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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We report the case of a 51-year old woman who developed headache, nausea, palpitations, tachycardia and hypertension 30 minutes after eating a tuna fish salad. Elevated histamine levels in the salad helped to confirm a suspected diagnosis of scombroid poisoning. The signs, symptoms, pathophysiology and management of poisoning from spoiled scombroid fish are discussed.
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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.