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Gagnon É, Côté AM, Roy-Lacroix MÈ, Massé É, Malick M, Sauvé N. Maternal and neonatal complications during delivery according to passive versus active second stage in woman with medical conditions (ComPActSS). Obstet Med 2023; 16:109-115. [PMID: 37441665 PMCID: PMC10334035 DOI: 10.1177/1753495x221089206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/16/2022] [Accepted: 03/03/2022] [Indexed: 09/20/2023] Open
Abstract
Background The incidence of serious complications during vaginal delivery with a passive second stage in women with medical conditions is unknown. Methods Our retrospective cohort study with matched groups (pairing 1 passive with 2 active second stage) included women who had a medical delivery plan from the high risk obstetric team at our center. The primary outcome was a composite of major maternal and neonatal complications. Results The primary outcome occurred in 50% (12/24) of women in the passive group versus 35.4% (17/48) (p = 0.24) in the active group. In the passive group, we observed a longer passive second stage of labor (28 vs. 8 min, p < 0.001), a tendency towards more assisted vaginal births (29.2% vs. 12.5%, p = 0.08), and more traumatic deliveries (16.7% vs. 0%, p = 0.012). Conclusion The higher proportion of complications in women who had a passive second stage should encourage physicians to make this recommendation only in selected cases.
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Affiliation(s)
- Élisabeth Gagnon
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Anne-Marie Côté
- Division of Nephrology and Obstetric Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Marie-Ève Roy-Lacroix
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Édith Massé
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Division of Neonatology, Department of Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Mandy Malick
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Nadine Sauvé
- Centre de Recherche du Centre Hospitalier, Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Division of Internal Medicine and Obstetric Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
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Tanguay Lecomte A, Vittoz L, Sauvé N, Roy-Lacroix MÈ, Malick M, Côté AM. Optimal management of post-discharge postpartum hypertensive disorders of pregnancy: a quality improvement initiative. Obstet Med 2023; 16:29-34. [PMID: 37139511 PMCID: PMC10150299 DOI: 10.1177/1753495x221074613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: Postpartum hypertensive disorders of pregnancy occur in 2-5% of pregnancies. It is a major cause of urgent postpartum consultation and is associated with life-threatening complications. Our objective was to evaluate if local management of postpartum hypertensive disorders of pregnancy was congruent with expert recommendations. Methods: We conducted a quality improvement initiative through a retrospective single-centre cross-sectional study. All women over 18-year-old consulting emergently for hypertensive disorders of pregnancy in the first six weeks postpartum, from 2015 to 2020, were eligible. Results: We included 224 women. Optimal management of postpartum hypertensive disorders of pregnancy was observed in 65.0%. While diagnosis and laboratory work-up were excellent, adequate blood pressure surveillance and recommendations upon discharge of an outpatient postpartum episode (69.7%) did not meet expectations. Conclusion: Efforts should be targeted to improve discharge recommendations on optimal blood pressure surveillance after delivery for women at risk for hypertensive disorders of pregnancy and for postpartum hypertensive disorders of pregnancy in women treated as outpatients.
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Affiliation(s)
- Alexia Tanguay Lecomte
- Division of Nephrology, Department of
Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke,
Sherbrooke, Canada
| | - Lauriane Vittoz
- Department of Medicine, Faculty of
Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nadine Sauvé
- Division of Internal Medicine,
Department of Medicine, Faculty of Medicine and Health Sciences, Université de
Sherbrooke, Sherbrooke, Canada
- Centre de recherche du Centre
Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
| | - Marie-Ève Roy-Lacroix
- Centre de recherche du Centre
Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
- Department of Obstetrics &
Gynecology, Faculty of Medicine and Health Sciences, Université de Sherbrooke,
Sherbrooke, Canada
| | - Mandy Malick
- Department of Medicine, Faculty of
Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Anne-Marie Côté
- Division of Nephrology, Department of
Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke,
Sherbrooke, Canada
- Centre de recherche du Centre
Hospitalier Universitaire de Sherbrooke, Sherbrooke, Canada
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3
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Lizotte F, Robillard S, Lavoie N, Rousseau M, Denhez B, Moreau J, Higgins S, Sabbagh R, Côté AM, Geraldes P. Enhanced SHP-1 Expression in Podocyturia Is Associated with Kidney Dysfunction in Patients with Diabetes. Kidney360 2022; 3:1710-1719. [PMID: 36514736 PMCID: PMC9717659 DOI: 10.34067/kid.0002152022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/25/2022] [Indexed: 01/12/2023]
Abstract
Background Diabetic kidney disease (DKD) remains the leading cause of end stage kidney disease worldwide. Despite significant advances in kidney care, there is a need to improve noninvasive techniques to predict the progression of kidney disease better for patients with diabetes. After injury, podocytes are shed in urine and may be used as a biologic tool. We previously reported that SHP-1 is upregulated in the kidney of diabetic mice, leading to podocyte dysfunction and loss. Our objective was to evaluate the expression levels of SHP-1 in urinary podocytes and kidney tissues of patients with diabetes. Methods In this prospective study, patients with and without diabetes were recruited for the quantification of SHP-1 in kidney tissues, urinary podocytes, and peripheral blood monocytes. Immunochemistry and mass spectrometry techniques were applied for kidney tissues. Urinary podocytes were counted, and expression of SHP-1 and podocyte markers were measured by quantitative PCR. Results A total of 66 participants (diabetic n=48, nondiabetic n=18) were included in the analyses. Diabetes was associated with increased SHP-1 expression in kidney tissues (P=0.03). Nephrin and podocin mRNA was not significantly increased in urinary podocytes from patients with diabetes compared with those without diabetes, whereas levels of SHP-1 mRNA expression significantly correlated with HbA1c and estimated glomerular filtration rate (eGFR). Additionally, follow-up (up to 2 years post recruitment) evaluation indicated that SHP-1 mRNA expression continued to increase with eGFR decline. Conclusions Levels of SHP-1 in urinary podocytes may serve as an additional marker of glomerular disease progression in this population.
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Affiliation(s)
- Farah Lizotte
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada
| | - Stéphanie Robillard
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada
| | - Nicolas Lavoie
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada
| | - Marina Rousseau
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada
| | - Benoit Denhez
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada
| | - Julie Moreau
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada
| | - Sarah Higgins
- Department of Medicine, Division of Nephrology, Université de Sherbrooke, Québec, Canada
| | - Robert Sabbagh
- Department of Surgery, Université de Sherbrooke, Québec, Canada
| | - Anne-Marie Côté
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada,Department of Medicine, Division of Nephrology, Université de Sherbrooke, Québec, Canada
| | - Pedro Geraldes
- Research Center, Centre Hospitalier, Université de Sherbrooke, Québec, Canada,Department of Medicine, Division of Endocrinology, Université de Sherbrooke, Québec, Canada
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Rousseau M, Denhez B, Spino C, Lizotte F, Guay A, Côté AM, Burger D, Geraldes P. Reduction of DUSP4 contributes to podocytes oxidative stress, insulin resistance and diabetic nephropathy. Biochem Biophys Res Commun 2022; 624:127-133. [DOI: 10.1016/j.bbrc.2022.07.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022]
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Côté AM. The expatriate entrepreneur: Demystification and conceptualization of an international career phenomenon in the era of COVID-19. Australian Journal of Career Development 2022. [PMCID: PMC9264379 DOI: 10.1177/10384162221100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
International mobility brings new avenues for career development. Although the literature in human resources management has extensively investigated the traditional assignment cycle of expatriates by multinationals abroad, only few studies have focused on other forms of expatriation. Among these forms is the “expat-preneurship” whereby the expatriate decides to become an entrepreneur in the host country. This phenomenon is challenging career development in bringing new work dynamics. This conceptual paper presents a demystification of this growing phenomenon and provides a better understanding of this international career dynamic in the context of the new normal brought by the impacts of COVID-19 pandemic. Although many expatriates have opted to return home due to the fallout from the coronavirus pandemic, others have chosen to embrace an entrepreneurial career abroad. This paper sheds new light on this career phenomenon in which some individuals, despite pandemic uncertainty, see opportunities where others see roadblocks.
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Cohen AA, Leung DL, Legault V, Gravel D, Blanchet FG, Côté AM, Fülöp T, Lee J, Dufour F, Liu M, Nakazato Y. Synchrony of biomarker variability indicates a critical transition: Application to mortality prediction in hemodialysis. iScience 2022; 25:104385. [PMID: 35620427 PMCID: PMC9127602 DOI: 10.1016/j.isci.2022.104385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 12/03/2022] Open
Abstract
Critical transition theory suggests that complex systems should experience increased temporal variability just before abrupt state changes. We tested this hypothesis in 763 patients on long-term hemodialysis, using 11 biomarkers collected every two weeks and all-cause mortality as a proxy for critical transitions. We find that variability-measured by coefficients of variation (CVs)-increases before death for all 11 clinical biomarkers, and is strikingly synchronized across all biomarkers: the first axis of a principal component analysis on all CVs explains 49% of the variance. This axis then generates powerful predictions of mortality (HR95 = 9.7, p < 0.0001, where HR95 is a scale-invariant metric of hazard ratio; AUC up to 0.82) and starts to increase markedly ∼3 months prior to death. Our results provide an early warning sign of physiological collapse and, more broadly, a quantification of joint system dynamics that opens questions of how system modularity may break down before critical transitions.
