Going Blind in Nepal

Following two months of backpacking in Southeast Asia, I arrived in Nepal in August 2014 for a much anticipated three-week global health elective in emergency medicine. Before I finished my first day, however, my trip took an unexpected turn; I began to experience a serious medical problem and was forced to seek immediate treatment. I was suddenly transformed from an enthusiastic student to a reluctant patient in a country whose medical system is very different from that of my own. This unfortunate circumstance did, however, allow me to learn about Nepalese medicine in ways that I never would have been able to as a medical student, and the lessons that I learned will undoubtedly help me in my future career.   Suite à deux mois de voyage en Asie du Sud-Est, je suis arrivé au Népal en août 2014 où j’ai fait un stage de trois semaines en méde­cine d’urgence. Suite à ma première journée de stage, j’ai dû me chercher un traitement médical pour un problème sérieux. J’ai été transformé d’étudiant enthousiaste en patient inquiet dans un pays où le système médical est très différent du mien. Mon expérience comme patient et étudiant en médecine au Népal m’a permis d’apprendre beaucoup au sujet de la médecine népalaise. Les leçons apprises dans ce pays étranger vont sans doute aider dans ma future carrière en tant que médecin

A Peer-Based Approach to Reducing Stigma and Improving Mental Health Support for Medical Students

Abstract Medical students experience a tremendous amount of stress during their training, which can have a profound effect on mental wellness. Several medical students at the University of Ottawa have created a peer-based program called Mind the Gap (MtG), which aims to improve mental health support and combat mental health-related stigma within the medical student community. The program consists of monthly meetings that invite students to discuss personal experiences and issues surrounding mental illness. The following article is a commentary outlining the MtG program, including its rationale and goals, and the challenges in implementing this type of program.  Résumé Les étudiants en médecine vivent un stress énorme au cours de leur formation, ce qui peut avoir un impact profond sur leur bien-être mental. Plusieurs étudiants en médecine à l’Université d’Ottawa ont mis sur pied un programme appelé « Mind the Gap » (MtG), qui vise à améliorer le soutien en santé mentale et à combattre la stigmatisation liée à la santé mentale dans la communauté médicale étudiante. Le programme est composé de rencontres mensuelles qui permettent aux étudiants de discuter de leurs expériences personnelles et des problèmes liés à la maladie mentale. L’article suivant est un commentaire donnant un aperçu du programme MtG, incluant sa raison d’être et ses buts, et les défis qui surviennent lors de la mise en place d’un tel programme.

Comparative, cross-sectional study of the format, content and timing of medication safety letters issued in Canada, the USA and the UK

Objectives To assess consistency in the format and content, and overlap of subject and timing, of medication safety letters issued by regulatory health authorities to healthcare providers in Canada, the USA and the UK. Design A cross-sectional study comparing medication safety letters issued for the purpose of alerting healthcare providers to newly identified medication problems associated with medications already on the market. Setting Online databases operated by Health Canada, the US Food and Drug Administration and the UK Medicines and Healthcare products Regulatory Agency were searched to select medication safety letters issued between 1 January 2010 and 31 December 2014. Format, content and timing of each medication safety letter were assessed using an abstraction tool comprising 21 characteristics deemed relevant by consensus of the research team. Main outcome measures Main outcome measures included, first, characteristics (format and content) of medication safety letters and second, overlap of subject and release date across countries. Results Of 330 medication safety letters identified, 227 dealt with unique issues relating to medications available in all three countries. Of these 227 letters, 21 (9%) medication problems were the subject of letters released in all three countries; 40 (18%) in two countries and 166 (73%) in only one country. Only 13 (62%) of the 21 letters issued in all three countries were released within 6 months of each other. Conclusions Significant discrepancies in both the subject and timing of medication safety letters issued by health authorities in three countries (Canada, the USA and the UK) where medical practice is otherwise comparable, raising questions about why, how and when medication problems are identified and communicated to healthcare providers by the authorities. More rapid communication of medication problems and better alignment between authorities could enhance patient safety

Generic Component-Based Mission-Centric Energy Model for Micro-Scale Unmanned Aerial Vehicles

The trend towards the usage of battery-electric unmanned aerial vehicles needs new strategies in mission planning and in the design of the systems themselves. To create an optimal mission plan and take appropriate decisions during the mission, a reliable, accurate and adaptive energy model is of utmost importance. However, most existing approaches either use very generic models or ones that are especially tailored towards a specific UAV. We present a generic energy model that is based on decomposing a robotic system into multiple observable components. The generic model is applied to a swarm of quadcopters and evaluated in multiple flights with different manoeuvres. We additionally use the data from practical experiments to learn and generate a mission-agnostic energy model which can match the typical behaviour of our quadcopters such as hovering; movement in x, y and z directions; landing; communication; and illumination. The learned energy model concurs with the overall energy consumption with an accuracy over 95% compared to the training flights for the indoor use case. An extended model reduces the error to less than 1.4%. Consequently, the proposed model enables an estimation of the energy used in flight and on the ground, which can be easily incorporated in autonomous systems and enhance decision-making with reliable input. The used learning mechanism allows to deploy the approach with minimal effort to new platforms needing only some representative test missions, which was shown using additional outdoor validation flights with a different quadcopter of the same build and the originally trained models. This set-up increased the prediction error of our model to 4.46%

