Saskatchewan Health

About: Saskatchewan Health is a government organization based out in Regina, Saskatchewan, Canada. It is known for research contribution in the topics: Population & Health care. The organization has 442 authors who have published 489 publications receiving 7728 citations.

Extended antithrombotic therapy for secondary prevention of cardiovascular events: A tool for pharmacists:

Abstract: Introduction Cardiovascular disease is the leading cause of hospitalization and the second leading cause of death in Canada. It causes approximately 70,000 myocardial infarctions (MIs) and 19,000 deaths in Canada annually. The term acute coronary syndrome (ACS) includes a spectrum of disorders, including ST-elevation myocardial infarction (STEMI), non–ST-elevation myocardial infarction and unstable angina. Guidelines advocate percutaneous coronary intervention (PCI) as a firstline management strategy for ACS. Dual antiplatelet therapy (DAPT) consisting of acetylsalicylic acid (ASA) plus a P2Y 12 inhibitor (such as clopidogrel or ticagrelor) is the cornerstone of therapy in the post-ACS population to prevent both secondary events and stent thrombosis in those who have undergone PCI. While traditionally, 12 months of DAPT and indefinite ASA has been the standard of care after PCI, recent evidence indicates the benefit of extended DAPT in select patients. Alternatively, a combination of ASA and rivaroxaban may be suitable for patient groups with stable atherosclerotic vascular disease. These extended antithrombotic strategies are predicated on the fact that 1 in 5 patients will experience a major adverse cardiovascular event (MACE) in the 3 years following DAPT discontinuation. Landmark trials have examined extended antithrombotic therapy beyond the standard 12-month duration. The PEGASUS-TIMI 54 trial and the DAPT trial, published in 2015 and 2014, respectively, demonstrated that in high-risk patients, extended combination antiplatelet therapy posed benefit. The COMPASS trial (2017) established favourable results in patients with stable atherosclerotic vascular disease, with an alternate strategy of low-dose ASA in combination with lowdose rivaroxaban compared with ASA monotherapy (Table 1). While the Canadian Cardiovascular Society (CCS) provides recommendations on the use of extended DAPT in highrisk populations, it has not yet incorporated the results of the COMPASS trial into its recommendations, although they suggest its consideration. The purpose of this practice tool is to aid pharmacists in decision-making regarding antithrombotic therapy for secondary prevention of cardiovascular events in patients with stable coronary artery disease (CAD) who are more than 12 months post-PCI.

Evaluation of toxicity following ammonia exposure: a case report

Abstract: Acute exposure to anhydrous ammonia gas or ammoniac liquids typically consists of rapid and painful irritation and inflammation of the eyes and mucous membranes of the nose, throat, and lungs Severe tissue inflammation and necrosis in the airways and lungs may rapidly lead to permanent injury or death A patient with a mild occupational exposure to ammonia is described This patient apparently self-medicated with large doses of acetaminophen that resulted in hepatic necrosis, hepatic encephalopathy, and death This case history provides an opportunity to contrast the pathophysiology of exogenous ammonia exposure and the pathophysiology of endogenous hyperammonemia

A Case Report of Nephrotic Syndrome While Undergoing Quinine Therapy.

Abstract: We summarize the case of an 81-year-old Caucasian female who presented to her family physician with signs and symptoms of nephrotic syndrome following a brief exposure to quinine. Prior to that visit, she was clinically well with no chronic medical ailments and met with her family physician for annual physical assessments. She had taken 11 tablets of quinine for nocturnal leg cramps over the course of 28 days before starting to notice mild peripheral edema, which subsequently progressed, leading to a family physician review. Her initial serum albumin level was 12 g/L, and a 24-hour urine protein output was quantified at 8.14 g/day; she was diagnosed as having nephrotic syndrome. A kidney biopsy confirmed the diagnosis of minimal change disease (MCD). Quinine therapy was stopped, and she was initiated on a tapering regime of prednisone with concurrent cyclosporine therapy. Within a fortnight of starting therapy, she went into remission and her immunosuppressive medications were rapidly tapered and discontinued. This paper reports an association between the use of quinine and subsequent MCD. This case report proposes that the use of quinine has an association with, and may be causal for, the development of minimal change disease. As this is yet an unreported adverse effect, this paper seeks to increase the knowledge of the varied and numerous effects of quinine.