Latest Updates

Renovascular Hypertension and Stenosis

    • Clinical trials demonstrate renal artery stenting offers no benefit over medical therapy among patients with renal artery stenosis and hypertension or chronic kidney disease.
    • Stenting should be reserved for patients who fail medical therapy.
    • Optimizing outcomes for renal artery stenting requires an understanding of clinical predictors that portend a higher probability of improved blood pressure or renal function with stenting.

Management of Chronic Kidney Disease and its Complications

    • 2024 KDIGO Practice Guidelines
    • Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada
    • Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update.

Renovascular Hypertension and Stenosis

    • Clinical trials demonstrate renal artery stenting offers no benefit over medical therapy among patients with renal artery stenosis and hypertension or chronic kidney disease.
    • Stenting should be reserved for patients who fail medical therapy.
    • Optimizing outcomes for renal artery stenting requires an understanding of clinical predictors that portend a higher probability of improved blood pressure or renal function with stenting.

Primary and Metastatic Central Nervous System Malignancies

    • The main function of corticosteroids in CNS tumors is to control brain and spinal cord vasogenic edema and decrease intracranial pressure. Corticosteroids should be used with caution because of its significant side effects, such as insomnia, hyperglycemia, myopathy, psychiatric effects, and opportunistic infections. 
    • Maximal safe resection is recommended for all glioma grades and subtypes if the tumor is surgically accessible and there are no absolute medical contraindications to surgery. Nevertheless, even a macroscopic complete resection is almost never curative because grade II to IV gliomas infiltrate the normal brain.
    • The addition of WBRT to either surgical resection or radiosurgery decreases the risk of brain metastasis recurrence but does not improve survival in patients with one to three brain metastases.

Classification Systems for Lower Extremity Occlusive Disease

    • The SVS runoff score provides a method for giving weight to those vessels contributing to the runoff. It was developed to anatomically stratify patients when designing studies to compare the outcome of lower extremity arterial bypass.
    • The TASC classification system guides the clinical management of a patient by providing vascular specialists with a basic framework for determining whether the patient’s vascular disease pattern is best treated with endovascular intervention or with surgical revascularization. The TASC classification is also used to stratify cohorts in research studies evaluating treatment modalities.
    • The Finnvasc score, Project of Ex-Vivo graft Engineering via Transfection (PREVENT) III (PIII) score, and BASIL Mortality Index are three tools designed to aid in decision making between open surgical revascularization and endovascular intervention. These tools stratify the risk of periprocedural morbidity and/or predict a patient’s probability for short-term, medium-term, and long-term survival.

Intellectual Disability

    • Individuals with intellectual disability have high rates of medical and psychiatric comorbidity.
    • Healthcare providers lack education and training to provide health care to individuals with an intellectual disability.
    • Expert consensus guidelines recommend using the same medications and therapeutic doses for individuals with intellectual disability.
    • Polypharmacy and chronic medication use are common in individuals with an intellectual disability, despite lack of evidence on safety and effectiveness.
    • The DM-ID adapts the DSM criteria to individuals with intellectual disability.  The DM-ID is considered the gold standard for diagnosing psychiatric disorders in individuals with an intellectual disability

Neck Dissection

    • The use of microvascular free tissue transfer to reconstruct surgical defects in the head has allowed surgeons to resect large tumors with large margins while simultaneously achieving improved functional results.
    • Imaging studies (e.g., computed tomography [CT] and magnetic resonance imaging) may be helpful in locating the source of a cervical metastasis. Positron emission tomography (PET) detects lesions with increased metabolic activity but has the limitation of being unable to detect lesions smaller than 1 cm in diameter. 

Neck Dissection

    • The use of microvascular free tissue transfer to reconstruct surgical defects in the head has allowed surgeons to resect large tumors with large margins while simultaneously achieving improved functional results.
    • Imaging studies (e.g., computed tomography [CT] and magnetic resonance imaging) may be helpful in locating the source of a cervical metastasis. Positron emission tomography (PET) detects lesions with increased metabolic activity but has the limitation of being unable to detect lesions smaller than 1 cm in diameter. 
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