Inhaled anaesthesia compared with conventional sedation in post cardiac arrest patients undergoing temperature control : a systematic review and meta-analysis

Patients admitted with return of spontaneous circulation (ROSC) following out of hospital cardiac arrest (OHCA) are often sedated to facilitate care. Volatile anaesthetics have been proposed as alternative sedatives because of their rapid offset. We performed a systematic review and meta-analysis comparing the use of volatile anaesthetics to conventional sedation in this population. We searched four databases (MEDLINE,Embase, CENTRAL, and Scopus) from inception to January 6, 2022. We included randomized trials and observational studies evaluating patients admitted following ROSC. We pooled data and reported summary estimates using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes, both with 95% confidence intervals (CIs). We assessed risk of bias using the Newcastle Ottawa Scale and certainty of evidence using GRADE methodology. Of 1,973 citations, we included three observational studies (n=604 patients). Compared to conventional sedation, volatile agents had an uncertain effect on delirium (OR 0.96, 95% CI 0.68-1.37), survival to discharge (OR 0.66, 95% CI 0.17-2.61), and ICU length of stay (MD 1.59 days fewer, 95% CI 1.17-4.36, all very low certainty). Patients who received volatile anaesthetic underwent a shorter duration of mechanical ventilation (MD 37.32 hours shorter, 95% CI 7.74-66.90), however this was based on low-certainty evidence. No harms were described with use of volatile anesthetics. Volatile anaesthetics may be associated with a decreased duration of mechanical ventilation in patients admitted with ROSC however this is based on low-certainty evidence. Further data are needed to assess their role in this population. [Abstract copyright: Copyright © 2022. Published by Elsevier B.V.

Revisiting the Evidence for Dipyridamole in Reducing Restenosis: A Systematic Review and Meta-analysis

Atherosclerosis remains a leading cause of morbidity and mortality, with revascularization remaining a cornerstone of management. Conventional revascularization modalities remain challenged by target vessel reocclusion-an event driven by mechanical, thrombotic, and proliferative processes. Despite considerable advancements, restenosis remains the focus of ongoing research. Adjunctive agents, including dipyridamole, offer a multitude of effects that may improve vascular homeostasis. We sought to quantify the potential therapeutic impact of dipyridamole on vascular occlusion. We performed a literature search (EMBASE and MEDLINE) examining studies that encompassed 3 areas: (1) one of the designated medical therapies applied in (2) the setting of a vascular intervention with (3) an outcome including vascular occlusion rates and/or quantification of neointimal proliferation/restenosis. The primary outcome was vascular occlusion rates. The secondary outcome was the degree of restenosis by neointimal quantification. Both human and animal studies were included in this translational analysis. There were 6,839 articles screened, from which 73 studies were included, encompassing 16,146 vessels followed up for a mean of 327.3 days (range 7-3650 days). Preclinical studies demonstrate that dipyridamole results in reduced vascular occlusion rates {24.9% vs. 48.8%, risk ratio 0.53 [95% confidence interval (CI) 0.40-0.70], I-2 = 39%, P < 0.00001}, owing to diminished neointimal proliferation [standardized mean differences -1.13 (95% CI -1.74 to -0.53), I-2 = 91%, P = 0.0002]. Clinical studies similarly demonstrated reduced occlusion rates with dipyridamole therapy [23.5% vs. 31.0%, risk ratio 0.77 (95% CI 0.67-0.88), I-2 = 84%, P < 0.0001]. Dipyridamole may improve post-intervention vascular patency and mitigate restenosis. Dedicated studies are warranted to delineate its role as an adjunctive agent after revascularization

Long-Term Outcomes of Cardiogenic Shock Complicating Myocardial Infarction

BACKGROUND: Cardiogenic shock secondary to acute myocardial infarction (AMI-CS) is associated with substantial short-term mortality; however, there are limited data on long-term outcomes and trends. OBJECTIVES: This study sought to examine long-term outcomes of AMI-CS patients. METHODS: This was a population-based, retrospective cohort study in Ontario, Canada of critically ill adult patients with AMI-CS who were admitted to hospitals between April 1, 2009 and March 31, 2019. Outcome data were captured using linked health administrative databases. RESULTS: A total of 9,789 consecutive patients with AMI-CS from 135 centers were included. The mean age was 70.5 ± 12.3 years, and 67.7% were male. The incidence of AMI-CS was 8.2 per 100,000 person-years, and it increased over the study period. Critical care interventions were common, with 5,422 (55.4%) undergoing invasive mechanical ventilation, 1,425 (14.6%) undergoing renal replacement therapy, and 1,484 (15.2%) receiving mechanical circulatory support. A total of 2,961 patients (30.2%) died in the hospital, and 4,004 (40.9%) died by 1 year. Mortality at 5 years was 58.9%. Small improvements in short- and long-term mortality were seen over the study period. Among survivors to discharge, 2,870 (42.0%) required increased support in care from their preadmission baseline, 3,244 (47.5%) were readmitted to the hospital within 1 year, and 1,047 (15.3%) died within 1 year. The mean number of days at home in the year following discharge was 307.9 ± 109.6. CONCLUSIONS: Short- and long-term mortality among patients with AMI-CS is high, with minimal improvement over time. AMI-CS survivors experience significant morbidity, with high risks of readmission and death. Future studies should evaluate interventions to minimize postdischarge morbidity and mortality among AMI-CS survivors

