Anabolic steroids, acute myocardial infarction and polycythemia: A case report and review of the literature

The association between testosterone-replacement therapy and cardiovascular risk remains unclear with most reports suggesting a neutral or possibly beneficial effect of the hormone in men and women. However, several cardiovascular complications including hypertension, cardiomyopathy, stroke, pulmonary embolism, fatal and nonfatal arrhythmias, and myocardial infarction have been reported with supraphysiologic doses of anabolic steroids. We report a case of an acute ST-segment elevation myocardial infarction in a patient with traditional cardiac risk factors using supraphysiologic doses of supplemental, intramuscular testosterone. In addition, this patient also had polycythemia, likely secondary to high-dose testosterone. The patient underwent successful percutaneous intervention of the right coronary artery. Phlebotomy was used to treat the polycythemia acutely. We suggest that the chronic and recent “stacked” use of intramuscular testosterone as well as the resultant polycythemia and likely increased plasma viscosity may have been contributing factors to this cardiovascular event, in addition to traditional coronary risk factors. Physicians and patients should be aware of the clinical consequences of anabolic steroid abuse

Initial experience using contrast enhanced real-time three-dimensional exercise stress echocardiography in a low-risk population

Although emerging data support the utility of real-time three-dimensional echocardiography (RT3DE) during dobutamine stress testing, the feasibility of performing contrast enhanced RT3DE during exercise treadmill stress has not been explored. Two-dimensional (2D) and three-dimensional (3D) acquisition were performed in 39 patients at rest and peak exercise. Contrast was used in 29 patients (74%). Reconstruction was performed manually by generating short axis cut planes at the base, mid-ventricle and apex, and automatically by generating 9 short axis slices. Three-dimensional acquisition was feasible during rest and stress regardless of the use of contrast. Time to acquire stress images was reduced using 3D (35.2±17.9 s) as compared to 2D acquisition (51.6±14.7 s; P<0.05). Using a 17-segment model, of all 663 segments, 588 resting (88.6%) and 563 stress segments (84.9%) were adequately visualized using manually reconstructed 3D data, compared with 618 resting (93.2%) and 606 stress segments (91.4%) using 2D data (P rest=0.06; P stress=0.07). We concluded that contrast enhanced RT3DE is feasible during treadmill stress echocardiography

Initial experience using contrast enhanced real-time three-dimensional exercise stress echocardiography in a low-risk population

Although emerging data support the utility of real-time three-dimensional echocardiography (RT3DE) during dobutamine stress testing, the feasibility of performing contrast enhanced RT3DE during exercise treadmill stress has not been explored. Two-dimensional (2D) and three-dimensional (3D) acquisition were performed in 39 patients at rest and peak exercise. Contrast was used in 29 patients (74%). Reconstruction was performed manually by generating short axis cut planes at the base, mid-ventricle and apex, and automatically by generating 9 short axis slices. Three-dimensional acquisition was feasible during rest and stress regardless of the use of contrast. Time to acquire stress images was reduced using 3D (35.2±17.9 s) as compared to 2D acquisition (51.6±14.7 s; P&lt;0.05)

The Development of Regional Networks to Promote Housing First Implementation in CanadaThe Development of Regional Networks to Promote Housing First Implementation in Canada

While knowledge mobilization strategies, such as training and technical assistance, have been used to facilitate the implementation of evidence-based practices, little is known about the role of networks in influencing implementation. In this article, we describe the role of a variety of networking strategies (regional training events, community of practice teleconference calls, and the creation of regional networks) used to implement Housing First (HF) in Canada during a three-year training and technical assistance initiative. We report on three main findings from research on this initiative. First, data from regional training events (n=110) revealed that 92% of participants wanted a regional HF network. Participants in the regional training events, as well as those who participated HF training needs assessment focus groups (k=11, n=83), believed that the networks should focus on mutual learning and influencing policy and have strong leadership and an open membership. Second, HF training events held in four regions of Canada (the West, the Prairies and northern territories, Ontario, and the Atlantic region) were very positively evaluated by participants (n=276) in terms of their value in increasing HF knowledge and comprehension, and overall satisfaction with the training. Third, field notes (n=146) were used to generate a narrative of HF networks that emerged from training and technical assistance activities, including a province-wide network in Ontario and practitioner-led networks in southwestern Ontario and British Columbia. We discuss how these network activities contributed to capacity-building in HF programs designed to end homelessness in Canada

The Development of Regional Networks to Promote Housing First Implementation in CanadaThe Development of Regional Networks to Promote Housing First Implementation in Canada

While knowledge mobilization strategies, such as training and technical assistance, have been used to facilitate the implementation of evidence-based practices, little is known about the role of networks in influencing implementation. In this article, we describe the role of a variety of networking strategies (regional training events, community of practice teleconference calls, and the creation of regional networks) used to implement Housing First (HF) in Canada during a three-year training and technical assistance initiative. We report on three main findings from research on this initiative. First, data from regional training events (n=110) revealed that 92% of participants wanted a regional HF network. Participants in the regional training events, as well as those who participated HF training needs assessment focus groups (k=11, n=83), believed that the networks should focus on mutual learning and influencing policy and have strong leadership and an open membership. Second, HF training events held in four regions of Canada (the West, the Prairies and northern territories, Ontario, and the Atlantic region) were very positively evaluated by participants (n=276) in terms of their value in increasing HF knowledge and comprehension, and overall satisfaction with the training. Third, field notes (n=146) were used to generate a narrative of HF networks that emerged from training and technical assistance activities, including a province-wide network in Ontario and practitioner-led networks in southwestern Ontario and British Columbia. We discuss how these network activities contributed to capacity-building in HF programs designed to end homelessness in Canada