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Affiliation(s)
- Alan A. Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
- Research Center on Aging, Sherbrooke, Quebec J1H 4C4, Canada
- Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Diana L. Leung
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Véronique Legault
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Dominique Gravel
- Département de Biologie, Université de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
| | - F. Guillaume Blanchet
- Research Center on Aging, Sherbrooke, Quebec J1H 4C4, Canada
- Département de Biologie, Université de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
- Département de mathématique, Université de Sherbrooke, Sherbrooke, Québec J1K 2R1, Canada
- Département des Sciences de la Santé Communautaires, Université de Sherbrooke, Sherbrooke, Québec J1H 5N4, Canada
| | - Anne-Marie Côté
- Department of Medicine, Nephrology Division, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Tamàs Fülöp
- Research Center on Aging, Sherbrooke, Quebec J1H 4C4, Canada
- Department of Medicine, Geriatric Division, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Juhong Lee
- InfoCentre, Centre intégré universitaire de santé et de services sociaux de l’Estrie – Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Frédérik Dufour
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
- Département de Biologie, Université de Sherbrooke, Sherbrooke, Quebec J1K 2R1, Canada
| | - Mingxin Liu
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, Quebec J1H 5N4, Canada
| | - Yuichi Nakazato
- Division of Nephrology, Hakuyukai Medical Corporation, Yuai Nisshin Clinic, 2-1914-6 Nisshin-cho, Kita-ku, Saitama-City, Saitama 331-0823, Japan
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Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Directive clinique n o 426 : Troubles hypertensifs de la grossesse : Diagnostic, prédiction, prévention et prise en charge. J Obstet Gynaecol Can 2022; 44:572-597.e1. [PMID: 35577427 DOI: 10.1016/j.jogc.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIF La présente directive a été élaborée par des fournisseurs de soins de maternité en obstétrique et en médecine interne. Elle aborde le diagnostic, l'évaluation et la prise en charge des troubles hypertensifs de la grossesse, la prédiction et la prévention de la prééclampsie ainsi que les soins post-partum des femmes avec antécédent de trouble hypertensif de la grossesse. POPULATION CIBLE Femmes enceintes. BéNéFICES, RISQUES ET COûTS: La mise en œuvre des recommandations de la présente directive devrait réduire l'incidence des troubles hypertensifs de la grossesse, en particulier la prééclampsie, et des issues défavorables associées. DONNéES PROBANTES: La revue exhaustive de la littérature a été mise à jour en tenant compte des nouvelles données probantes jusqu'en décembre 2020 et en suivant la même méthodologie que pour la précédente directive de la Société des obstétriciens et gynécologues du Canada (SOGC) sur les troubles hypertensifs de la grossesse. La recherche s'est limitée aux articles publiés en anglais ou en français. Les recommandations relatives aux traitements s'appuient d'abord sur les essais cliniques randomisés et les revues systématiques (lorsque disponibles), ainsi que sur l'évaluation des résultats cliniques substantiels chez les mères et les bébés. MéTHODES DE VALIDATION: Les auteurs se sont entendus sur le contenu et les recommandations par consensus et ont répondu à l'examen par les pairs du comité de médecine fœto-maternelle de la SOGC. Les auteurs ont évalué la qualité des données probantes et la force des recommandations en utilisant le cadre méthodologique d'évaluation, de développement et d'évaluation (GRADE) et se sont gardé l'option de désigner certaines recommandations par la mention « bonne pratique ». Voir l'annexe A en ligne (tableau A1 pour les définitions et tableau A2 pour l'interprétation des recommandations fortes et conditionnelles [faibles]). Le conseil d'administration de la SOGC a approuvé la version définitive aux fins de publication. PROFESSIONNELS CIBLES Tous les fournisseurs de soins de santé (obstétriciens, médecins de famille, sages-femmes, infirmières et anesthésistes) qui prodiguent des soins aux femmes avant, pendant ou après la grossesse. RECOMMANDATIONS
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Svoboda E, Côté AM, Moreau J, Camden C, Richard MN, Corriveau G, Francoeur C. Barrières et facilitateurs à la participation en recherche des femmes ayant eu un trouble hypertensif de la grossesse. Journal of Obstetrics and Gynaecology Canada 2022. [DOI: 10.1016/j.jogc.2022.02.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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9
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Magee LA, Smith GN, Bloch C, Côté AM, Jain V, Nerenberg K, von Dadelszen P, Helewa M, Rey E. Guideline No. 426: Hypertensive Disorders of Pregnancy: Diagnosis, Prediction, Prevention, and Management. J Obstet Gynaecol Can 2022; 44:547-571.e1. [PMID: 35577426 DOI: 10.1016/j.jogc.2022.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This guideline was developed by maternity care providers from obstetrics and internal medicine. It reviews the diagnosis, evaluation, and management of the hypertensive disorders of pregnancy (HDPs), the prediction and prevention of preeclampsia, and the postpartum care of women with a previous HDP. TARGET POPULATION Pregnant women. BENEFITS, HARMS, AND COSTS Implementation of the recommendations in these guidelines may reduce the incidence of the HDPs, particularly preeclampsia, and associated adverse outcomes. EVIDENCE A comprehensive literature review was updated to December 2020, following the same methods as for previous Society of Obstetricians and Gynaecologists of Canada (SOGC) HDP guidelines, and references were restricted to English or French. To support recommendations for therapies, we prioritized randomized controlled trials and systematic reviews (if available), and evaluated substantive clinical outcomes for mothers and babies. VALIDATION METHODS The authors agreed on the content and recommendations through consensus and responded to peer review by the SOGC Maternal Fetal Medicine Committee. The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).The Board of the SOGC approved the final draft for publication. INTENDED USERS All health care providers (obstetricians, family doctors, midwives, nurses, and anesthesiologists) who provide care to women before, during, or after pregnancy. RECOMMENDATIONS
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10
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Allain Wouterlood M, Malhamé I, Lévesque K, Dayan N, Mahone M, Côté AM, Cumyn A, Malick M, Sauvé N. Pregnancy-associated pelvic vein thrombosis: Insights from a multicenter case series. J Thromb Haemost 2021; 19:1926-1931. [PMID: 33834605 DOI: 10.1111/jth.15333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/09/2021] [Accepted: 03/29/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pelvic vein thrombosis (PVT) is a rare complication of pregnancy that can lead to life-threatening complications, such as pulmonary embolism (PE). OBJECTIVE To describe characteristics of PVT and its treatment in pregnancy in the province of Quebec, Canada. PATIENTS/METHODS We developed a province-wide case series of PVT in pregnancy including four tertiary care centers and the Registry of Rare Diseases of the Groupe d'Étude en Médecine Obstétricale du Québec. Using diagnostic codes, we included cases with confirmed PVT on imaging during pregnancy or within 6 weeks postpartum from July 2003 to June 2018. RESULTS A total of 47 cases were identified. PVT diagnosis was generally made in the early postpartum period (median of 9 [interquartile range (IQR) 4.5-12] days postpartum). Most PVT (94%) included in this series were symptomatic. Women presented primarily with abdominal pain (77%) and fever (55%), often prolonged despite antibiotics (mean 4.45 ± 2.39 days, with 39% having fever for more than 5 days). The most common risk factor was surgery (57%) and peripartum infections (54%). Thirty-eight (83%) women received antibiotics and 41 (89%) were anticoagulated. Three cases of PE (7%) occurred concomitantly, 11% of women required intensive care, and 19% had inferior vena cava (IVC) clot extension. The episode resulted in prolonged hospitalization (median 6 [IQR 3-10.75] days), with 48% being hospitalized more than 7 days. CONCLUSION Symptomatic PVT has significant clinical implications with prolonged fever and risks of extension in the IVC and PE, leading to prolonged hospitalization including in the intensive care unit. Therapeutic anticoagulation and antibiotics, when infection is documented, should be considered for management.
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Affiliation(s)
| | - Isabelle Malhamé
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kateri Lévesque
- Department of Medicine, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
| | - Natalie Dayan
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michèle Mahone
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Anne-Marie Côté
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Annabelle Cumyn
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mandy Malick
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nadine Sauvé
- Department of Medicine, Centre Hospitalier de l'Université de Sherbrooke, Sherbrooke, Quebec, Canada
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11
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Liu M, Legault V, Fülöp T, Côté AM, Gravel D, Blanchet FG, Leung DL, Lee SJ, Nakazato Y, Cohen AA. Prediction of Mortality in Hemodialysis Patients Using Moving Multivariate Distance. Front Physiol 2021; 12:612494. [PMID: 33776784 PMCID: PMC7993059 DOI: 10.3389/fphys.2021.612494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
There is an increasingly widespread use of biomarkers in network physiology to evaluate an organism’s physiological state. A recent study showed that albumin variability increases before death in chronic hemodialysis patients. We hypothesized that a multivariate statistical approach would better allow us to capture signals of impending physiological collapse/death. We proposed a Moving Multivariate Distance (MMD), based on the Mahalanobis distance, to quantify the variability of the multivariate biomarker profile as a whole from one visit to the next. Biomarker profiles from a visit were used as the reference to calculate MMD at the subsequent visit. We selected 16 biomarkers (of which 11 are measured every 2 weeks) from blood samples of 763 chronic kidney disease patients hemodialyzed at the CHUS hospital in Quebec, who visited the hospital regularly (∼every 2 weeks) to perform routine blood tests. MMD tended to increase markedly preceding death, indicating an increasing intraindividual multivariate variability presaging a critical transition. In survival analysis, the hazard ratio between the 97.5th percentile and the 2.5th percentile of MMD reached as high as 21.1 [95% CI: 14.3, 31.2], showing that higher variability indicates substantially higher mortality risk. Multivariate approaches to early warning signs of critical transitions hold substantial clinical promise to identify early signs of critical transitions, such as risk of death in hemodialysis patients; future work should also explore whether the MMD approach works in other complex systems (i.e., ecosystems, economies), and should compare it to other multivariate approaches to quantify system variability.
