ore than 90% of childhood-and youth-onset diabetes in Canada is type 1 diabetes. 1,2 The peak prevalence of persistent autoantibodies to islet cell antigens occurs by age 2 years, 3 with some individuals progressing to type 1 diabetes years later on in life. Indicators of higher likelihood of progression (e.g., recurrent enteroviral infections or absence of rotavirus vaccination, 4,5 higher maternal or paternal age 6) could potentially facilitate early detection and management. Underscoring the importance of early detection and management, we previously showed that about one-quarter of children and youth with newonset type 1 diabetes present with diabetic ketoacidosis at diagnosis, an avoidable acute complication of type 1 diabetes. 7 A large retrospective cohort study from Sweden, 8 where more than 90% of childhood-and youth-onset diabetes is type 1 diabetes, 9 showed a 6.2-fold higher incidence rate ratio (IRR) for childhood-and youth-onset diabetes with maternal type 1 diabetes and a 7.6-fold higher IRR with paternal type 1 diabetes. 8 The IRR was 1.9 times higher for a composite exposure of maternal type 2 diabetes and gestational diabetes mellitus versus neither maternal condition, and 2.5 times as high with versus without paternal diabetes. In a large retrospective cohort, we previously showed gestational diabetes mellitus and gestational hypertension to be indicators of incident diabetes, hypertension and cardiovascular disease or mortality in mothers, and of incident diabetes in fathers. 10,11 Using the same cohort, we examined maternal gestational diabetes mellitus as a risk indicator of diabetes in children and youth.

Background. Medical emergency teams (METs) or rapid response teams (RRTs) facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system's impact on time to intervention, code blue rates, and ICU transfer rates. Results. Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10), compared to 3.4 hours (IQR 0.6–12.4) before system implementation (p < 0.001). Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (±2.2) before intervention to 3.3/1000 patient days (±1.4) after intervention (IRR: 0.82, p = 0.04 (CI 95%: 0.69–0.99)). CTU code blue rates decreased from 2.2/1000 patient days (±1.6) before intervention to 1.2/1000 patient days (±1.3) after intervention (IRR: 0.51, p = 0.02 (CI 95%: 0.30–0.89)). Conclusion. Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources.

Rheumatoid meningitis is a rare complication of rheumatoid arthritis (RA). It is associated with substantial morbidity and mortality. The condition may present in a variety of ways and is therefore diagnostically challenging. Uncertainty still exists regarding the optimal treatment strategy. Herein, we describe the case of a 74-year-old man with a history of well-controlled seropositive RA on low-dose prednisone, hydroxychloroquine, and methotrexate. The patient presented with a several-month history of multiple prolonged episodes of expressive aphasia, right hemiparesis, and encephalopathy. Although no epileptiform activity was recorded on repeated electroencephalography, the symptoms fully resolved following treatment with antiepileptic drugs. He subsequently developed acute asymmetrical parkinsonism of the right hemibody. Magnetic resonance imaging revealed subtle enhancement of the leptomeninges over the left frontoparietal convexity. Cerebrospinal fluid analysis revealed a mild lymphocytic pleocytosis and elevated proteins. Histopathologic analysis of a meningeal biopsy revealed nodular rheumatoid meningitis. The patient was treated with corticosteroids and cyclophosphamide, following which he incompletely recovered. This is the first description of rheumatoid meningitis manifesting with acute parkinsonism and protracted non-convulsive seizures. A summary of cases reported since 2005, including data on pathology, therapy and outcomes, along with a discussion on the efficacy of different treatment strategies are provided.