CardioDiabetes: Core Competencies for Cardiovascular Clinicians in a Rapidly Evolving Era of Type 2 Diabetes Management

A sea change in the management of diabetes is occurring with the publication of clinical trials showing unequivocal cardiovascular (CV) protection through the use of certain antihyperglycemic agents. This change is similar to the change that occurred when lipid lowering with statins was first shown to have CV benefits, an event necessitating changes in training and the proactive treatment of lipids by CV specialists. As was the case then, many CV specialists currently feel poorly equipped to address diabetes with this new information even though diabetes is common in CV practice. The purpose of this overview is to provide an updated, comprehensive, and evidence-based CV protection plan for patients with type 2 diabetes, intended specifically for cardiologists and vascular medicine specialists. We attempt to elucidate a set of “CardioDiabetes” core competencies by merging the CV-relevant elements of the Diabetes Canada 2018 guidelines within a framework of comprehensive vascular protection as supported by other CV guidelines. We review the rationale for measuring hemoglobin A1C, understanding its use for establishing a diagnosis and for monitoring treatment. We also provide a brief review of the medications most important for a CV specialist to know. We provide useful memory aids and a succinct set of reminders and tips (“ABCDEFR’S”) that can serve as a comprehensive checklist in the clinic and help to motivate trainees and clinicians to consult the original guideline source documents to enrich their knowledge and improve treatment in this rapidly changing arena.     

Effect of endocrine pancreas allotransplantation on diabetic nerve dysfunction

The effect of pancreatic endocrine tissue allotransplantation on the development of peripheral nerve dysfunction in streptozotocin induced diabetic rat recipients across major histocompatibility barrier was evaluated. Motor nerve conduction velocity (MNCV) and evoked muscle potential amplitudes (EMPA) were used to assess nerve function. Of the 49 transplanted diabetic animals, 40 had permanent functional allograft of either intraportal pancreatic whole islets (PWI) or intracerebral pancreatic endocrine cells (PEC). Normal MNCV and EMPA values (47.65 +/- 2.03; 5.22 +/- 0.43) were found among the recipients of intracerebral transplantation of PEC. The MNCV and EMPA were 43.30 +/- 2.59 and 4.49 +/- 0.53 respectively, in recipient rats with successful intraportal whole islet transplant. The nine animals with rejected whole islet allografts yielded MNCV and EMPA values (38.90 +/- 2.73; 3.87 +/- 0.59) comparable to the diabetic control rats.     

Pan-Canadian Estimates of Chronic Pain Prevalence From 2000 to 2014: A Repeated Cross-Sectional Survey Analysis

Recent temporal trends in the population prevalence of chronic pain in Canada on a national and provincial level are unknown. Five cycles of the Canadian Community Health Survey (2000/2001, 2007/2008, 2009/2010, 2011/2012, and 2013/2014) were used to derive population-based estimates of the self-reported prevalence of chronic pain. Sensitivity analyses examined chronic pain prevalence among those reporting no other chronic health conditions. The prevalence of chronic pain among the general Canadian population increased by almost 4.0% (to 21.0%) in 2011/2012, after being in the range of 15.7 to 17.2% from 2000 to 2009/2010. The sudden increase in prevalence was observed 1) across all provinces in Canada, 2) in all age categories, and 3) among Canadians with no other chronic health conditions. Increasing chronic pain prevalence in Canada, most significantly occurring between 2010 and 2012, and including among healthy and young individuals, emphasizes the need for targeted research and resources to help alleviate chronic pain.PerspectiveThis study uncovers a significant increase in chronic pain prevalence in Canada between 2009/2010 and 2011/2012, driven by younger Canadians that are free of the most common chronic health conditions. This discovery emphasizes the importance of further directed research and resources to help mitigate the trend of increasing chronic pain.     

Pain Relief as a Motivation for Cannabis Use Among Young Adult Users With and Without Chronic Pain

This study aims to determine the rate of chronic pain in a community sample of young adult cannabis users, assess the extent to which pain relief is an important motivation for cannabis use, and explore differences in consumption patterns and problem behaviors between users with and without chronic pain. The study design was cross-sectional. Self-selected community-dwelling young adults (ages 18–29 years; n = 143) who regularly use cannabis completed an online survey. Results revealed that approximately 40% of the sample met the criteria for chronic pain, and pain relief was their primary motivation for use. There were no differences between groups with respect to frequency of use or estimated potency of their preferred strains; however, users with chronic pain reported using a wider variety of administration methods and a greater quantity of cannabis with each use. Users with chronic pain also reported more extensive histories of use, with younger age at initiation and longer duration of regular use. Despite riskier consumption patterns, there were no between-group differences in negative consequences owing to use after controlling for gender and educational status. On average, the total sample reported approximately 8 problems in the past 30 days owing to use. These findings suggest that chronic pain is commonly experienced among young adult cannabis users and pain relief is the primary motivation for users with pain. For some users, clinically significant chronic pain and pain-related interference persist despite heavy use. Cannabis users with and without chronic pain report experiencing several negative consequences owing to their use.PerspectiveThis article compares motivations for cannabis use and describes differences in consumption patterns among a community sample of young adult users with and without chronic pain. This information may be useful for providers who assess and treat pain in young adults, particularly in settings that have legalized recreational use.     

Effects of LH-RH and des-Gly10[D-Ala6]LH-RH-ethylamide on plasma gonadotropin levels and oocyte maturation in adult female coho salmon (Oncorhynchus kisutch)

Plasma gonadotropin (GtH) levels and state of oocyte development were determined in adult female coho salmon following single intraperitoneal injections of LH-RH or its superactive analog des-Gly10[D-Ala6]LH-RH-ethylamide (LH-RHA DAla6). The peptides injected at dosages of 1.0 or 0.2 mg LH-RH and 0.2 or 0.02 mg LH-RHA DAla6/kg bw elevated plasma GtH by 1.5 hr postinjection. The response to the analog was of longer duration. Plasma GtH levels returned to basal levels 24 hr following LH-RH injection while elevated plasma GtH levels were maintained for at least 96 hr in response to the analog. Only those fish injected with LH-RHA DAla6 showed an accelerated rate of germinal vesicle breakdown (GVBD). Based on their relative effects on GVBD, LH-RHA DAla6 has at least 50 times the biological potency of LH-RH in adult female coho salmon.     

Spread of Cryptococcus gattii into Pacific Northwest Region of the United States

Cryptococcus gattii has emerged as a human and animal pathogen in the Pacific Northwest. First recognized on Vancouver Island, British Columbia, Canada, it now involves mainland British Columbia, and Washington and Oregon in the United States. In Canada, the incidence of disease has been one of the highest worldwide. In the United States, lack of cryptococcal species identification and case surveillance limit our knowledge of C. gattii epidemiology. Infections in the Pacific Northwest are caused by multiple genotypes, but the major strain is genetically novel and may have emerged recently in association with unique mating or environmental changes. C. gattii disease affects immunocompromised and immunocompetent persons, causing substantial illness and death. Successful management requires an aggressive medical and surgical approach and consideration of potentially variable antifungal drug susceptibilities. We summarize the study results of a group of investigators and review current knowledge with the goal of increasing awareness and highlighting areas where further knowledge is required.     

Analysis of mortality and morbidity in 100 composite resections for oral carcinoma.

The postoperative morbidity and mortality in one hundred patients who underwent composite resection for oral malignant disease are reviewed. Although there was a 7 per cent mortality and significant morbidity, the majority of patients did well. This procedure offers potential cure for life-threatening malignant disease.