year: 2016

Hantavirus infections, recently renamed hantavirus fever (HTVF), belong to the most common but also most underestimated zoonoses in the world. A small number of reports described the so-called lipid paradox in HTVF, i.e. the striking contrast between a very low serum total cholesterol and/or high-density lipoprotein cholesterol (HDLc), and a paradoxical concomitant hypertriglyceridaemia. In a prospective study, with patients being their own control after illness, we wanted to verify if this quick and easy bedside test was robust enough to warrant a preliminary diagnosis of acute kidney injury (AKI) caused by HTVF. The study cohort consisted of 58 Belgian cases (mean age 44years), admitted with varying degrees of AKI and of thrombocytopaenia, both characteristic for presumptive HTVF. All cases were sero-confirmed as having acute HTVF. At or shortly after hospital admission, a significant (p<0.001) decrease of total cholesterol and HDLc was found in comparison with normalised levels in the same cohort, quantified a few days after spontaneous AKI recovery. Conversely, fasting triglyceride levels during HTVF infection were significantly (p<0.001) higher during illness than after recovery. This lipid paradox was most outspoken in severe HTVF cases, often accompanying, or even predicting, major kidney or lung complications. Thus, this bedside assessment seems to hold even promise for presumptive diagnosis of more severe so-called hantavirus cardio-pulmonary syndrome (HCPS) cases, mostly described hitherto in the New World. In more severe AKI cases, the mean total cholesterol was significantly lower (p=0.02) than in milder cases, i.e. cases with peak serum creatinine levels of<1.5mg/dL. Thrombocytopaenia, generally accepted as the severity index in HTVF, appeared, moreover, significantly correlated with serum levels of total cholesterol (R=0.52, p<0.001) and with serum levels of HDLc (R=0.45, p<0.01). A link with the novel clinical entity of haemophagocytic syndromes, also characterised by manifest hypertriglyceridaemia, is discussed.

Chouchou F.,University of Montréal | Chouchou F.,Center for Advanced Research in Sleep Medicine | Khoury S.,University of Montréal | Khoury S.,Center for Advanced Research in Sleep Medicine | And 8 more authors.
Sleep Medicine Reviews | Year: 2014

Despite the substantial advances in the understanding of pain mechanisms and management, postoperative pain relief remains an important health care issue. Surgical patients also frequently report postoperative sleep complaints. Major sleep alterations in the postoperative period include sleep fragmentation, reduced total sleep time, and loss of time spent in slow wave and rapid eye movement sleep. Clinical and experimental studies show that sleep disturbances may exacerbate pain, whereas pain and opioid treatments disturb sleep. Surgical stress appears to be a major contributor to both sleep disruptions and altered pain perception. However, pain and the use of opioid analgesics could worsen sleep alterations, whereas sleep disruptions may contribute to intensify pain. Nevertheless, little is known about the relationship between postoperative sleep and pain. Although the sleep-pain interaction has been addressed from both ends, this review focuses on the impact of sleep disruptions on pain perception. A better understanding of the effect of postoperative sleep disruptions on pain perception would help in selecting patients at risk for more severe pain and may facilitate the development of more effective and safer pain management programs. © 2013 Elsevier Ltd.

Milani G.,Emergency Unit | Ragazzi M.,University of Bern | Simonetti G.D.,University of Bern | Ramelli G.P.,University of Bern | And 3 more authors.
British Journal of Clinical Pharmacology | Year: 2010

Aims To compare the taste of equivalent doses of pulverized amlodipine and lercanidipine, two calcium channel blockers, among children with kidney disease. Methods Each child received a test dose of 1 mg of amlodipine besylate and 2 mg of lercanidipine in a single-blinded fashion. Children indicated their preference by pointing to the appropriate face on a visual analogue scale (VAS) that depicts five degrees of pleasure. Results The VAS palatability score assigned to lercanidipine was higher than that assigned to amlodipine both in nine children 4-7 years of age (P < 0.005) and in 10 children 8-11 years of age (P < 0.005). The preference for lercanidipine was statistically significant in both girls (P < 0.02) and boys (P < 0.001) and in both children initially presented amlodipine (P < 0.005) and children initially presented lercanidipine (P < 0.005). Conclusions There is a lack of appropriate formulations for children prescribed drugs originally designed for adults, such as calcium channel blockers. Parents therefore crush available tablets and administer the medication mixed with solid food or a palatable drink. From the perspective of the child, the taste of pulverized lercanidipine is superior to that of pulverized amlodipine. © 2010 The British Pharmacological Society.

Agostoni C.,University of Milan | Baselli L.,University of Milan | Mazzoni M.B.,Emergency Unit
European Journal of Internal Medicine | Year: 2013

In the last decades several studies tested the hypothesis that at early development stages certain foods or nutrients, in specific amounts, fed during limited sensitive periods, may determine an endocrine metabolic asset leading to clinical alterations that take place decades later (early nutritional programming of long term health). Evidence is mounting for programming effects of infant feeding. Observational studies indicate that breast feeding, relative to formula feeding, reduces the risk for obesity at school age by about 20% even after adjustment for biological and sociodemographic confounders. Moreover, breastfeeding is constantly associated with increased neurodevelopmental scores up to early adulthood, while its outcome in terms of delayed decay of brain function is still unknown. Besides the environment surrounding breastfeeding, specific nutrients within human milk may play a direct role. With the introduction of solids the major changes in diet are represented by the sudden decrease of fat intake from 50 to 30% of total energy. A protein excess, commonly found throughout all European Countries, has been associated to a higher risk of adiposity in early childhood, as confirmed by first reports from a large European trial. The amount of fat does not seem to be associated with later adiposity, while its quality may affect blood lipoproteins, blood pressure and neurodevelopmental performance. Early intake of dietary fibers might also have beneficial effects. Epidemiologic data show that episodes of rapid growth (growth acceleration hypothesis), whichever the dietary habits, are associated with later unfavorable health conditions and should be prevented. © 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

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