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Affiliation(s)
- Mingxin Liu
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Véronique Legault
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Tamàs Fülöp
- Research Center on Aging, Sherbrooke, QC, Canada.,Department of Medicine, Geriatric Division, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Anne-Marie Côté
- Department of Medicine, Nephrology Division, University of Sherbrooke, Sherbrooke, QC, Canada.,Research Center of Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Dominique Gravel
- Département de Biologie, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - F Guillaume Blanchet
- Research Center on Aging, Sherbrooke, QC, Canada.,Département de Biologie, Université de Sherbrooke, Sherbrooke, QC, Canada.,Département de Mathématique, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Diana L Leung
- Department of Pathology, Yale University, New Haven, CT, United States
| | - Sylvia Juhong Lee
- InfoCentre, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Yuichi Nakazato
- Division of Nephrology, Yuai Nisshin Clinic, Hakuyukai Medical Corporation, Saitama, Japan
| | - Alan A Cohen
- PRIMUS Research Group, Department of Family Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
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12
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Denhez B, Wang L, Moreau J, Dubé J, Côté AM. Interlaboratory bias of albuminuria and proteinuria in hypertensive pregnancy. Clin Biochem 2020; 87:13-18. [PMID: 33031818 DOI: 10.1016/j.clinbiochem.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/23/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Measurement of proteinuria in women with hypertensive disorders of pregnancy is of major importance in the diagnosis and management of preeclampsia. Urinary protein/creatinine ratio, which is commonly used to detect kidney damage in preeclampsia, suffers from important analytical limitations, including poor harmonization of results between laboratories. Adoption of albuminuria could help reduce interlaboratory bias, since methods used to quantify it are better harmonized. METHODS A total of 27 urinary samples collected from hypertensive women evaluated for preeclampsia were sent to four different clinical laboratories in Canada. Urinary proteins and albumin as well as urinary creatinine were measured in duplicates in one batch to calculate protein/creatinine (PCR) and albumin/creatinine (ACR) ratio. Statistical analyses were done to evaluate interlaboratory variability of urinary proteins and urinary albumin. RESULTS Interlaboratory bias for urinary proteins ranged from 64.7% at low concentration to 3.9% at higher concentrations. In contrast, urinary albumin interlaboratory bias ranged from 29.2% to 4% from low to high concentrations. Coefficient of variation for urinary proteins reached a maximum of 91.5% in lower concentration while urinary albumin highest value was 42.7%. When looking at PCR and ACR ratio, eight samples had PCR measurement range that contained the diagnostic threshold used to detect kidney damage in HDP (30 mg/mmol), while only four samples had ACR ratio measurement range that contained the diagnostic threshold used outside of pregnancy in Canada (2 mg/mmol). CONCLUSION Interlaboratory bias was lower for urinary albumin measurement compared to urinary proteins in hypertensive women evaluated for preeclampsia. Better harmonization with the use of albumin instead of protein measurement would reduce instances where results of different laboratories lead to opposite diagnosis of kidney damage in pregnancy.
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Affiliation(s)
- Benoit Denhez
- Département de médecine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Li Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, BC, Canada
| | - Julie Moreau
- Centre de recherche du CHUS, Sherbrooke, QC, Canada
| | - Jean Dubé
- Département de médecine, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche du CHUS, Sherbrooke, QC, Canada
| | - Anne-Marie Côté
- Département de médecine, Université de Sherbrooke, Sherbrooke, QC, Canada; Centre de recherche du CHUS, Sherbrooke, QC, Canada.
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13
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Su Z, Togay G, Côté AM. Artificial intelligence: a destructive and yet creative force in the skilled labour market. Human Resource Development International 2020. [DOI: 10.1080/13678868.2020.1818513] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Zhan Su
- Department of Management, Faculty of Business Administration, Université Laval, Québec, Canada
| | - Guillaume Togay
- Department of Management, Faculty of Business Administration, Université Laval, Québec, Canada
| | - Anne-Marie Côté
- Department of Management, Faculty of Business Administration, Université Laval, Québec, Canada
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Tourigny C, Rey E, Moreau J, Guimond MO, Ouellet A, Dubé J, Côté AM. Albumin/Creatinine Ratio for the Detection of Significant Proteinuria of Preeclampsia in Hospitalized Hypertensive Women. J Obstet Gynaecol Can 2020; 43:S1701-2163(20)30687-3. [PMID: 34756405 DOI: 10.1016/j.jogc.2020.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Preeclampsia is a hypertensive disorder of pregnancy associated with proteinuria detected by 24-hour urine collection (≥0.3 g/24 h) or protein/creatinine ratio (≥30 mg/mmol). The albumin/creatinine ratio (ACR) is used outside pregnancy to detect abnormal amounts of albumin in the urine, but there is little data on its value in pregnancy. Our objective was to determine the diagnostic threshold for ACR to detect significant proteinuria in women investigated for preeclampsia. METHODS A prospective observational study involving 99 hypertensive women (≥140/90 mm Hg) over 20 weeks gestation who were hospitalized at 2 Canadian tertiary centres. A 24-hour urine collection and a morning urine sample were collected. The optimal ACR threshold was determined by a receiver operating characteristic (ROC) curve using the 24-hour collection as the reference test; sensitivity and specificity analyses were performed. Maternal and perinatal characteristics were extracted from medical records. RESULTS Of the 87 women who had completed urine collection, 74 (85%) had an initial diagnosis of preeclampsia and 63 (72%) had significant proteinuria confirmed by 24-hour collection. The area under the morning ROC curve was 0.92 (95% CI 0.86-0.98) and the optimal threshold obtained for the ACR was 9 mg/mmol, with a sensitivity and specificity of 84% (95% CI 73-92) and 88% (95% CI 68-97), respectively. CONCLUSION Our results suggest that an ACR threshold of 9 mg/mmol on a morning urine sample can be used to detect significant proteinuria of preeclampsia in hospitalized hypertensive women.
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Affiliation(s)
- Camille Tourigny
- Département de médecine, Université de Sherbrooke, Sherbrooke, QC
| | - Evelyne Rey
- Département d'obstétrique-gynécologie and Centre de Recherche, CHU Sainte-Justine, Montréal, QC
| | | | | | - Annie Ouellet
- Département d'obstétrique-gynécologie, CHUS, Sherbrooke, QC
| | - Jean Dubé
- Département de biochimie, CHUS, Sherbrooke, QC
| | - Anne-Marie Côté
- Département de médecine, Université de Sherbrooke, Sherbrooke, QC; Centre de recherche du CHUS, Sherbrooke, QC.
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Parfenova M, Côté AM, Cumyn A, Pesant MH, Champagne M, Roy-Lacroix MÈ, Malick M, Sauvé N. Impact of an Educational Pamphlet on Knowledge About Health Risks After Hypertensive Disorders of Pregnancy: A Randomized Trial. J Obstet Gynaecol Can 2020; 43:182-190. [PMID: 33039316 DOI: 10.1016/j.jogc.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/06/2020] [Accepted: 07/09/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate patients' knowledge, risk perception, and anxiety about future health risks after an episode of hypertensive disorder of pregnancy (HDP), as well as their satisfaction with an educational pamphlet. METHODS From January 2016 to June 2017, participants were randomly assigned to one of 2 groups and asked to complete questionnaire #1 (demographics, knowledge, risk perception, anxiety, and satisfaction) after receiving medical counselling at the HDP postpartum clinic. Participants in the intervention group then received the educational pamphlet. One month later, both groups completed the questionnaire again (questionnaire #2). The primary outcome of this study was improvement in the global knowledge score at 1 month, reflecting improved understanding of the health risks of HDP. Secondary outcomes included retention of information, risk perception, satisfaction, and anxiety level. RESULTS Of 137 eligible women, 57 were randomly assigned to the intervention group and 56, to the control group. Participants in both groups had similar baseline characteristics. Thirteen percent of participants did not complete questionnaire #2. The knowledge score was higher in the intervention group than the control group at 1 month, (88.2%; 95% confidence interval [CI] 26.37-28.32 and 71.3%; 95% CI 20.78-23.45, respectively [P <0.0001]). No difference was seen in anxiety level between the groups (4.0 ± 1.00 vs. 3.8 ± 0.92; P = 0.6746). The intervention group was highly satisfied with the medical counselling they received (5.5 ± 0.84 out 6) and with the pamphlet (5.6 ± 0.66 out 6). CONCLUSION The educational pamphlet increased women's knowledge about future health risks of HDP without increasing anxiety and it may be helpful in promoting lifestyle changes necessary to modify these risks.
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Affiliation(s)
- Maria Parfenova
- Obstetric Medicine, Division of General Internal Medicine, Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC.
| | - Anne-Marie Côté
- Nephrology and Obstetric Medicine, Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Annabelle Cumyn
- Obstetric Medicine, Division of General Internal Medicine, Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Marie-Hélène Pesant
- Endocrinology, Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Myriam Champagne
- Perinatology, Department of Family Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Marie-Ève Roy-Lacroix
- Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Mandy Malick
- Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
| | - Nadine Sauvé
- Obstetric Medicine, Division of General Internal Medicine, Department of Medicine, CIUSSS de l'Estrie-Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC
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16
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Gheidi S, Akintola K, Akella KS, Côté AM, Dunsiger SR, Broholm C, Fuhrman WT, Saha SR, Paglione J, Sonier JE. Intrinsic Low-Temperature Magnetism in SmB_{6}. Phys Rev Lett 2019; 123:197203. [PMID: 31765191 DOI: 10.1103/physrevlett.123.197203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 07/29/2019] [Indexed: 06/10/2023]
Abstract
By means of new muon spin relaxation experiments, we disentangle extrinsic and intrinsic sources of low-temperature bulk magnetism in the candidate topological Kondo insulator (TKI) SmB_{6}. Results on Al-flux-grown SmB_{6} single crystals are compared to those on a large floating-zone-grown ^{154}Sm ^{11}B_{6} single crystal in which a 14 meV bulk spin exciton has been detected by inelastic neutron scattering. Below ∼10 K, we detect the gradual development of quasistatic magnetism due to rare-earth impurities and Sm vacancies. Our measurements also reveal two additional forms of intrinsic magnetism: (1) underlying low-energy (∼100 meV) weak magnetic moment (∼10^{-2} μ_{B}) fluctuations similar to those detected in the related candidate TKI YbB_{12} that persist down to millikelvin temperatures, and (2) magnetic fluctuations consistent with a 2.6 meV bulk magnetic excitation at zero magnetic field that appears to hinder surface conductivity above ∼4.5 K. We discuss potential origins of the magnetism.
