Trigatti B.L.,Hamilton Health Sciences
Current Opinion in Lipidology | Year: 2017
PURPOSE OF REVIEW: To outline the roles of SR-B1 and PDZK1 in hepatic selective HDL cholesterol uptake and reverse cholesterol transport and the consequences for atherosclerosis development. RECENT FINDINGS: Much of our understanding of the physiological roles of SR-B1 and PDZK1 in HDL metabolism and atherosclerosis comes from studies of genetically manipulated mice. These show SR-B1 and PDZK1 play key roles in HDL metabolism and protection against atherosclerosis. The recent identification of rare loss of function mutations in the human SCARB1 gene verifies that it plays similar roles in HDL metabolism in humans. Other rare mutations in both the human SCARB1 and PDZK1 genes remain to be characterized but may have potentially devastating consequences to SR-B1 function. SUMMARY: Identification of carriers of rare mutations in human SCARB1 and PDZK1 that impair the function of their gene products and characterization of the effects of these mutations on HDL cholesterol levels and atherosclerosis will add to our understanding of the importance of HDL function and cholesterol flux, as opposed to HDL-cholesterol levels, per se, for protection against cardiovascular disease. Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2011.2.4.2-2 | Award Amount: 7.85M | Year: 2011
Biomarkers are considered as tools to enhance cardiovascular risk estimation. However, the value of biomarkers on risk estimation beyond European risk scores, their comparative impact among different European regions and their role in the drive towards personalised medicine remains uncertain. Based on harmonised and standardised European population cohorts we have built significant research collaboration, expertise and infrastructure in the EU. We will apply highly innovative SME-driven technologies and perform large-scale biomarker determination to assess the predictive value of existing and emerging biomarkers. Selection of emerging biomarkers will be based on integrated cutting-edge quantitative proteomic, transcriptomic, metabolomic, and miRNomic datasets established by private and public consortium members that will be disclosed to this consortium. Existing biomarkers will be selected based on non-redundancy and their association with cardiovascular risk and phenotypes. After SME-guided development of innovative assay systems biomarkers will be tested and validated in a stepwise fashion among European populations in primary and secondary prevention. In addition to their impact on risk prediction, their association with lifestyle determinants and cardiovascular phenotypes assessed by ultrasound and MRI technique will be evaluated. We will establish a BiomarCaRE panel which leads to improved disease prediction among different European populations. International collaborations with world-class clinical trial investigators will add data on the interaction of the BiomarCaRE panel with risk-lowering medication and lifestyle changes. The outcome of SME-driven technology development and clinical validation will undergo a medical technology assessment. The determination of cost-effectiveness will guide further clinical evaluation. These studies will reveal new methods of improved cardiovascular risk estimation and will open the path towards personalised medicine.
Vege S.S.,Mayo Medical School |
Ziring B.,Thomas Jefferson University |
Jain R.,Texas Digestive Disease Consultants |
Moayyedi P.,Hamilton Health Sciences
Gastroenterology | Year: 2015
This article has an accompanying continuing medical education activity on page e12. Learning Objective: At the conclusion of this exercise, the learner will understand the approach to counseling patients regarding the optimal method and frequency of radiologic imaging, indications for invasive tests like endoscopic ultrasonography (EUS) and surgery, select patients for follow-up after surgery, decide the duration of such follow-up, and decide when to stop surveillance for those with and without surgery. © 2015 by the AGA Institute.
Agency: European Commission | Branch: FP7 | Program: CP-SICA | Phase: HEALTH-2007-3.5-1 | Award Amount: 3.35M | Year: 2009
Goal: To understand long-term trends of population health as a consequence of socio-economic transitions, with a focus on lifestyle-related issues. Overviews: A unique team with extensive expertise in health effects of transition will generate new knowledge on health determinants in 11 CIS countries: Russia, Belarus, Ukraine, Moldova, Kazakhstan, Uzbekistan, Kyrgyzstan, Armenia, Azerbaijan and Georgia. It employs a model of health determinants acting at individual and societal level, with distal and proximal influences on health. It focuses on alcohol, tobacco, diet, and health care, each linked to diseases specified in the call. Objectives: a) measure and explain prevalence and distribution of risk factors, health outcomes, and their social, cultural, and economic determinants; b) develop and implement validated community profiles to capture the opportunities and obstacles to leading a healthy lifestyle (in relation to diet, alcohol, smoking); c) assess health system performance, focussing on accessibility and quality of health services; d) quantify the cost of ill health through reduced labour supply and productivity; e) identify opportunities for and obstacles to policy change (alcohol and tobacco) in Russia: f) market analysis (alcohol & tobacco); g) regional analysis of alcohol -related mortality in Ukraine. Methods (corresponding to objectives): a) Large scale household surveys, multiple regressions; b&c) Rapid appraisal using structured observation, mapping, media analysis, interviews, focus groups d) econometric modelling (instrumental variables) e) stakeholder analyses f) econometrics g) multivariate analysis Finally, the project will bring concrete benefits by influencing policy in ways that will support health by: disseminating findings within each country and to EU policymakers and international researchers; identifying policy implications based upon informed research.
