Impact of the 2016 Canadian Lipid Guidelines on Daily Practice at a Community Hospital.

OBJECTIVES: The aim of this study was to determine the impact of the 2016 Canadian cardiovascular society guidelines for the management of dyslipidemia. More specifically, we assessed the use of 1) alternate lipid targets when triglyceride (TG) levels are high; and 2) nonfasting lipid testing. METHODS: Lipid profiles and pharmacy data were obtained from patients with a history of myocardial infarction and from patients ≥40 years of age with a diagnosis of diabetes. RESULTS: As TG increased to >1.5 mmol/L, percent within target for non-high-density lipoprotein cholesterol and apolipoprotein B 18 months after guideline release remained low in both patients with atherosclerotic cardiovascular disease (40%) and patients with diabetes in primary prevention (30%). Approximately 50% of patients were fasting when presenting for lipid testing. Use of high-intensity statin was suboptimal in both groups. CONCLUSIONS: The concept of alternate lipid targets may not be well understood by many physicians, leading to undertreatment of patients. Progress was made in the promotion of routine nonfasting lipid testing.

Screening recommendations for diabetics.

Diabetes is one of the leading causes of morbidity and mortality in the United States. Patients with diabetes are at risk for multiple ophthalmologic complications including, but not limited to, cataracts, glaucoma, and retinopathy. Eye-exams are an important screening tool for patients with diabetes in order to prevent the more severe and vision-threatening sequela of disease. Early detection and treatment of diabetic retinopathy can result in a significant decrease in vision-loss. However, recent estimates demonstrate that few diabetic patients meet the recommended screening guidelines. Appropriate referral and follow-up is important for monitoring the ophthalmologic conditions associated with diabetes. Our purpose is to review current recommendations for ophthalmic screening for patients with diabetes in a clear and concise manor for primary care physicians.

Impact of the Martin/Hopkins modified equation for estimating LDL-C on lipid target attainment in a high risk patient population.

OBJECTIVE: To evaluate the Martin/Hopkins equation for estimating LDL-C as target in a population composed of high cardiac risk patients. METHODS: Lipid profile data from patients with TG ≤ 4.52 mmol/L (<400 mg/dl) were used. The high cardiac risk group (N 4150) consisted of patients over 40 years of age that had an A1C level of 6.5% or above and patients with a history of atherosclerotic cardiovascular disease (ASCVD). Comparisons were made between the Martin/Hopkins formula (MH-LDL-C), the Friedewald formula (F-LDL-C), Non-HDL-C and ApoB. RESULTS: Higher LDL-C values (0.15 mmol/L or 7.3%) were obtained using MH-LDL-C compared to the F-LDL-C. The % within target (%WT) values for F-LDL-C, MH-LDL-C, Non-HDL-C and ApoB were similar when TG levels were ≤ 1.5 mmol/L with a high degree of concordance as measured by the kappa statistic. When compared to F-LDL-C, Non-HDL-C and ApoB showed a profound decrease in the WT value as TG levels increased from normal (67.7%) to intermediate (39.1%) and high levels (20.8%). MH-LDL-C showed an attenuated decrease in the WT value as TG increased from normal (61.4%) intermediate (43.4%) and high levels (32.7%). Concordance with the alternate target parameters was higher for MH-LDL-C than for F-LDL-C when triglycerides levels were increased. CONCLUSION: The Martin/Hopkins modified equation for estimating LDL-C is a significant improvement on the decade's old Friedewald formula; however it remains an imperfect tool to estimate the atherogenic load in patients with high TG levels.

Comics, Corn, and the Queer Phenomenology of Depression.

Grounded in analyses of two graphic memoirs, Ellen Forney's Marbles: Mania, Depression, Michelangelo and Me and Allie Brosh's "Depression (Parts One & Two)," this article draws from Sara Ahmed's 2006 book, Queer Phenomenology: Objects, Orientations, Others, in order to theorize the "queer phenomenology" of what gets called depression within many Western psychiatric, medical, and cultural discourses. Arguing that queer desires orient the subject away from (hetero)normative objects (or "happy objects," as Ahmed calls them, because they promise a life of happiness), Queer Phenomenology suggests that the subsequent turn toward queer objects produces feelings of dis-orientation in the subject. Noting the similarities between Ahmed's idea of queer disorientations and my own disorienting experiences of depression, this essay posits that depression similarly constitutes a turn away from"happy objects" andtoward objects which, through their newfound prominence in the depressed person's life, may appear as strange or even queer.

Activation of PKCßII by PMA facilitates enhanced epithelial wound repair through increased cell spreading and migration.

Rapid repair of epithelial wounds is essential for intestinal homeostasis, and involves cell proliferation and migration, which in turn are mediated by multiple cellular signaling events including PKC activation. PKC isoforms have been implicated in regulating cell proliferation and migration, however, the role of PKCs in intestinal epithelial cell (IEC) wound healing is still not completely understood. In the current work we used phorbol 12-myristate 13-acetate (PMA), a well recognized agonist of classical and non-conventional PKC subfamilies to investigate the effect of PKC activation on IEC wound healing. We found that PMA treatment of wounded IEC monolayers resulted in 5.8±0.7-fold increase in wound closure after 24 hours. The PMA effect was specifically mediated by PKCßII, as its inhibition significantly diminished the PMA-induced increase in wound closure. Furthermore, we show that the PKCßII-mediated increase in IEC wound closure after PMA stimulation was mediated by increased cell spreading/cell migration but not proliferation. Cell migration was mediated by PKCßII dependent actin cytoskeleton reorganization, enhanced formation of lamellipodial extrusions at the leading edge and increased activation of the focal adhesion protein, paxillin. These findings support a role for PKCßII in IEC wound repair and further demonstrate the ability of epithelial cells to migrate as a sheet thereby efficiently covering denuded surfaces to recover the intestinal epithelial barrier.