Management and Outcomes of Type I and Type II Myocardial Infarction in Cardiogenic Shock

Background: Type I myocardial infarction (T1MI) or type II myocardial infarction (T2MI) have different underlying mechanisms; however, in the setting of cardiogenic shock (CS), it is not understood if patients experience resultantly different outcomes. The objective of this study was to determine clinical features, biomarker patterns, and outcomes in these subgroups. Methods: Patients from the CAPITAL-DOREMI trial presenting with acute myocardial infarction-associated CS (n = 103) were classified as T1MI (n = 61) or T2MI (n = 42). The primary endpoint was a composite of all-cause in-hospital mortality, cardiac arrest, the need for mechanical circulatory support, or initiation of renal replacement therapy at 30 days. Secondary endpoints were evaluated as individual components of the primary endpoint. Results: Patients with T1MI CS did not have a higher incidence of the primary composite endpoint compared with T2MI CS (adjusted hazard ratio [HR], 1.63; 95% confidence interval [CI], 0.96-2.77; P = 0.07). Cardiac biomarkers including troponin I (P < 0.001), and creatine kinase levels (P = 0.001) were elevated in patients with T1MI CS compared with T2MI. Furthermore, patients with T1MI CS presented with decreased urine output (P = 0.01) compared with T2MI. Predictors of T2MI CS included nonischemic ventricular dysfunction (P = 0.002), atrial fibrillation (P = 0.02), and chronic obstructive pulmonary disease (P = 0.002). Conclusions: There were no differences in adverse clinical outcomes between patients with T1MI and T2MI CS, although the events were numerically increased, and the sample size was small. Overall, this study provides a hypothesis-generating analysis regarding the clinical and biochemical outcomes in T1MI vs T2MI CS. Résumé: Introduction: L’infarctus du myocarde de type 1 (IMT1) et l’infarctus du myocarde de type 2 (IMT2) ont des mécanismes sous-jacents différents. Toutefois, dans le contexte du choc cardiogénique (CC), nous ignorons si les patients ont donc des résultats cliniques différents. Les objectifs de la présente étude étaient de déterminer les caractéristiques cliniques, les profils des biomarqueurs et les résultats cliniques dans ces sous-groupes. Méthodes: Les patients de l’essai CAPITAL-DOREMI qui présentaient un CC associé à un infarctus aigu du myocarde (n = 103) étaient classifiés dans le sous-groupe IMT1 (n = 61) ou dans le sous-groupe IMT2 (n = 42). Le critère de jugement principal était un critère composite qui regroupait la mortalité à l’hôpital toutes causes confondues, l’arrêt cardiaque, la nécessité d’une assistance circulatoire mécanique ou l’amorce d’une thérapie de remplacement rénal dans les 30 jours. Les critères secondaires étaient évalués en fonction des composantes individuelles du critère de jugement principal. Résultats: Les patients qui avaient un CC-IMT1 n’avaient pas une plus grande fréquence de survenue du critère de jugement principal composite que les patients qui avaient un CC-IMT2 (rapport de risque [RR] ajusté, 1,63 ; intervalle de confiance [IC] à 95 %, 0,96-2,77 ; P = 0,07). Les biomarqueurs cardiaques dont les concentrations de la troponine I (P < 0,001) et de la créatine kinase (P = 0,001) étaient élevées chez les patients qui avaient un CC-IMT1, mais non chez les patients qui avaient un CC-IMT2. De plus, les patients qui avaient eu un CC-IMT1 avaient une diurèse réduite (P = 0,01), mais non les patients qui avaient un CC-IMT2. Les prédicteurs du CC-IMT2 étaient la dysfonction ventriculaire non ischémique (P = 0,002), la fibrillation auriculaire (P = 0,02) et la maladie pulmonaire obstructive chronique (P = 0,002). Conclusions: Il n’y avait aucune différence dans les résultats cliniques défavorables entre les patients qui avaient un CC-IMT1 et les patients qui avaient un CC-IMT2, bien que les événements aient augmenté en nombre, et que la taille de l’échantillon était petite. Dans l’ensemble, cette étude fournit une analyse de génération d’hypothèses quant aux résultats cliniques et biochimiques du CC-IMT1 vs du CC-IMT2