Nunes M.C.P.,Federal University of Minas Gerais |
Dones W.,Ryder Memorial Hospital |
Morillo C.A.,Hamilton Health Sciences |
Encina J.J.,Hospital Universitario Japones |
Ribeiro A.L.,Federal University of Minas Gerais
Journal of the American College of Cardiology | Year: 2013
Chagas disease, caused by the parasite Trypanosoma cruzi, is a serious health problem in Latin America and is an emerging disease in non-endemic countries. In recent decades, the epidemiological profile of the disease has changed due to new patterns of immigration and successful control in its transmission, leading to the urbanization and globalization of the disease. Dilated cardiomyopathy is the most important and severe manifestation of human chronic Chagas disease and is characterized by heart failure, ventricular arrhythmias, heart blocks, thromboembolic phenomena, and sudden death. This article will present an overview of the clinical and epidemiological aspects of Chagas disease. It will focus on several clinical aspects of the disease, such as chronic Chagas disease without detectable cardiac pathology, as well as dysautonomia, some specific features, and the principles of treatment of chronic cardiomyopathy. © 2013 by the American College of Cardiology Foundation Published by Elsevier Inc.
Connolly B.S.,Hamilton Health Sciences |
Lang A.E.,Toronto Western Hospital |
Lang A.E.,University of Toronto
JAMA - Journal of the American Medical Association | Year: 2014
IMPORTANCE: Parkinson disease is the second most common neurodegenerative disease worldwide. Although no available therapies alter the underlying neurodegenerative process, symptomatic therapies can improve patient quality of life. OBJECTIVE: To provide an evidence-based review of the initial pharmacological management of the classic motor symptoms of Parkinson disease; describe management of medication-related motor complications (such as motor fluctuations and dyskinesia), and other medication adverse effects (nausea, psychosis, and impulse control disorders and related behaviors); and discuss the management of selected nonmotor symptoms of Parkinson disease, including rapid eyemovement sleep behavior disorder, cognitive impairment, depression, orthostatic hypotension, and sialorrhea. EVIDENCE REVIEW: References were identified using searches of PubMed between January 1985 and February 2014 for English-language human studies and the full database of the Cochrane Library. The classification of studies by quality (classes I-IV) was assessed using the levels of evidence guidelines from the American Academy of Neurology and the highest-quality data for each topic. RESULTS: Although levodopa is the most effective medication available for treating the motor symptoms of Parkinson disease, in certain instances (eg, mild symptoms, tremor as the only or most prominent symptom, aged <60 years) other medications (eg, monoamine oxidase type B inhibitors [MAOBIs], amantadine, anticholinergics, β-blockers, or dopamine agonists) may be initiated first to avoid levodopa-related motor complications. Motor fluctuations may be managed by modifying the levodopa dosing regimen or by adding several other medications, such as MAOBIs, catechol-O-methyltransferase inhibitors, or dopamine agonists. Impulse control disorders are typically managed by reducing or withdrawing dopaminergic medication, particularly dopamine agonists. Evidence-based management of some nonmotor symptoms is limited by a paucity of high-quality positive studies. CONCLUSIONS AND RELEVANCE: Strong evidence supports using levodopa and dopamine agonists for motor symptoms at all stages of Parkinson disease. Dopamine agonists and drugs that block dopamine metabolism are effective for motor fluctuations and clozapine is effective for hallucinations. Cholinesterase inhibitors may improve symptoms of dementia and antidepressants and pramipexole may improve depression. Evidence supporting other therapies for motor and nonmotor features is less well established. Copyright 2014 American Medical Association. All rights reserved.
Warkentin T.E.,McMaster University |
Warkentin T.E.,Hamilton Health Sciences
Seminars in Thrombosis and Hemostasis | Year: 2015
Many critically ill patients receive heparin, either before intensive care unit (ICU) admission (e.g., postcardiac surgery), for prophylaxis/treatment of thrombosis, for hemodialysis/filtration, or even incidentally (e.g., flushing of intravascular catheters), and are therefore at risk for developing immune heparin-induced thrombocytopenia (HIT), a prothrombotic drug reaction caused by platelet-activating antiplatelet factor 4 (PF4)/heparin antibodies. However, HIT explains at most 1 in 100 thrombocytopenic ICU patients (HIT frequency 0.3-0.5% vs. 30-50% background frequency of ICU-associated thrombocytopenia), and most patients who form anti-PF4/heparin antibodies do not develop HIT; hence, HIT overdiagnosis often occurs. This review discusses HIT-related issues relevant to ICU patients, including how to (1) distinguish HIT both clinically and serologically from non-HIT-related thrombocytopenia; (2) recognize HIT-mimicking disorders, such as the acute disseminated intravascular coagulation (DIC)/liver necrosis-limb necrosis syndrome; (3) prevent HIT in the ICU through use of low-molecular-weight heparin; and (4) treat HIT, including awareness of PTT confounding when anticoagulating patients with DIC. Copyright © 2015 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York.