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Affiliation(s)
- S Gheidi
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - K Akintola
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - K S Akella
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
| | - A M Côté
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Kwantlen Polytechnic University, Richmond, British Columbia V6X 3X7, Canada
| | - S R Dunsiger
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Centre for Molecular and Materials Science, TRIUMF, Vancouver, British Columbia V6T 2A3, Canada
| | - C Broholm
- Institute for Quantum Matter and Department of Physics and Astronomy, The Johns Hopkins University, Baltimore, Maryland 21218, USA
- Department of Materials Science and Engineering, The Johns Hopkins University, Baltimore, Maryland 21218, USA
- Canadian Institute for Advanced Research, Toronto, Ontario M5G 1Z8, Canada
| | - W T Fuhrman
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S R Saha
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J Paglione
- Canadian Institute for Advanced Research, Toronto, Ontario M5G 1Z8, Canada
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J E Sonier
- Department of Physics, Simon Fraser University, Burnaby, British Columbia V5A 1S6, Canada
- Canadian Institute for Advanced Research, Toronto, Ontario M5G 1Z8, Canada
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17
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Cohen AA, Nakazato Y, Sugiyama T, Leung DL, Legault V, Côté AM. INCREASED PHYSIOLOGICAL VARIABILITY PREDICTS DECLINING HEALTH AND CRITICAL TRANSITIONS IN HEMODIALYSIS PATIENTS. Innov Aging 2019. [PMCID: PMC6844849 DOI: 10.1093/geroni/igz038.2905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Increased variability in levels of several individual biomarkers has been shown to predict adverse outcomes, particularly in hemodialysis patients, for whom time series data is often available. Here, we evaluate the feasibility of using multivariate approaches to quantify global physiological variability as a potential predictor of adverse outcomes. We used data on 588 deaths and 1196 hospitalisations across ~38,000 visits of 591 hemodialysis patients at a Quebec hospital, as well as data on frailty and mortality in 580 patients assessed 20+ times within a one-year period at a hospital in Saitama, Japan. We use two approaches: principal components analysis (PCA) of the coefficients of variation (CVs) of the individual biomarkers over the previous year, and Mahalanobis distance (MD) of the biomarker profile relative to the same profile at the previous time point. We show that both methods provide substantial prediction of both impending mortality and impending hospitalisation, with hazard ratios across the 95% quantile range of the indices varying between 1.5 and 3.5 (p<0.0001). Each unit change on the first PCA axis (PC1) increased frailty odds by 2.34 (95% CI: 1.21-4.52). PCA performed substantially better than MD. CVs of various biomarkers were consistently positively correlated, and PC1 was a good predictor of frailty, mortality, and hospitalisation. Overall, these results confirm that complex physiological integration can break down, resulting in loss of homeostatic control and increasing variability, as predicted by complex systems theory. The resulting indices provide a predictive signal of impending critical health transitions, with both theoretical and clinical implications.
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Affiliation(s)
- Alan A Cohen
- University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | - Diana L Leung
- Yale University, New Haven, Connecticut, United States
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18
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Sundar S, Gheidi S, Akintola K, Côté AM, Dunsiger SR, Ran S, Butch NP, Saha SR, Paglione J, Sonier JE. Coexistence of ferromagnetic fluctuations and superconductivity in the actinide superconductor UTe 2. Phys Rev B 2019; 100:10.1103/physrevb.100.140502. [PMID: 34131607 PMCID: PMC8201662 DOI: 10.1103/physrevb.100.140502] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report low-temperature muon spin relaxation/rotation (μSR) measurements on single crystals of the actinide superconductor UTe2. Below 5 K we observe a continuous slowing down of magnetic fluctuations that persists through the superconducting transition temperature (T c = 1.6 K), but we find no evidence of long-range or local magnetic order down to 0.025 K. The temperature dependence of the dynamic relaxation rate down to 0.4 K agrees with the self-consistent renormalization theory of spin fluctuations for a three-dimensional weak itinerant ferromagnetic metal. Our μSR measurements also indicate that the superconductivity coexists with the magnetic fluctuations.
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Affiliation(s)
- Shyam Sundar
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
| | - S Gheidi
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
| | - K Akintola
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
| | - A M Côté
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
- Kwantlen Polytechnic University, Richmond, British Columbia, Canada V6X 3X7
| | - S R Dunsiger
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
- Centre for Molecular and Materials Science, TRIUMF, Vancouver, British Columbia, Canada V6T 2A3
| | - S Ran
- NIST Center for Neutron Research, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - N P Butch
- NIST Center for Neutron Research, National Institute of Standards and Technology, Gaithersburg, Maryland 20899, USA
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - S R Saha
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - J Paglione
- Center for Nanophysics and Advanced Materials, Department of Physics, University of Maryland, College Park, Maryland 20742, USA
- Canadian Institute for Advanced Research, Toronto, Ontario, Canada M5G 1Z8
| | - J E Sonier
- Department of Physics, Simon Fraser University, Burnaby, British Columbia, Canada V5A 1S6
- Canadian Institute for Advanced Research, Toronto, Ontario, Canada M5G 1Z8
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19
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Magee LA, Synnes AR, von Dadelszen P, Hutfield AM, Chanoine JP, Côté AM, Devlin AM, Dorling J, Gafni A, Ganzevoort W, Helewa ME, Hutton EK, Koren G, Lee SK, Mcarthur D, Rey E, Robinson WP, Roseboom TJ, Singer J, Wilson S, Moutquin JM. CHIPS-Child: Testing the developmental programming hypothesis in the offspring of the CHIPS trial. Pregnancy Hypertens 2018; 14:15-22. [PMID: 30527103 DOI: 10.1016/j.preghy.2018.04.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 04/26/2018] [Accepted: 04/28/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES As a follow-up to the CHIPS trial (Control of Hypertension In Pregnancy Study) of 'less tight' (versus 'tight') control of maternal blood pressure in pregnancy, CHIPS-Child investigated potential developmental programming of maternal blood pressure control in pregnancy, by examining measures of postnatal growth rate and hypothalamic-pituitary adrenal (HPA) axis activation. METHODS CHIPS follow-up was extended to 12 ± 2 months corrected post-gestational age for anthropometry (weight, length, head/waist circumference). For eligible children with consent for a study visit, we collected biological samples (hair/buccal samples) to evaluate HPA axis function (hair cortisol levels) and epigenetic change (DNA methylation analysis of buccal cells). The primary outcome was 'change in z-score for weight' between birth and 12 ± 2 mos. Secondary outcomes were hair cortisol and genome-wide DNA methylation status. RESULTS Of 683 eligible babies, 183 (26.8%) were lost to follow-up, 83 (12.2%) declined, 3 (0.4%) agreed only to ongoing contact, and 414 (60.6%) consented. 372/414 (89.9%) had weight measured at 12mos. In 'less tight' (vs. 'tight') control, the primary outcome was similar [-0.26 (-0.53, +0.01); p = 0.14, padjusted = 0.06]; median (95% confidence interval) hair cortisol (N = 35 samples) was lower [-496 (-892, -100) ng/g; p = 0.02], and buccal swab DNA methylation (N = 16 samples) was similar. No differences in growth rate could be demonstrated up to 5 years. CONCLUSIONS Results demonstrate no compelling evidence for developmental programming of growth or the HPA axis. Clinicians should look to the clinical findings of CHIPS to guide practice. Researchers should seek to replicate these findings and extend outcomes to paediatric blood pressure and neurodevelopment.
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Affiliation(s)
- Laura A Magee
- Department of Women and Children's Health, King's College London, UK; School of Life Course Sciences, King's College London, UK.
| | - Anne R Synnes
- Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | - Peter von Dadelszen
- Department of Women and Children's Health, King's College London, UK; School of Life Course Sciences, King's College London, UK.
| | - Anna M Hutfield
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada; British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
| | - Jean-Pierre Chanoine
- Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | | | - Angela M Devlin
- Department of Paediatrics, BC Children's Hospital, University of British Columbia, Vancouver, Canada.
| | | | - Amiram Gafni
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Wessel Ganzevoort
- Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Netherlands.
| | | | - Eileen K Hutton
- Obstetrics and Gynaecology, McMaster University, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
| | - Gideon Koren
- Department of Paediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Shoo K Lee
- Pediatrics, The Centre for Mother, Infant and Child Research, Sunnybrook Research Institute, University of Toronto, Canada.
| | - Dawn Mcarthur
- British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada.
| | - Evelyne Rey
- Medicine and Obstetrics and Gynaecology, University of Montreal, Canada.
| | - Wendy P Robinson
- Department of Medical Genetics, University of British Columbia, Canada.
| | - Tessa J Roseboom
- Obstetrics and Gynaecology, Academic Medical Centre, University of Amsterdam, Netherlands; Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Netherlands.
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Canada
| | - Samantha Wilson
- Department of Medical Genetics, University of British Columbia, Canada.
