Sunnybrook Health Sciences Centre (SHSC), simply known as Sunnybrook Hospital or Sunnybrook, is an academic health science centre located in Toronto, Ontario, Canada. It is the largest trauma centre in Canada and one of two trauma centres in Toronto; the other being St. Michael's Hospital. Sunnybrook is a teaching hospital, fully affiliated with the University of Toronto. The hospital is home to Canada's largest veterans centre, located in the Kilgour Wing and the George Hees Wing of the hospital, where World War II and Korean War veterans are cared for. Sunnybrook made surgical breakthroughs in its history, including in 2015 when the world's first non-invasive opening of the blood–brain barrier was done.
Critically ill patients with acute leukemia often require an intensive care unit (ICU) admission. As major therapeutic advances have been made during the last decades, the aim of this study was to assess temporal trends in ICU mortality, and identify prognostic factors to inform clinician decision-making. We conducted an individual participant data meta-analysis of studies including adults with acute leukemia admitted to the ICU. Patients with a history of allogeneic hematopoietic stem cell transplantation were excluded. Mixed-effects logistic regression models, accounting for center of ICU admission as a random variable, evaluated factors associated with ICU mortality, with particular focus on year of ICU admission, age (> 65 years) and invasive mechanical ventilation. A total of 2003 patients from 55 ICUs across 19 countries were included (median age 58 years [IQR 44–67]; 72
In patients with reduced renal function, drug monographs recommend reduced doses of oral beta-lactams. However, dose reductions could result in suboptimal pharmacokinetic-pharmacodynamic target attainment, compromising efficacy. This study evaluated the safety of full doses of oral beta-lactams in patients with reduced renal function by assessing the incidence of neurotoxic symptoms. This single-site, retrospective cohort study included patients with renal insufficiency prescribed full dose or renally adjusted doses of oral beta-lactams. Neurotoxicity symptoms were graded via chart review using the Naranjo Adverse Drug Reaction Probability Scale. The primary outcome was incidence of ‘probable’ or ‘definite’ beta-lactam related neurotoxicity. Multivariate logistic regression was used to adjust for differences in baseline characteristics. The cohort included 987 patients with renal insufficiency receiving 1001 full-dose courses and 122 renally adjusted dose courses. The rate of ‘probable’ or ‘definite’ neurotoxicity was 0.1
The optimal adjuvant alkylating chemotherapy regimen for high-risk WHO grade 2 glioma in the molecular era remains uncertain. We evaluated real-world treatment patterns, toxicity, and outcomes following radiotherapy with adjuvant temozolomide (TMZ) or procarbazine, lomustine, and vincristine (PCV) in a multicentre Canadian cohort. PROTECT is a retrospective multicentre cohort study including adults with clinically defined high-risk WHO grade 2 diffuse glioma treated with radiotherapy and adjuvant alkylating chemotherapy. Clinical, molecular, treatment delivery, toxicity, surveillance, and survival data were collected. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method and compared using the log-rank test and Cox regression. A total of 116 patients were included, with a median follow-up of 71 months. Isocitrate dehydrogenase (IDH) mutation was present in 84.6
BACKGROUND:The primary cause of morbidity and mortality in traumatic rib fractures is respiratory complications due to compromised respiratory mechanics secondary to pain and opioid-related respiratory depression. Thoracic epidural analgesia (TEA) provides effective analgesia but may not be possible in patients due to spinal cord injuries, thoracic vertebral fractures, and coagulopathy. New thoracic fascial plane blocks provide new options for patients with multiple rib fractures (MRFs). OBJECTIVE:Our primary objective was to assess the effectiveness of thoracic fascial plane blocks for patients with MRFs by looking at pain control, opioid consumption, and respiratory function postblock compared with preblock. EVIDENCE REVIEW:Literature was searched using keywords and controlled terms, based on the two concepts "rib fractures" and "fascial plane blocks". Terms were searched in PubMed, Embase, Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, Web of Science, Scopus, Google Scholar and ClinicalTrials.gov from inception to October 11, 2023, using medical subject headings (MeSH) and free-text terms without date or language restrictions. The terms included rib fractures, thoracic trauma, chest injuries, fascial plane blocks, PEC 1, PEC 2, PEC 3, pectoralis plane, serratus anterior plane (SAPB) and erector spinae plane block. FINDINGS:The available evidence shows that erector spinae plane block and SAPB are effective blocks to provide analgesia and reduce opioid requirements in patients with unilateral or bilateral rib fractures. CONCLUSIONS:More randomized control studies are needed to compare these blocks with paravertebral block or TEA to see if they provide analgesia, improve respiratory function, and reduce opioid requirements.
BACKGROUND:Apixaban and rivaroxaban are the oral anticoagulants most frequently used to treat acute venous thromboembolism. However, uncertainty remains about the difference in bleeding risk between the two medications. METHODS:In an international trial with a prospective, randomized, open-label, blinded end-point design, we assigned, in a 1:1 ratio, eligible patients with acute symptomatic pulmonary embolism or proximal deep-vein thrombosis to receive apixaban or rivaroxaban for 3 months. Apixaban was given at a dose of 10 mg twice daily for 7 days followed by 5 mg twice daily, and rivaroxaban was given at a dose of 15 mg twice daily for 21 days followed by 20 mg daily. The primary outcome was clinically relevant bleeding, a composite of major bleeding or clinically relevant nonmajor bleeding, as defined according to the International Society on Thrombosis and Haemostasis, during the 3-month trial period. Secondary outcomes included death from any cause. RESULTS:A total of 2760 patients underwent randomization: 1370 to the apixaban group and 1390 to the rivaroxaban group. A primary-outcome event occurred in 44 of 1345 patients (3.3%) in the apixaban group and 96 of 1355 patients (7.1%) in the rivaroxaban group (relative risk, 0.46; 95% confidence interval [CI], 0.33 to 0.65; P<0.001). Death from any cause occurred in 1 patient (0.1%) in the apixaban group and in 4 patients (0.3%) in the rivaroxaban group (relative risk, 0.25; 95% CI, 0.03 to 2.26). Serious adverse events unrelated to bleeding or venous thrombosis occurred in 36 patients (2.7%) in the apixaban group and in 30 patients (2.2%) in the rivaroxaban group. CONCLUSIONS:Among patients with acute venous thromboembolism, the risk of clinically relevant bleeding was significantly lower with apixaban than with rivaroxaban during the 3-month treatment period. (Funded by the Canadian Institutes of Health Research and others; COBRRA ClinicalTrials.gov number, NCT03266783.).
