Hypertension and hypertension severity in Hispanics/Latinx with MS.

BACKGROUND: Vascular comorbidities (VCs) including hypertension (HTN) are associated with worse multiple sclerosis (MS) outcomes. HTN is common in Latinx, but the prevalence and relationship with disability are unknown in Latinx with MS. METHODS: Latinx (n = 451) from the Alliance for Research in Hispanic MS (ARHMS) seen between 2007 and 2019 were included. HTN, diabetes (DM), hyperlipidemia (HLD), ischemic events, and smoking were considered VC. Blood pressures (BPs) were classified using the American Heart Association (AHA) criteria. Logistic regression determined associations between VC and ambulatory disability accounting for age, sex, and disease duration. RESULTS: Medical comorbidities were found in 41.9% and VC in 24.2%. Smoking (13.6%) and HTN (7.3%) were the most common. HTN was the most common over the age of 40 (12.6%). The odds of having severe disability were three times higher for those with HTN (odds ratio [OR], 3.12; 95% confidence interval (CI), 1.37-7.12). Stage II HTN according to AHA also tripled the odds (OR, 2.89; 95%CI, 1.11-7.55). AHA BP confirmed HTN in 27.5% (compared to 7.3% with established diagnosis). CONCLUSION: HTN diagnosis and stage II HTN defined by AHA were independently associated with severe ambulatory disability in Latinx with MS. HTN was underdiagnosed. Future studies should assess whether HTN treatment control would prevent disability in MS.

Rectal Perforation by an Intrauterine Device Leading to Fatal Intra-Abdominal Sepsis and Necrotizing Fasciitis.

BACKGROUND: Colorectal injury from an intrauterine device (IUD) is rare but may lead to major complications. CASE: A 55-year-old woman presented to a tertiary care hospital with 4 days of generalized weakness, confusion, dysuria, and lower back pain. She provided a vague history of an unsuccessful attempt to remove an IUD 30 years prior. A computed tomography scan demonstrated an IUD in the rectal lumen, with gluteal and pelvic gas and fluid collections. Emergency surgery found necrotizing fasciitis. Despite multiple debridements, sigmoidoscopic IUD removal, and long-term intravenous antibiotics, the patient died from sepsis and multiorgan failure. CONCLUSION: IUDs require proper monitoring and timely removal to prevent potential complications associated with organ perforation.

Guideline No. 395-Female Genital Cutting.

OBJECTIVES: To decrease the likelihood that the practice of female genital cutting (FGC) be continued in the future and to improve the care of girls and women who have been subjected to FGC or who are at risk by providing (1) information intended to strengthen knowledge and understanding of the practice, (2) information regarding the legal issues related to the practice, (3) guidance for the management of its obstetrical and gynaecological complications, and (4) guidance on the provision of culturally competent care to girls and women affected by FGC. OPTIONS: Strategies for the primary, secondary, and tertiary prevention of FGC and its complications. OUTCOMES: The short- and long-term consequences of FGC. INTENDED USERS: Health care providers delivering obstetrical and gynaecological care. TARGET POPULATION: Women from countries where FGC is commonly practised and Canadian girls and women from groups who may practise FGC for cultural or religious reasons. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library in September 2010 using appropriate controlled vocabulary (e.g., Circumcision, Female) and key words (e.g., female genital mutilation, clitoridectomy, infibulation). Searches were updated and incorporated in the guideline revision December 2018. VALIDATION METHODS: The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: There are no anticipated harms or costs to health care facilities with implementation of this guideline. Benefits may include a greater willingness of women living with FGC to seek timely care. SUMMARY STATEMENTS: RECOMMENDATIONS.

Directive clinique No 395 - Excision génitale féminine.