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Cumyn A, Ouellet K, Côté AM, Francoeur C, St-Onge C. Role of Researchers in the Ethical Conduct of Research: A Discourse Analysis From Different Stakeholder Perspectives. Ethics & Behavior 2018. [DOI: 10.1080/10508422.2018.1539671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Annabelle Cumyn
- Department of Medecine, Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Kathleen Ouellet
- Centre for Health Sciences Education, Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Anne-Marie Côté
- Department of Medicine, Division of Nephrology, Faculty of Medicine and Health Sciences, Université de Sherbrooke
| | - Caroline Francoeur
- Direction de la coordination de la mission universitaire du CIUSSS de l'Estrie-CHUS, Centre intégré universitaire de santé et des services sociaux de l’Estrie-Centre hospitalier universitaire de Sherbrooke
| | - Christina St-Onge
- Centre for Health Sciences Education, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke
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Nerenberg KA, Zarnke KB, Leung AA, Dasgupta K, Butalia S, McBrien K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Padwal RS, Tran KC, Grover S, Rabkin SW, Moe GW, Howlett JG, Lindsay P, Hill MD, Sharma M, Field T, Wein TH, Shoamanesh A, Dresser GK, Hamet P, Herman RJ, Burgess E, Gryn SE, Grégoire JC, Lewanczuk R, Poirier L, Campbell TS, Feldman RD, Lavoie KL, Tsuyuki RT, Honos G, Prebtani APH, Kline G, Schiffrin EL, Don-Wauchope A, Tobe SW, Gilbert RE, Leiter LA, Jones C, Woo V, Hegele RA, Selby P, Pipe A, McFarlane PA, Oh P, Gupta M, Bacon SL, Kaczorowski J, Trudeau L, Campbell NRC, Hiremath S, Roerecke M, Arcand J, Ruzicka M, Prasad GVR, Vallée M, Edwards C, Sivapalan P, Penner SB, Fournier A, Benoit G, Feber J, Dionne J, Magee LA, Logan AG, Côté AM, Rey E, Firoz T, Kuyper LM, Gabor JY, Townsend RR, Rabi DM, Daskalopoulou SS. Hypertension Canada's 2018 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults and Children. Can J Cardiol 2018; 34:506-525. [PMID: 29731013 DOI: 10.1016/j.cjca.2018.02.022] [Citation(s) in RCA: 409] [Impact Index Per Article: 68.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 12/13/2022] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children. This year, the adult and pediatric guidelines are combined in one document. The new 2018 pregnancy-specific hypertension guidelines are published separately. For 2018, 5 new guidelines are introduced, and 1 existing guideline on the blood pressure thresholds and targets in the setting of thrombolysis for acute ischemic stroke is revised. The use of validated wrist devices for the estimation of blood pressure in individuals with large arm circumference is now included. Guidance is provided for the follow-up measurements of blood pressure, with the use of standardized methods and electronic (oscillometric) upper arm devices in individuals with hypertension, and either ambulatory blood pressure monitoring or home blood pressure monitoring in individuals with white coat effect. We specify that all individuals with hypertension should have an assessment of global cardiovascular risk to promote health behaviours that lower blood pressure. Finally, an angiotensin receptor-neprilysin inhibitor combination should be used in place of either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in individuals with heart failure (with ejection fraction < 40%) who are symptomatic despite appropriate doses of guideline-directed heart failure therapies. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Kara A Nerenberg
- Division of General Internal Medicine, Departments of Medicine, Obstetrics and Gynecology, Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
| | - Kelly B Zarnke
- O'Brien Institute for Public Health and Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kaberi Dasgupta
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kerry McBrien
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Department of Medicine and Centre for Outcomes Research and Evaluation, McGill University and Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St. Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- Alberta Health Services and Covenant Health, Edmonton, Alberta, Canada
| | - Raj S Padwal
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen C Tran
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven Grover
- McGill Comprehensive Health Improvement Program (CHIP), Montreal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Patrice Lindsay
- Director of Stroke, Heart and Stroke Foundation of Canada, Adjunct Faculty, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mike Sharma
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - Thalia Field
- University of British Columbia, Vancouver Stroke Program, Vancouver, British Columbia, Canada
| | - Theodore H Wein
- McGill University, Stroke Prevention Clinic, Montreal General Hospital, Montreal, Quebec, Canada
| | - Ashkan Shoamanesh
- McMaster University, Hamilton Health Sciences, Population Health Research Institute, Hamilton, Ontario, Canada
| | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Robert J Herman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ellen Burgess
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven E Gryn
- Department of Medicine, Western University, London, Ontario, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | - Richard Lewanczuk
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Luc Poirier
- Institut National d'Excellence en Sante et Services Sociaux, Québec, Quebec, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Ross D Feldman
- Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kim L Lavoie
- University of Quebec at Montreal (UQAM), Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - George Honos
- CHUM, University of Montreal, Montreal, Quebec, Canada
| | - Ally P H Prebtani
- Internal Medicine, Endocrinology and Metabolism, McMaster University, Hamilton, Ontario, Canada
| | - Gregory Kline
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Sheldon W Tobe
- University of Toronto, Toronto, Ontario, and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Lawrence A Leiter
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Charlotte Jones
- Department of Medicine, UBC Southern Medical Program, Kelowna, British Columbia, Canada
| | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, Toronto Rehab and Peter Munk Cardiac Centre, Toronto, Ontario, Canada
| | - Milan Gupta
- Department of Medicine, McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Janusz Kaczorowski
- Department of Family and Emergency Medicine, Université de Montréal and CRCHUM, Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
| | - Norman R C Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Swapnil Hiremath
- University of Ottawa and the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joanne Arcand
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, Ontario, Canada
| | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | - Cedric Edwards
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Praveena Sivapalan
- Division of General Internal Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Anne Fournier
- Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Service de néphrologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Janis Dionne
- Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Laura A Magee
- Department of Women and Children's Health, St Thomas' Hospital, London, and Department of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | | | | | - Evelyne Rey
- CHU Sainte-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Tabassum Firoz
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Laura M Kuyper
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Y Gabor
- Interlake-Eastern Regional Healthy Authority, Concordia Hospital, Winnipeg, Manitoba, Canada
| | - Raymond R Townsend
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Doreen M Rabi
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine and Community Health Sciences, O'Brien Institute for Public Health and Libin Cardiovascular Institute, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Division of Internal Medicine, Department of Medicine, McGill University, Montréal, Quebec, Canada
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Butalia S, Audibert F, Côté AM, Firoz T, Logan AG, Magee LA, Mundle W, Rey E, Rabi DM, Daskalopoulou SS, Nerenberg KA. Hypertension Canada's 2018 Guidelines for the Management of Hypertension in Pregnancy. Can J Cardiol 2018; 34:526-531. [PMID: 29731014 DOI: 10.1016/j.cjca.2018.02.021] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 11/18/2022] Open
Abstract
We present Hypertension Canada's inaugural evidence-based Canadian recommendations for the management of hypertension in pregnancy. Hypertension in pregnancy is common, affecting approximately 7% of pregnancies in Canada, and requires effective management to reduce maternal, fetal, and newborn complications. Because of this importance, these guidelines were developed in partnership with the Society of Obstetricians and Gynaecologists of Canada with the main common objective of improving the management of women with hypertension in pregnancy. Guidelines for the diagnosis, assessment, prevention, and treatment of hypertension in adults and children are published separately. In this first Hypertension Canada guidelines for hypertension in pregnancy, 7 recommendations for the management of nonsevere and severe hypertension in pregnancy are presented. For nonsevere hypertension in pregnancy (systolic blood pressure 140-159 mm Hg and/or diastolic blood pressure 80-109 mm Hg), we provide guidance for the threshold for initiation of antihypertensive therapy, blood pressure targets, as well as first- and second-line antihypertensive medications. Severe hypertension (systolic blood pressure ≥ 160 mm Hg and/or diastolic blood pressure ≥ 110 mm Hg) requires urgent antihypertensive therapy to reduce maternal, fetal, and newborn adverse outcomes. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Sonia Butalia
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
| | - Francois Audibert
- Department of Obstetrics and Gynecology, CHU Sainte Justine, Université de Montréal, Montréal, Québec, Canada
| | | | - Tabassum Firoz
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | | | - Laura A Magee
- Department of Women and Children's Health, St Thomas' Hospital, London, United Kingdom; School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - William Mundle
- Maternal Fetal Medicine Clinic, Windsor Regional Hospital, Windsor, Ontario, Canada
| | - Evelyne Rey
- Division of Obstetric Medicine, Department of Obstetrics and Gynecology, CHU Sainte Justine, Montréal, Québec, Canada
| | - Doreen M Rabi
- Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Stella S Daskalopoulou
- Division of General Internal Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Kara A Nerenberg
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Departments of Medicine, Obstetrics and Gynecology, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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23
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Leung AA, Daskalopoulou SS, Dasgupta K, McBrien K, Butalia S, Zarnke KB, Nerenberg K, Harris KC, Nakhla M, Cloutier L, Gelfer M, Lamarre-Cliche M, Milot A, Bolli P, Tremblay G, McLean D, Tran KC, Tobe SW, Ruzicka M, Burns KD, Vallée M, Prasad GVR, Gryn SE, Feldman RD, Selby P, Pipe A, Schiffrin EL, McFarlane PA, Oh P, Hegele RA, Khara M, Wilson TW, Penner SB, Burgess E, Sivapalan P, Herman RJ, Bacon SL, Rabkin SW, Gilbert RE, Campbell TS, Grover S, Honos G, Lindsay P, Hill MD, Coutts SB, Gubitz G, Campbell NRC, Moe GW, Howlett JG, Boulanger JM, Prebtani A, Kline G, Leiter LA, Jones C, Côté AM, Woo V, Kaczorowski J, Trudeau L, Tsuyuki RT, Hiremath S, Drouin D, Lavoie KL, Hamet P, Grégoire JC, Lewanczuk R, Dresser GK, Sharma M, Reid D, Lear SA, Moullec G, Gupta M, Magee LA, Logan AG, Dionne J, Fournier A, Benoit G, Feber J, Poirier L, Padwal RS, Rabi DM. Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults. Can J Cardiol 2017; 33:557-576. [PMID: 28449828 DOI: 10.1016/j.cjca.2017.03.005] [Citation(s) in RCA: 212] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/04/2017] [Accepted: 03/05/2017] [Indexed: 01/29/2023] Open
Abstract
Hypertension Canada provides annually updated, evidence-based guidelines for the diagnosis, assessment, prevention, and treatment of hypertension. This year, we introduce 10 new guidelines. Three previous guidelines have been revised and 5 have been removed. Previous age and frailty distinctions have been removed as considerations for when to initiate antihypertensive therapy. In the presence of macrovascular target organ damage, or in those with independent cardiovascular risk factors, antihypertensive therapy should be considered for all individuals with elevated average systolic nonautomated office blood pressure (non-AOBP) readings ≥ 140 mm Hg. For individuals with diastolic hypertension (with or without systolic hypertension), fixed-dose single-pill combinations are now recommended as an initial treatment option. Preference is given to pills containing an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker in combination with either a calcium channel blocker or diuretic. Whenever a diuretic is selected as monotherapy, longer-acting agents are preferred. In patients with established ischemic heart disease, caution should be exercised in lowering diastolic non-AOBP to ≤ 60 mm Hg, especially in the presence of left ventricular hypertrophy. After a hemorrhagic stroke, in the first 24 hours, systolic non-AOBP lowering to < 140 mm Hg is not recommended. Finally, guidance is now provided for screening, initial diagnosis, assessment, and treatment of renovascular hypertension arising from fibromuscular dysplasia. The specific evidence and rationale underlying each of these guidelines are discussed.