Bader M.S.,Hamilton Health Sciences
Postgraduate medicine | Year: 2013
Herpes zoster (Hz), which generally presents as a localized, painful cutaneous eruption, is a common clinical problem, particularly among adults ≥ 50 years of age and immunocompromised patients. The diagnosis of Hz is mainly made clinically, except in patients with atypical manifestations or certain complications, such as central nervous system involvement, in which laboratory virologic testing is required. In addition to having a higher mortality rate, immunocompromised individuals have atypical and severe clinical findings and are at greater risk for complications and recurrence of Hz. Treatment of Hz includes the use of antiviral agents, analgesics for control of acute zoster pain, good skin care for healing, and prevention of secondary bacterial infection. Antiviral agents, preferably valacyclovir or famciclovir, should be started within 72 hours of onset to reduce the severity of the infection, the duration of the eruptive phase, and the intensity of acute pain. Herpes zoster has been associated with several complications, of which post-herpetic neuralgia (PHN) is the most common and debilitating. Varicella-zoster virus vaccine and early treatment with either famciclovir or valacyclovir are the only measures proven to prevent PHN. The options for treating PHN include topical agents, such as lidocaine patches, and systemic agents, such as the anticonvulsants gabapentin and pregabalin. Measures for preventing Hz include infection control through routine hand hygiene and appropriate use of isolation precautions and personal protective equipment; immunoglobulins, such as the varicella-zoster virus immunoglobulin and vaccine; and antiviral agents. The zoster vaccine has been shown to be effective in reducing the incidence of Hz and PHN. The vaccine is recommended for all individuals aged ≥ 60 years who have no contraindications, including individuals who report a previous episode of Hz.
Connolly B.,Hamilton Health Sciences |
Fox S.H.,University of Toronto
Neurotherapeutics | Year: 2014
Neuropsychiatric symptoms are common in Parkinson's disease (PD) and add significantly to the burden of disease. These symptoms are most commonly part of the disease spectrum owing to pathological changes within relevant brain regions. Neuropsychiatric problems include disorders of cognition, ranging from mild cognitive impairment to dementia, psychotic symptoms, including, most commonly, well-formed visual hallucinations and paranoid delusions, and mood disorders, such as depression and anxiety. The other common cause of neuropsychiatric problem is secondary to use of dopaminergic drugs. Some PD patients may develop behavioral disorders, including impulse control disorders (ICDs) and addictive symptoms. Psychosis can be due to a mixture of underlying pathology, with triggering or worsening of symptoms with changes to PD medications. Currently, management of these disorders primarily uses therapies developed for general psychiatry and cognitive neurology, rather than specifically for PD. However, significant adverse effects, such as worsening of the motor symptoms of PD, can limit use of some drug therapies. Identification of drug-induced symptoms, such as ICDs, enables withdrawal of the offending drug as the principal management strategy. Research is ongoing in an effort to develop more specific therapies for PD-related neuropsychiatric symptoms. © 2013 The American Society for Experimental NeuroTherapeutics, Inc.
News Article | December 9, 2016
The International Nurses Association is pleased to welcome Catherine Semple, RN, BSc, to their prestigious organization with her upcoming publication in the Worldwide Leaders in Healthcare. Catherine is a highly trained and qualified Registered Nurse with an extensive expertise in all facets of nursing, especially labor and delivery, public health, women’s health, and sexual health. She is currently serving patients at Hamilton Health Sciences in Ontario, Canada. Catherine Semple graduated with her initial Nursing Degree from George Brown College in Toronto, Canada. An advocate for continuing education, Catherine then went on to obtain her Bachelor of Science Degree in Nursing from McMaster University in Hamilton, Ontario. Catherine attributes her great success in the nursing field to her passion for women’s health and risk reduction. She is proud to be a nurse, seeing the best and worst of people and always providing the highest quality care to them. When she is not tending to her patients, Catherine enjoys knitting, quilting and functional art. Learn more about Catherine Semple here: http://inanurse.org/network/index.php?do=/4133723/info/ and be sure to read her upcoming publication in the Worldwide Leaders in Healthcare.