CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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Whether there is an association between depression at the time of acute myocardial infarction and subsequent risk of cardiac complications and death remains controversial. Most studies of this risk factor have been limited to patients of single institutions, and this might account for the varying results. We prospectively evaluated patients admitted to 5 tertiary care and 5 community hospitals and followed them for 1 year to measure the prevalence and prognostic impact of depressive symptoms after acute myocardial infarction. ⋯ Depressive symptoms are common after acute myocardial infarction and are associated with a slight increase in risk of in-hospital catheterization and angiography and readmission because of cardiac complications. Death was infrequent, with no statistically significant difference between the 2 groups.
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Graves' disease is characterized by hyperthyroidism, diffuse goitre, ophthalmopathy and, rarely, dermopathy. Although diagnostic testing is straightforward once Graves' disease is suspected, physicians need to be aware of heterogeneous and even atypical presentations of the disease, particularly in elderly patients. ⋯ Although all of the available treatments are effective, compliance is best assured by a full discussion of the risks and benefits of each approach. This review focuses on issues of diagnosis and management that will allow the primary care physician to identify patients with Graves' disease and guide them to recovery.
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Comparative Study
What happens to patients who leave hospital against medical advice?
Patients who leave hospital against medical advice (AMA) may be at risk of adverse health outcomes and readmission. In this study we examined rates of readmission and predictors of readmission among patients leaving hospital AMA. ⋯ The significantly increased risk of readmission among general medicine patients who leave hospital AMA is concentrated in the first 2 weeks after discharge. However, it is difficult to identify which patients will likely be readmitted.
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Comparative Study
An observational study comparing 2-hour 75-g oral glucose tolerance with fasting plasma glucose in pregnant women: both poorly predictive of birth weight.
The definition and treatment of glucose intolerance during pregnancy are matters of intense controversy. Our goal was to examine the value of the 75-g oral glucose tolerance test (OGTT) in terms of its ability to predict birth weight percentile in a group of women with singleton pregnancies who received minimal treatment for their glucose intolerance. ⋯ In this population of pregnant, untreated diabetic women, plasma glucose levels (either fasting or after various glucose loads) were independently but poorly correlated with birth weight; no more than 3% to 5% of birth weight variability could be explained by changes in glucose tolerance. Fasting plasma glucose was consistently but marginally better than the plasma glucose level 2 hours after 75-g glucose load for predicting LGA neonates. We conclude that neonatal macrosomia is influenced by variables that are largely independent of plasma glucose concentrations.