OBJECTIFS: La présente directive clinique vise à diminuer la probabilité que la pratique de l'excision génitale féminine (EGF) se poursuive et à améliorer les soins prodigués aux filles et aux femmes qui ont subi une EGF ou qui risquent d'en subir une en fournissant (1) des renseignements destinés à améliorer les connaissances et la compréhension de la pratique, (2) des renseignements sur les enjeux juridiques liés à cette pratique, (3) des directives relatives au traitement des complications obstétricales et gynécologiques connexes et (4) des directives sur la compétence culturelle dans la prestation de soins aux filles et femmes touchées par l'EGF. OPTIONS: Des stratégies de prévention primaire, secondaire et tertiaire de l'EGF et de ses complications. RéSULTATS: Les conséquences à court et à long terme de l'EGF. UTILISATEURS CIBLES: Les fournisseurs de soins de santé qui fournissent des soins obstétricaux et gynécologiques. POPULATION CIBLE: Les femmes originaires de pays où l'EGF est couramment pratiquée ainsi que les filles et femmes canadiennes issues de groupes où l'EGF est parfois pratiquée pour des motifs culturels ou religieux. DONNéES PROBANTES: Des recherches ont été effectuées en septembre 2010 dans le moteur PubMed et les bases de données CINAHL et Cochrane Library au moyen d'une terminologie contrôlée appropriée (p. ex. Circumcision, Female) et de mots-clés en anglais (p. ex. female genital mutilation, clitoridectomy, infibulation) afin de rassembler la littérature publiée sur le sujet. Les recherches ont été mises à jour et intégrées à la révision de la directive clinique en décembre 2018. MéTHODES DE VALIDATION: La qualité des données probantes contenues dans le présent document a été évaluée en fonction des critères décrits dans le rapport du Groupe d'étude canadien sur les soins de santé préventifs. AVANTAGES, PRéJUDICES, ET COûTS: Aucun coût ni préjudice n'est anticipé pour la mise en œuvre de cette directive clinique dans les établissements de santé. Au nombre des avantages, la directive pourrait inciter les femmes ayant subi une EGF à solliciter rapidement des soins. DÉCLARATIONS SOMMAIRES: RECOMMANDATIONS.

No. 279-Female Sexual Health Consensus Clinical Guidelines.

OBJECTIVE: To establish national guidelines for the assessment of women's sexual health concerns and the provision of sexual health care for women. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library from May to October 2010, using appropriate controlled vocabulary (e.g., sexuality, "sexual dysfunction," "physiological," dyspareunia) and key words (e.g., sexual dysfunction, sex therapy, anorgasmia). Results were restricted, where possible, to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by The Society of Obstetricians and Gynaecologists of Canada. VALUES: The quality of evidence was evaluated and recommendations made using the use of criteria described by the Canadian Task Force on Preventive Health Care (Table).

The Johns Hopkins Fall Risk Assessment Tool: A Study of Reliability and Validity.

Patient falls and fall-related injury remain a safety concern. The Johns Hopkins Fall Risk Assessment Tool (JHFRAT) was developed to facilitate early detection of risk for anticipated physiologic falls in adult inpatients. Psychometric properties in acute care settings have not yet been fully established; this study sought to fill that gap. Results indicate that the JHFRAT is reliable, with high sensitivity and negative predictive validity. Specificity and positive predictive validity were lower than expected.

No. 345-Primary Dysmenorrhea Consensus Guideline.

OBJECTIVE: This guideline reviews the investigation and treatment of primary dysmenorrhea. INTENDED USERS: Health care providers. TARGET POPULATION: Women and adolescents experiencing menstrual pain for which no underlying cause has been identified. EVIDENCE: Published clinical trials, population studies, and review articles cited in PubMed or the Cochrane database from January 2005 to March 2016. VALIDATION METHODS: Seven clinical questions were generated by the authors and reviewed by the SOGC Clinical Practice-Gynaecology Committee. The available literature was searched. Guideline No. 169 was reviewed and rewritten in order to incorporate current evidence. Recommendations addressing the identified clinical questions were formulated and evaluated using the ranking of the Canadian Task Force on Preventive Health Care. BENEFITS, HARMS, AND COSTS: Primary dysmenorrhea is common and frequently undertreated. Effective therapy is widely available at minimal cost. Treatment has the potential to improve quality of life and to decrease time lost from school or work. GUIDELINE UPDATE: This guideline is a revision and update of No. 169, December 2005. SPONSORS: SOGC. SUMMARY STATEMENTS: RECOMMENDATIONS.