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Affiliation(s)
- Alexander A Leung
- Division of Endocrinology and Metabolism, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Stella S Daskalopoulou
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kaberi Dasgupta
- Divisions of General Internal Medicine, Clinical Epidemiology and Endocrinology, Department of Medicine, McGill University, McGill University Health Centre, Montreal, Quebec, Canada
| | - Kerry McBrien
- Departments of Family Medicine and Community Health Sciences, Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Departments of Medicine and Community Health Sciences, Libin Cardiovascular Institute of Alberta, O'Brien Institute of Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kelly B Zarnke
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kara Nerenberg
- Department of Medicine and Department of Obstetrics and Gynecology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin C Harris
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Meranda Nakhla
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Mark Gelfer
- Department of Family Medicine, University of British Columbia, Copeman Healthcare Centre, Vancouver, British Columbia, Canada
| | - Maxime Lamarre-Cliche
- Institut de Recherches Cliniques de Montréal, Université de Montréal, Montréal, Quebec, Canada
| | - Alain Milot
- Department of Medicine, Université Laval, Québec, Quebec, Canada
| | - Peter Bolli
- McMaster University, Hamilton, Ontario, Canada
| | - Guy Tremblay
- CHU-Québec-Hopital St Sacrement, Québec, Quebec, Canada
| | - Donna McLean
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Marcel Ruzicka
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Michel Vallée
- Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada
| | | | - Steven E Gryn
- Department of Medicine, Division of Clinical Pharmacology, Western University, London, Ontario, Canada
| | - Ross D Feldman
- Discipline of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador
| | - Peter Selby
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Pipe
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Ernesto L Schiffrin
- Department of Medicine and Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Philip A McFarlane
- Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Oh
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Robert A Hegele
- Departments of Medicine (Division of Endocrinology) and Biochemistry, Western University, London, Ontario, Canada
| | - Milan Khara
- Vancouver Coastal Health Addiction Services, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Thomas W Wilson
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - S Brian Penner
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ellen Burgess
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Praveena Sivapalan
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Robert J Herman
- Division of General Internal Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Simon L Bacon
- Department of Exercise Science, Concordia University, and Montreal Behavioural Medicine Centre, Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal (CIUSSS-NIM), Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada
| | - Simon W Rabkin
- Vancouver Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard E Gilbert
- University of Toronto, Division of Endocrinology, St Michael's Hospital, Toronto, Ontario, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Steven Grover
- Division of Clinical Epidemiology, Montreal General Hospital, Montreal, Quebec, Canada
| | - George Honos
- University of Montreal, Montreal, Quebec, Canada
| | - Patrice Lindsay
- Stroke, Heart and Stroke Foundation of Canada, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Shelagh B Coutts
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Gord Gubitz
- Division of Neurology, Halifax Infirmary, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Norman R C Campbell
- Medicine, Community Health Sciences, Physiology and Pharmacology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Gordon W Moe
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan G Howlett
- Departments of Medicine and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jean-Martin Boulanger
- Charles LeMoyne Hospital Research Centre, Sherbrooke University, Sherbrooke, Quebec, Canada
| | | | - Gregory Kline
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lawrence A Leiter
- Keenan Research Centre in the Li Ka Shing Knowledge Institute of St Michael's Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Jones
- University of British Columbia, Southern Medical Program, Kelowna, British Columbia, Canada
| | | | - Vincent Woo
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Janusz Kaczorowski
- Université de Montréal and Centre hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Luc Trudeau
- Division of Internal Medicine, McGill University, Montréal, Quebec, Canada
| | - Ross T Tsuyuki
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Swapnil Hiremath
- Faculty of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Drouin
- Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal, Montréal, Quebec, Canada
| | - Pavel Hamet
- Faculté de Médicine, Université de Montréal, Montréal, Quebec, Canada
| | - Jean C Grégoire
- Université de Montréal, Institut de cardiologie de Montréal, Montréal, Quebec, Canada
| | | | - George K Dresser
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Mukul Sharma
- McMaster University, Hamilton Health Sciences Population Health Research Institute, Hamilton, Ontario, Canada
| | - Debra Reid
- Centre intégré de santé et de services sociaux (CISSS) de l'Outaouais, Groupes de médecine de famille (GMF) de Wakefield, Wakefield, Quebec, Canada
| | - Scott A Lear
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Gregory Moullec
- Research Center, Hôpital du Sacré-Coeur de Montréal, Public Health School, University of Montréal, Montréal, Quebec, Canada
| | - Milan Gupta
- McMaster University, Hamilton, Ontario, and Canadian Collaborative Research Network, Brampton, Ontario, Canada
| | - Laura A Magee
- St George's, University of London and the St George's Hospital National Health Service (NHS) Foundation Trust, London, United Kingdom
| | | | - Janis Dionne
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anne Fournier
- Service de cardiologie, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Geneviève Benoit
- Centre Hospitalier Universitaire Sainte-Justine, Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Janusz Feber
- Division of Neurology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Poirier
- Centre Hospitalier Universitaire de Québec et Faculté de Pharmacie, Université Laval, Québec, Quebec, Canada
| | - Raj S Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Doreen M Rabi
- Departments of Medicine, Community Health and Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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Correa ME, Côté AM, De Silva DA, Wang L, Packianathan P, von Dadelszen P, Magee LA. Visual or automated dipstick testing for proteinuria in pregnancy? Pregnancy Hypertens 2017; 7:50-53. [DOI: 10.1016/j.preghy.2017.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/11/2017] [Accepted: 01/12/2017] [Indexed: 11/25/2022]
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25
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Bujold E, Côté AM, Douglas MJ, Eastabrook G, Firoz T, Gibson P, Gruslin A, Hutcheon J, Koren G, Lange I, Leduc L, Logan AG, MacDonell KL, Moutquin JM, Sebbag I, Audibert F. Letter to the Editor: In Response. J Obstet Gynaecol Can 2015; 37:775-776. [PMID: 26605445 DOI: 10.1016/s1701-2163(15)30146-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Guillemette L, Lacroix M, Allard C, Patenaude J, Battista MC, Doyon M, Moreau J, Ménard J, Ardilouze JL, Perron P, Côté AM, Hivert MF. Preeclampsia is associated with an increased pro-inflammatory profile in newborns. J Reprod Immunol 2015; 112:111-4. [PMID: 26454417 DOI: 10.1016/j.jri.2015.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 09/15/2015] [Indexed: 10/23/2022]
Abstract
Hypertensive disorders of pregnancy (HDP) lead to high rates of maternal and fetal morbidity. Existing studies on inflammatory marker TNFα in HDP offspring are inconsistent. We performed a population-based cohort study of 636 pregnancies, including normotensive (NT) women and women with preeclampsia (PE) or gestational hypertension (GH). TNFα was measured in maternal blood in the first and second trimesters and in cord blood at the time of delivery. Cord blood TNFα was higher in offspring delivered of women with PE (6.53 [4.94-8.38]pg/mL) versus those delivered of NT women (5.13 [4.11-6.72]pg/mL; p=0.01), independent of confounders. Maternal TNFα levels were not different among groups (p>0.1) in either the first or second trimester.
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Affiliation(s)
- Laetitia Guillemette
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Marilyn Lacroix
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Catherine Allard
- Département de mathématiques, Faculté des sciences, Université de Sherbrooke, 2500, boul. de l'Université, Sherbrooke J1K 2R1, QC, Canada
| | - Julie Patenaude
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Marie-Claude Battista
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Myriam Doyon
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Julie Moreau
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Julie Ménard
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Jean-Luc Ardilouze
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Patrice Perron
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Anne-Marie Côté
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada
| | - Marie-France Hivert
- Département de médecine, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, 3001 12(e) Avenue Nord, Sherbrooke J1H 5N4, QC, Canada; Department of Population Medicine, Harvard Pilgrim Health Care Institute, Harvard Medical School, 133 Brookline Avenue, Boston 02215, MA, USA; Diabetes Unit, Massachusetts General Hospital, 55 Fruit Street, Boston 02114, MA, USA.
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Audibert F, Bujold E, Côté AM, Douglas MJ, Eastabrook G, Firoz T, Gibson P, Gruslin A, Hutcheon J, Koren G, Lange I, Leduc L, Logan AG, MacDonell KL, Moutquin JM, Sebbag I. The hypertensive disorders of pregnancy (29.3). Best Pract Res Clin Obstet Gynaecol 2015; 29:643-57. [DOI: 10.1016/j.bpobgyn.2015.04.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 11/28/2022]
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De Silva DA, Halstead AC, Côté AM, Sabr Y, von Dadelszen P, Magee LA. Urinary Dipstick Proteinuria Testing: Does Automated Strip Analysis Offer an Advantage Over Visual Testing? Journal of Obstetrics and Gynaecology Canada 2014; 36:605-612. [DOI: 10.1016/s1701-2163(15)30540-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Magee LA, Pels A, Helewa M, Rey E, von Dadelszen P, Magee LA, Audibert F, Bujold E, Côté AM, Joanne Douglas M, Eastabrook G, Firoz T, Gibson P, Gruslin A, Hutcheon J, Koren G, Lange I, Leduc L, Logan AG, MacDonell KL, Moutquin JM, Sebbag I. Diagnostic, évaluation et prise en charge des troubles hypertensifs de la grossesse : Résumé directif. Journal of Obstetrics and Gynaecology Canada 2014. [DOI: 10.1016/s1701-2163(15)30589-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lamontagne A, Côté AM, Rey E. The Urinary Protein-to-Creatinine Ratio in Canadian Women at Risk of Preeclampsia: Does the Time of Day of Testing Matter? Journal of Obstetrics and Gynaecology Canada 2014; 36:303-308. [DOI: 10.1016/s1701-2163(15)30605-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Kairy D, Tousignant M, Leclerc N, Côté AM, Levasseur M. The patient's perspective of in-home telerehabilitation physiotherapy services following total knee arthroplasty. Int J Environ Res Public Health 2013; 10:3998-4011. [PMID: 23999548 PMCID: PMC3799503 DOI: 10.3390/ijerph10093998] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 11/16/2022]
Abstract
This study aimed at exploring patients’ perceptions regarding telerehabilitation services received post total knee replacement. In this qualitative embedded single case study, semi-structured interviews were conducted with five patients who had previously received in-home telerehabilitation post total knee arthroplasty. Participants were asked to reflect on their 8-week rehabilitation process and on their experience with the home telerehabilitation program. Interviews were transcribed and a qualitative thematic analysis was conducted. Six overarching themes emerged from the patients’ perceptions: (1) improving access to services with reduced need for transportation; (2) developing a strong therapeutic relationship with therapist while maintaining a sense of personal space; (3) complementing telerehabilitation with in-person visits; (4) providing standardized yet tailored and challenging exercise programs using telerehabilitation; (5) perceived ease-of-use of telerehabilitation equipment; and (6) feeling an ongoing sense of support. Gaining a better understating of the patient’s experience in telerehabilitation will be essential as programs continue to be developed and implemented.