No. 279-Female Sexual Health Consensus Clinical Guidelines.

OBJECTIVE: To establish national guidelines for the assessment of women's sexual health concerns and the provision of sexual health care for women. EVIDENCE: Published literature was retrieved through searches of PubMed, CINAHL, and the Cochrane Library from May to October 2010, using appropriate controlled vocabulary (e .g., sexuality, "sexual dysfunction," "physiological," dyspareunia) and key words (e .g ., sexual dysfunction, sex therapy, anorgasmia). Results were restricted, where possible, to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no language restrictions. Searches were updated on a regular basis and incorporated in the guideline to December 2010. Grey (unpublished) literature was identified through searching the websites of health technology assessment and health technology assessment-related agencies, clinical practice guideline collections, clinical trial registries, and national and international medical specialty societies. Each article was screened for relevance and the full text acquired if determined to be relevant. The evidence obtained was reviewed and evaluated by the members of the Expert Workgroup established by The Society of Obstetricians and Gynaecologists of Canada. VALUES: The quality of evidence was evaluated and recommendations made using the use of criteria described by the Canadian Task Force on Preventive Health Care (Table).

Cellular properties of extensor carpi radialis brevis and trapezius muscles in healthy males and females.

In this study, we sought to determine whether differences in cellular properties associated with energy homeostasis could explain the higher incidence of work-related myalgia in trapezius (TRAP) compared with extensor carpi radialis brevis (ECRB). Tissue samples were obtained from the ECRB (n = 19) and TRAP (n = 17) of healthy males and females (age 27.9 ± 2.2 and 28.1 ± 1.5 years, respectively; mean ± SE) and analyzed for properties involved in both ATP supply and utilization. The concentration of ATP and the maximal activities of creatine phosphokinase, phosphorylase, and phosphofructokinase were higher (P < 0.05) in ECRB than TRAP. Succinic dehydrogenase, citrate synthase, and cytochrome c oxidase were not different between muscles. The ECRB also displayed a higher concentration of Na(+)-K(+)-ATPase and greater sarcoplasmic reticulum Ca(2+) release and uptake. No differences existed between muscles for either monocarboxylate transporters or glucose transporters. It is concluded that the potentials for high-energy phosphate transfer, glycogenolysis, glycolysis, and excitation-contraction coupling are higher in ECRB than TRAP. Histochemical measurements indicated that the muscle differences are, in part, related to differing amounts of type II tissue. Depending on the task demands, the TRAP may experience a greater metabolic and excitation-contraction coupling strain than the ECRB given the differences observed.

Preliminary observations on high energy phosphates and metabolic pathway and transporter potentials in extensor carpi radialis brevis and trapezius muscles of women with work-related myalgia.

This study compared both the extensor carpi radialis brevis (ECRB) and the trapezius (TRAP) muscles of women with work-related myalgia (WRM) with healthy controls (CON) to determine whether abnormalities existed in cellular energy status and the potentials of the various metabolic pathways and segments involved in energy production and substrate transport. For both the ECRB (CON, n = 6-9; WRM, n = 13) and the TRAP (CON, n = 6-7; WRM, n = 10), no differences (P > 0.05) were found for the concentrations (in millimoles per kilogram of dry mass) of ATP, PCr, lactate, and glycogen. Similarly, with one exception, the maximal activities (in moles per milligram of protein per hour) of mitochondrial enzymes representative of the citric acid cycle (CAC), the electron transport chain (ETC), and ß-oxidation, as well as the cytosolic enzymes involved in high energy phosphate transfer, glycogenolysis, glycolysis, lactate oxidation, and glucose phosphorylation were not different (P > 0.05). The glucose transporters GLUT1 and GLUT4, and the monocarboxylate transporters MCT1 and MCT4, were also normal in WRM. It is concluded that, in general, abnormalities in the resting energy and substrate state, the potential of the different metabolic pathways and segments, as well as the glucose and monocarboxylate transporters do not appear to be involved in the cellular pathophysiology of WRM.

Excitation-contraction coupling properties in women with work-related myalgia: a preliminary study.

We investigated the potential role of selected excitation-contraction coupling processes in females with work-related myalgia (WRM) by comparing WRM with healthy controls (CON) using tissue from extensor carpi radialis brevis (ECRB) and trapezius (TRAP) muscles. For the ECRB, age (mean ± SE) was 29.6 ± 3.5 years for CON (n = 9) and 39.2 ± 2.8 years for WRM (n = 13), while for the TRAP, the values were 26.0 ± 2.1 years for CON (n = 7) and 44.6 ± 2.9 years for WRM (n = 11). For the sarcoplasmic reticulum (SR) of the ECRB, WRM displayed concentrations (nmol·(mg protein)(-1)·min(-1)) that were lower (P < 0.05) for Total (202 ± 4.4 vs 178 ± 7.1), Basal (34 ± 1.6 vs 30.1 ± 1.3), and maximal Ca(2+)-ATPase activity (Vmax, 168 ± 4.9 vs 149 ± 6.3), and Ca(2+)-uptake (5.06 ± 0.31 vs 4.13 ± 0.29), but not SERCA1a and SERCA2a isoforms, by comparison with CON. When age was incorporated as a co-variant, Total, Basal, and Ca(2+)-uptake remained different from CON (P < 0.05), but not Vmax (P = 0.13). For TRAP, none of the ATPase properties differed between groups (P > 0.05) either before or following adjustment for age. No differences (P > 0.05) were observed between the groups for Ca(2+)-release in the SR for either TRAP or ECRB. Similarly, no deficiencies, regardless of muscle, were noted for either the Na(+)-K(+)-ATPase content or the α and ß subunit isoform distribution in WRM. This preliminary study provides a basis for further research, with expanded numbers, investigating the hypothesis that abnormalities in SR Ca(2+)-regulation are involved in the cellular etiology of WRM.

A pilot study to determine whether differences exist in histochemical properties between the trapezius and extensor carpi radialis brevis muscles in women with work-related myalgia.

To investigate fibre-type abnormalities in women with work-related myalgia (WRM), tissue samples were extracted from their trapezius (TRAP) and the extensor carpi radialis brevis (ECRB) muscles and compared with healthy controls (CON). For the ECRB samples (CON, n = 6; WRM, n = 11), no differences (P > 0.05) were found between groups for any of the properties examined, namely fibre-type (I, IIA, IIX, IIAX) distribution, cross-sectional fibre area, capillary counts (CC), capillary to fibre area ratio, and succinic dehydrogenase activity. For the TRAP samples (CON, n = 6; WRM, n = 8), the only difference (P < 0.05) observed between groups was for CC (CON > WRM), which was not statistically significant (P > 0.05) when age was used a covariant. A comparison of the properties of these 2 muscles in the CON group indicated a higher (P < 0.05) and lower (P < 0.05) percentage of type I and type IIA fibres, respectively, in the TRAP as well as higher (P < 0.05) CC, which was not specific to fibre type. These preliminary results suggest that the properties employed to characterize fibre types do not differentiate CON from WRM for either the TRAP or ECRB. As a consequence, the role of inherent fibre-type differences between these muscles in the pathogenesis of WRM remains uncertain.

Adaptations in muscle metabolic regulation require only a small dose of aerobic-based exercise.