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Affiliation(s)
- Dahlia Kairy
- School of Rehabilitation, Université de Montréal and Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal—IRGLM site, 6300 Darlington Avenue, Montreal, Quebec H3S 2J4, Canada
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-514-343-6301; Fax: +1-514-343-6929
| | - Michel Tousignant
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (M.T.); (N.L.)
| | - Nancy Leclerc
- Research Centre on Aging, University Institute of Geriatrics of Sherbrooke, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (M.T.); (N.L.)
| | - Anne-Marie Côté
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (A.-M.C.); (M.L.)
| | - Mélanie Levasseur
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 1036 Belvédère Sud, Sherbrooke, Quebec J1H 4C4, Canada; E-Mails: (A.-M.C.); (M.L.)
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De Silva DA, Halstead AC, Côté AM, Sabr Y, von Dadelszen P, Magee LA. Unexpected random urinary protein:creatinine ratio results-limitations of the pyrocatechol violet-dye method. BMC Pregnancy Childbirth 2013; 13:152. [PMID: 23865673 PMCID: PMC3733961 DOI: 10.1186/1471-2393-13-152] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 07/07/2013] [Indexed: 12/03/2022] Open
Abstract
Background For clinicians, it is important to rely on accurate laboratory results for patient care and optimal use of health care resources. We sought to explore our observations that urine protein:creatinine ratios (PrCr) ≥30 mg/mmol are seen not infrequently associated with normal pregnancy outcome. Methods Urine samples were collected prospectively from 160 pregnant women attending high-risk maternity clinics at a tertiary care facility. Urinary protein was measured using a pyrocatechol violet assay and urinary creatinine by an enzymatic method on Vitros analysers. Maternal/perinatal outcomes were abstracted from hospital records. Results 91/233 (39.1%) samples had a PrCr ≥30 mg/mmol, especially when urinary creatinine concentration was <3 mM (94.1%) vs. ≥3 mM (16.4%) (p < 0.001). When using the last sample before delivery, 47/160 (29.4%) had a PrCr ≥30 mg/mmol in diluted urine vs. only 17/160 (15.4%) in more concentrated urine (p < 0.001); PrCr positive results were also more frequent among the 32 (20.0%) women with known normal pregnancy outcome (90.9% vs. 0) (p < 0.001). Using the same analyser, 0.12 g/L urinary protein was ‘detected’ in deionised water. Re-analysis of data from two cohorts revealed substantially less inflation of PrCr in dilute urine using a pyrogallol red assay. Conclusions Random urinary PrCr was overestimated in dilute urine when tested using a common pyrocatechol violet dye-based method. This effect was reduced in cohorts when pyrogallol red assays were used. False positive results can impact on diagnosis and patient care. This highlights the need for both clinical and laboratory quality improvement projects and standardization of laboratory protein measurement.
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De Silva DA, Halstead AC, Côté AM, Sabr Y, von Dadelszen P, Magee LA. Random urine albumin:creatinine ratio in high-risk pregnancy - Is it clinically useful? Pregnancy Hypertens 2013; 3:112-4. [PMID: 26105946 DOI: 10.1016/j.preghy.2013.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/03/2013] [Indexed: 11/15/2022]
Abstract
We evaluated the frequency of measurable albuminuria (⩾6.00mg/L) for albumin:creatinine ratios (ACr) among 160 consecutive women attending high-risk clinics. Of last urine samples before delivery, 76 had measurable albuminuria and 41/76 (53.9%) had ACr ⩾2mg/mmol of which 7.3% had normal pregnancy outcome. 84 samples had albuminuria <6.00mg/L and 43/84 (51.2%) had ACr ⩾2mg/mmol of which 25.6% had normal pregnancy outcome (p=0.025). Excluding 48/160 (30.0%) dilute samples (urinary creatinine <3mM), no samples with unmeasurable albuminuria had ACr ⩾2mg/mmol. In pregnancy, urine is often dilute and without measurable albuminuria, leading to a clinically relevant proportion of false positive results by ACr.
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Affiliation(s)
- Dane A De Silva
- Department of Pathology and Laboratory Medicine, Children and Women's Health Centre of British Columbia and the University of British Columbia, Vancouver, Canada; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Anne C Halstead
- Department of Pathology and Laboratory Medicine, Children and Women's Health Centre of British Columbia and the University of British Columbia, Vancouver, Canada.
| | - Anne-Marie Côté
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Canada.
| | - Yasser Sabr
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada.
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
| | - Laura A Magee
- Department of Medicine, University of British Columbia, Vancouver, Canada; Department of Specialized Women's Health, British Columbia Women's Hospital and Health Centre, Vancouver, Canada; Child and Family Research Institute, University of British Columbia, Vancouver, Canada.
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Payne B, Magee LA, Côté AM, Hutcheon JA, Li J, Kyle PM, Menzies JM, Peter Moore M, Parker C, Pullar B, von Dadelszen P, Walters BN, von Dadelszen P, Magee L, Douglas M, Walley K, Russell J, Lee S, Gruslin A, Smith G, Côté A, Moutquin JM, Brown M, Davis G, Walters B, Sass N, Duan T, Zhou J, Mahajan S, Noovao A, McCowan L, Kyle P, Moore M, Bhutta S, Bhutta Z, Hall, Steyn D, Broughton Pipkin F, Loughna P, Robson S, de Swiet M, Walker J, Grobman W, Lindheimer M, Roberts J, Mark Ansermino J, Benton S, Cundiff G, Hugo D, Joseph K, Lalji S, Li J, Lott P, Ouellet AB, Shaw D, Keith Still D, Tawagi G, Wagner B, Biryabarema C, Mirembe F, Nakimuli A, Tsigas E, Merialdi M, Widmer M. PIERS Proteinuria: Relationship With Adverse Maternal and Perinatal Outcome. Journal of Obstetrics and Gynaecology Canada 2011; 33:588-597. [DOI: 10.1016/s1701-2163(16)34907-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bettez M, Carmel M, Temmar R, Côté AM, Sauvé N, Asselah J, Sabbagh R. Fatal Fast-Growing Renal Cell Carcinoma During Pregnancy. Journal of Obstetrics and Gynaecology Canada 2011; 33:258-61. [DOI: 10.1016/s1701-2163(16)34827-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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von Dadelszen P, Payne B, Li J, Ansermino JM, Broughton Pipkin F, Côté AM, Douglas MJ, Gruslin A, Hutcheon JA, Joseph KS, Kyle PM, Lee T, Loughna P, Menzies JM, Merialdi M, Millman AL, Moore MP, Moutquin JM, Ouellet AB, Smith GN, Walker JJ, Walley KR, Walters BN, Widmer M, Lee SK, Russell JA, Magee LA. Prediction of adverse maternal outcomes in pre-eclampsia: development and validation of the fullPIERS model. Lancet 2011; 377:219-27. [PMID: 21185591 DOI: 10.1016/s0140-6736(10)61351-7] [Citation(s) in RCA: 342] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pre-eclampsia is a leading cause of maternal deaths. These deaths mainly result from eclampsia, uncontrolled hypertension, or systemic inflammation. We developed and validated the fullPIERS model with the aim of identifying the risk of fatal or life-threatening complications in women with pre-eclampsia within 48 h of hospital admission for the disorder. METHODS We developed and internally validated the fullPIERS model in a prospective, multicentre study in women who were admitted to tertiary obstetric centres with pre-eclampsia or who developed pre-eclampsia after admission. The outcome of interest was maternal mortality or other serious complications of pre-eclampsia. Routinely reported and informative variables were included in a stepwise backward elimination regression model to predict the adverse maternal outcome. We assessed performance using the area under the curve (AUC) of the receiver operating characteristic (ROC). Standard bootstrapping techniques were used to assess potential overfitting. FINDINGS 261 of 2023 women with pre-eclampsia had adverse outcomes at any time after hospital admission (106 [5%] within 48 h of admission). Predictors of adverse maternal outcome included gestational age, chest pain or dyspnoea, oxygen saturation, platelet count, and creatinine and aspartate transaminase concentrations. The fullPIERS model predicted adverse maternal outcomes within 48 h of study eligibility (AUC ROC 0·88, 95% CI 0·84-0·92). There was no significant overfitting. fullPIERS performed well (AUC ROC >0·7) up to 7 days after eligibility. INTERPRETATION The fullPIERS model identifies women at increased risk of adverse outcomes up to 7 days before complications arise and can thereby modify direct patient care (eg, timing of delivery, place of care), improve the design of clinical trials, and inform biomedical investigations related to pre-eclampsia. FUNDING Canadian Institutes of Health Research; UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development, and Research Training in Human Reproduction; Preeclampsia Foundation; International Federation of Obstetricians and Gynecologists; Michael Smith Foundation for Health Research; and Child and Family Research Institute.
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Affiliation(s)
- Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada.
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Poitras S, Durand MJ, Côté AM, Tousignant M. Use of low-back pain guidelines by occupational therapists: A qualitative study of barriers and facilitators. Work 2011; 39:465-75. [DOI: 10.3233/wor-2011-1196] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Marie-José Durand
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Anne-Marie Côté
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
| | - Michel Tousignant
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Canada
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Côté AM, Durand MJ, Tousignant M, Poitras S. Physiotherapists and use of low back pain guidelines: a qualitative study of the barriers and facilitators. J Occup Rehabil 2009; 19:94-105. [PMID: 19219536 DOI: 10.1007/s10926-009-9167-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2008] [Accepted: 01/27/2009] [Indexed: 05/27/2023]
Abstract
INTRODUCTION A new set of clinical practice guidelines (CPGs) for the management of low back pain (LBP) and prevention of persistent disability entitled "Clinic on Low back pain in Interdisciplinary Practice" (CLIP) was developed in the province of Quebec, Canada. The literature shows that simply disseminating CPGs does not necessarily lead to their adoption by clinicians. To improve adherence to CPGs among healthcare professionals, the literature suggests that there is a need to identify and address the factors impeding or facilitating their use. The aim of this study was therefore to identify the barriers to and facilitators of CLIP CPG use, as perceived by physiotherapists (PTs). METHODS A descriptive study using a qualitative method was conducted with a sample of 16 PTs from a variety of professional backgrounds. Each participant used the CPGs over a 6-week period with two patients suffering from LBP, and then participated in a semi-structured interview in which he or she was asked to identify the barriers and facilitators experienced. RESULTS The participating PTs identified many barriers and facilitators pertaining to the guidelines themselves, the users and the environment. Four key nodes emerged from these barriers and facilitators during data analysis. It appears that the clinicians' understanding of the CPGs, the level of compatibility between their practices and the CLIP CPG recommendations, the level of CPG relevance as perceived by the clinicians, and their level of agreement with the CPGs, all affected their use of the guidelines. CONCLUSIONS In order to increase CLIP CPG use, the implementation strategy to be developed should take into account the barriers and facilitators that were identified in this study.
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Affiliation(s)
- Anne-Marie Côté
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, J1H 5N4, Canada.
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Côté AM, Firoz T, Mattman A, Lam EM, von Dadelszen P, Magee LA. The 24-hour urine collection: gold standard or historical practice? Am J Obstet Gynecol 2008; 199:625.e1-6. [PMID: 18718568 DOI: 10.1016/j.ajog.2008.06.009] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Revised: 03/13/2008] [Accepted: 06/03/2008] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The objective of the study was to determine completeness of 24-hour urine collection in pregnancy. STUDY DESIGN This was a retrospective laboratory/chart review of 24-hour urine collections at British Columbia Women's Hospital. Completeness was assessed by 24-hour urinary creatinine excretion (UcreatV): expected according to maternal weight for single collections and between-measurement difference for serial collections. RESULTS For 198 randomly selected pregnant women with a hypertensive disorder (63% preeclampsia), 24-hour urine collections were frequently inaccurate (13-54%) on the basis of UcreatV of 97-220 micromol/kg per day (11.0-25.0 mg/kg per day) or 133-177 micromol/kg per day (15.1-20.1 mg/kg per day) of prepregnancy weight (respectively). Lean body weight resulted in more inaccurate collections (24-68%). The current weight was frequently unavailable (28%) and thus not used. For 161 women (81% proteinuric) with serial 24-hour urine levels, a median [interquartile range] of 11 [5-31] days apart, between-measurement difference in UcreatV was 14.4% [6.0-24.9]; 40 women (24.8%) had values 25% or greater, exceeding analytic and biologic variation. CONCLUSION Twenty-four hour urine collection is frequently inaccurate and not a precise measure of proteinuria or creatinine clearance.
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Côté AM, Brown MA, Lam E, von Dadelszen P, Firoz T, Liston RM, Magee LA. Diagnostic accuracy of urinary spot protein:creatinine ratio for proteinuria in hypertensive pregnant women: systematic review. BMJ 2008; 336:1003-6. [PMID: 18403498 PMCID: PMC2364863 DOI: 10.1136/bmj.39532.543947.be] [Citation(s) in RCA: 149] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2008] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To review the spot protein:creatinine ratio and albumin:creatinine ratio as diagnostic tests for significant proteinuria in hypertensive pregnant women. DESIGN Systematic review. DATA SOURCES Medline and Embase, the Cochrane Library, reference lists, and experts. Review methods Literature search (1980-2007) for articles of the spot protein:creatinine ratio or albumin:creatinine ratio in hypertensive pregnancy, with 24 hour proteinuria as the comparator. RESULTS 13 studies concerned the spot protein:creatinine ratio (1214 women with primarily gestational hypertension). Nine studies reported sensitivity and specificity for eight cut-off points, median 24 mg/mmol (range 17-57 mg/mmol; 0.15-0.50 mg/mg). Laboratory assays were not well described. Diagnostic test characteristics were recalculated for a cut-off point of 30 mg/mmol. No significant heterogeneity in cut-off points was found between studies over a range of proteinuria. Pooled values gave a sensitivity of 83.6% (95% confidence interval 77.5% to 89.7%), specificity of 76.3% (72.6% to 80.0%), positive likelihood ratio of 3.53 (2.83 to 4.49), and negative likelihood ratio of 0.21 (0.13 to 0.31) (nine studies, 1003 women). Two studies of the spot albumin:creatinine ratio (225 women) found optimal cut-off points of 2 mg/mmol for proteinuria of 0.3 g/day or more and 27 mg/mmol for albuminuria. CONCLUSION The spot protein:creatinine ratio is a reasonable "rule-out" test for detecting proteinuria of 0.3 g/day or more in hypertensive pregnancy. Information on use of the albumin:creatinine ratio in these women is insufficient.
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Affiliation(s)
- Anne-Marie Côté
- BC Women's Hospital and Health Centre, Vancouver, BC, Canada
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Magee LA, Miremadi S, Li J, Cheng C, Ensom MHH, Carleton B, Côté AM, von Dadelszen P. Therapy with both magnesium sulfate and nifedipine does not increase the risk of serious magnesium-related maternal side effects in women with preeclampsia. Am J Obstet Gynecol 2005; 193:153-63. [PMID: 16021073 DOI: 10.1016/j.ajog.2004.11.059] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Does the use of nifedipine and magnesium sulfate together increase serious magnesium-related effects? STUDY DESIGN This was a retrospective chart review of women who were admitted to BC Women's Hospital and Health Centre (1997-2001) and were given intravenous magnesium sulfate for preeclampsia. Serious magnesium-related effects were compared among 162 cases who received magnesium sulfate and contemporaneous nifedipine and 215 control subjects who received magnesium sulfate and either another antihypertensive (n=32 women) or no antihypertensive (n=183 women) medication. Chi-squared test, Fisher's exact test, or the Student t test was used for data comparison between cases and each control group. A probability value of <.05 was considered statistically significant. RESULTS The cases had more severe preeclampsia and a longer magnesium sulfate infusion. However, cases had no excess of neuromuscular weakness (53.1%) versus control subjects who received antihypertensive medication (53.1%; P=.99) or control subjects who received no antihypertensive medication (44.8%; P=.13) or other serious magnesium-related effects. Cases versus control subjects who received antihypertensive medication had less neuromuscular blockade (odds ratio, 0.04; 95% CI, 0.002-0.80). Cases versus control subjects who received no antihypertensive medication had less maternal hypotension (41.4% vs 53.0%; P=.04). CONCLUSION The use of nifedipine and magnesium sulfate together does not increase the risk of serious magnesium-related effects.
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Affiliation(s)
- Laura A Magee
- Centre for Healthcare Innovation and Improvement, British Columbia Research Institute for Children's and Women's Health, Department of Specialized Women's Health, BC Women's Hospital and Health Centre, Canada.
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Abstract
A meta-analysis of randomized controlled trials suggests that nifedipine appears to be a reasonable agent for treatment of acute severe hypertension in pregnancy. However, in a 1999 survey of Canadian practitioners, most stated that they rarely or never use nifedipine capsules for treatment of acute severe pregnancy hypertension. Also, there are case reports of adverse outcomes following use of nifedipine capsules in pregnancy, although the risks appear to have been overplayed. We suggest that a reasonable approach is ongoing use of nifedipine capsules, with perhaps an initial dosage of 5 mg rather than 10 mg. Having women swallow the capsule without first biting it may also be a prudent approach, because there is insufficient information from most of the published clinical trials to say exactly how the nifedipine capsules were administered. Further, use of the 10 mg nifedipine prolonged action tablet may also be a reasonable approach for treatment of severe hypertension in pregnancy, although more data are needed. Such research would be particularly relevant given that nifedipine appears to be a promising treatment for spontaneous preterm labour. We must resist the temptation to throw out of our limited therapeutic armamentarium an effective oral preparation before adequately considering the evidence.
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Affiliation(s)
- Laura A Magee
- Department of Specialized Women's Health, BC Women's Hospital and Health Centre, Vancouver, British Columbia, Canada
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Côté AM, Sobela F, Dzokoto A, Nzambi K, Asamoah-Adu C, Labbé AC, Mâsse B, Mensah J, Frost E, Pépin J. Transactional sex is the driving force in the dynamics of HIV in Accra, Ghana. AIDS 2004; 18:917-25. [PMID: 15060439 DOI: 10.1097/00002030-200404090-00009] [Citation(s) in RCA: 136] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To delineate the population attributable fraction (PAF) of transactional sex in prevalent cases of HIV infection in the male adult population of Accra, Ghana. DESIGN AND METHODS Cross-sectional study of clients who visited a sex worker (SW), of boyfriends of SW and of male personnel in prostitution venues. A questionnaire was administered and urine obtained for detection of anti-HIV antibodies. The PAF of prevalent HIV acquired from SW was calculated using a combination of data from this survey of clients, from on-going SW surveys, the national HIV surveillance system and the national census. RESULTS HIV prevalence was 4.9% (8/162) among clients of mobile SW, 15.8% (53/335) among clients of home-based SW, 17.5% (10/57) among personnel and 32.1% (9/28) among boyfriends. A condom was used in 90% of intercourses, according to clients. Non-use of a condom was clustered in selected locations and independently associated with older age of client, frequency of intercourse with SW in the last year and current urethritis. Among the male population of Accra aged 15-59 years, 84% of prevalent cases of HIV were attributable to transactional sex. A sensitivity analysis showed that under various assumptions PAF varied between 47% and 100%. CONCLUSIONS In Accra, approximately four-fifths of prevalent cases of HIV in adult males were acquired from SW. Comprehensive interventions providing education, condoms and treatment for sexually transmitted diseases for SW and their clients should be approached as other public health priorities and provided in all cities, large and small, of West Africa.
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Affiliation(s)
- Anne-Marie Côté
- Centre for International Health, University of Sherbrooke, 3001 12th Avenue North, Sherbrooke, Québec, Canada J1H 5N4
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