This study investigated the hypothesis that the duration of aerobic-based cycle exercise would affect the adaptations in substrate and metabolic regulation that occur in vastus lateralis in response to a short-term (10 day) training program. Healthy active but untrained males (n = 7) with a peak aerobic power ([Formula: see text]) of 44.4 ± 1.4 ml kg(-1) min(-1) participated in two different training programs with order randomly assigned (separated by ≥2 weeks). The training programs included exercising at a single intensity designated as light (L) corresponding to 60 % [Formula: see text], for either 30 or 60 min. In response to a standardized task (60 % [Formula: see text]), administered prior to and following each training program, L attenuated the decrease (P < 0.05) in phosphocreatine and the increase (P < 0.05) in free adenosine diphosphate and free adenosine monophosphate but not lactate. These effects were not altered by daily training duration. In the case of muscle glycogen, training for 60 versus 30 min exaggerated the increase (P < 0.05) that occurred, an effect that extended to both rest and exercise concentrations. No changes were observed in [Formula: see text] measured during progressive exercise to fatigue or in [Formula: see text] and RER during submaximal exercise with either training duration. These findings indicate that reductions in metabolic strain, as indicated by a more protected phosphorylation potential, and higher glycogen reserves, can be induced with a training stimulus of light intensity applied for as little as 30 min over 10 days. Our results also indicate that doubling the duration of daily exercise at L although inducing increased muscle glycogen reserves did not result in a greater metabolic adaptation.

Role of exercise duration on metabolic adaptations in working muscle to short-term moderate-to-heavy aerobic-based cycle training.

This study aimed at investigating the relative roles of the duration versus intensity of exercise on the metabolic adaptations in vastus lateralis to short-term (10 day) aerobic-based cycle training. Healthy males with a peak aerobic power (VO2 peak) of 46.0 ± 2.0 ml kg(-1) min(-1) were assigned to either a 30-min (n = 7) or a 60-min (n = 8) duration performed at two different intensities (with order randomly assigned), namely moderate (M) and heavy (H), corresponding to 70 and 86 % VO2 peak, respectively. No change (P > 0.05) in VO2 peak was observed regardless of the training program. Based on the metabolic responses to prolonged exercise (60 % VO2 peak), both M and H and 30 and 60 min protocols displayed less of a decrease (P < 0.05) in phosphocreatine (PCr) and glycogen (Glyc) and less of an increase (P < 0.05) in free adenosine diphosphate (ADPf), free adenosine monophosphate (AMPf), inosine monophosphate (IMP) and lactate (La). Training for 60 min compared with 30 min resulted in a greater protection (P < 0.05) of ADPf, AMPf, PCr and Glyc during exercise, effects that were not displayed between M and H. The reduction in both VO2 and RER (P < 0.05) observed during submaximal exercise did not depend on training program specifics. These findings indicate that in conjunction with our earlier study (Green et al., Eur J Appl Physiol, 2012b), a threshold exists for duration rather than intensity of aerobic exercise to induce a greater training impact in reducing metabolic strain.

RETIRED: Female genital cutting.

This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.This document has been archived because it contains outdated information. It should not be consulted for clinical use, but for historical research only. Please visit the journal website for the most recent guidelines.

Ce document a été archivé, car il contient des informations périmées. Il ne devrait pas être consulté pour un usage clinique, mais uniquement pour des recherches historiques. Veuillez consulter le site web du journal pour les directives les plus récentes.

Utility of a writing station in the multiple mini-interview.

The multiple mini-interview (MMI) is a reliable and valid method of selecting applicants for admission to health professional schools on the basis of non-cognitive traits. Because the MMI is a series of short interview stations that applicants rotate through in coordinated sequence, it can potentially be resource intensive. However, the MMI design has room for innovation and efficiency. At the University of Manitoba Faculty of Medicine, a 10-minute unsupervised writing station (WS) was incorporated into the MMI to obtain a writing sample from each applicant, to increase the number of independent scores per applicant, and to increase the number of applicants interviewed per circuit without increasing interviewer numbers. One assessor evaluated all the writing samples and assigned a score ranging from 1 to 7. With the inclusion of a WS into an 11-station MMI, the faculty's capacity to interview applicants increased by 9% (from 297 to 324) without substantially increasing interviewer hours needed per day. For 1,257 applicants interviewed in 2008-2011, the mean WS score was 4.03 (SD=1.36), whereas applicants' mean of 10 oral station (OS) scores was 4.62 (SD=0.69). Correlations between WS score and mean OS score ranged from .16 to .27 (p<.01) over the four years. Because inter-station correlations for OS ranged from .01 to .37, the correlation of .21 between WS and mean OS scores for all four years combined appears reasonable. Institutions that want to effectively increase the capacity of their MMI process might consider adding a WS.