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Canadian Medical Association Journal
Canadian Medical Association
Canadian Medical Association Journal

Canadian Medical Association

0820-3946

Canadian Medical Association Journal/Journal Canadian Medical Association JournalAHCISCIISTP
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    5 infectious disease topics to watch

    Diana Duong
    2页
    查看更多>>摘要：Experts at the AMMI Canada conference in Vancouver shared hot topics in infection control, from the changing role of infectious disease (ID) physicians to striking research on masks and air filters. They also highlighted growing concern about drug-resistant infections and new data on the dangers of sinks. Redefining the ID doc The COVID-19 pandemic sparked an explosion of interest in infection control — and cast ID doctors in new roles, said Lynora Saxinger, an ID specialist and associate professor at the University of Alberta. According to Saxinger, ID physicians have spent a “tremendous amount of uncompensated time” over the past two years acting as a bridge between lab colleagues and public health, and pharmacists and clinicians. She said the specialty should consider integrating science communication, media literacy, social media, and knowledge translation into its core competencies. Looking to the future, Saxinger said the official role and training of ID physicians could expand to include communicating with the medical community, the public, and the media to help “interpret the science, triangulate on recommendations and leverage trust.”
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Re-visioning

    2页
    查看更多>>摘要：The light was changing from amber to red when I turned left onto Main Street. My stepdaughter and I were on our way to a workout on a rainy Saturday morning. From the passenger seat of my trusty Subaru, she screamed — at what, I did not know. Although we made it through the intersection without hitting an oncoming car that I did not see, our hearts were racing before we hit the gym. On the way home, I wondered about the car’s fitness, but the sudden mechanical failure turned out to be mine. A few days later, my eye doctor stopped examining me, picked up his desk phone and speed-dialled the head of ophthalmology at the university. “There’s someone you must see right away,” he said. On Dec. 1, 2011, I received a diagnosis of Stargardt disease, an inherited retinal disorder that affects central vision. Genetic testing showed that my mother carried the mutation, and my father contributed a common variant. One in 10 000 are afflicted with this rare condition, which often presents in childhood. I was lucky to have reached the age of 50 before I had to give up my keys. But I was in shock. Since the first day behind the wheel of my father’s Ford truck when I was 14, I knew that driving would be my portal to other worlds. He wanted me to gain skills early and comprehensively. What better way than in the old ’48, with its manual transmission and well-worn body? ^z>Carol Yaple
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Bilateral neuralgic amyotrophy in a patient with livestock-associated hepatitis E virus infection

    Nicholas J. MillerDavyd R. HooperAditya Sharma
    5页
    查看更多>>摘要：A 52-year-old, previously healthy, right-handed male livestock trader woke in the middle of the night with acute, 9/10 right shoulder and forearm pain. He was unable to go back to sleep because of the pain, despite taking analgesics. The following day, he noticed weakness in his right hand and presented to the emergency department. He was found to have severe right shoulder pain and decreased active range of motion. Hand weakness was not documented. A presumptive diagnosis of inflammatory arthritis was made. Blood work showed normal complete blood count, electrolytes, creatinine kinase and erythrocyte sedimentation rate and elevated hepatic enzymes: aspartate aminotransferase 205 (normal range 16-51) U/L, alanine aminotransferase 472 (normal < 52) U/L, lactate dehydrogenase 861 (normal range 230-490) U/L, γ-glutamyl transferase 442 (normal range 5-38) U/L, and alkaline phosphatase 186 (normal range 36-144) U/L. The elevated hepatic enzymes were felt to be unrelated to the working diagnosis. The patient was prescribed prednisone 50 mg orally daily and analgesics and instructed to follow up with his family physician.
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Maternal and neonatal trauma following operative vaginal delivery

    Giulia M. MuracaAmélie BoutinNeda RazazSarka Lisonkova...
    12页
    查看更多>>摘要：Background: Operative vaginal delivery (OVD) is considered safe if carried out by trained personnel. However, opportunities for training in OVD have declined and, given these shifts in practice, the safety of OVD is unknown. We estimated incidence rates of trauma following OVD in Canada, and quantified variation in trauma rates by instrument, region, level of obstetric care and institutional OVD volume. Methods: We conducted a cohort study of all singleton, term deliveries in Canada between April 2013 and March 2019, excluding Quebec. Our main outcome measures were maternal trauma (e.g., obstetric anal sphincter injury, high vaginal lacerations) and neonatal trauma (e.g., subgaleal hemorrhage, brachial plexus injury). We calculated adjusted and stabilized rates of trauma using mixed-effects logistic regression. Results: Of 1326191 deliveries, 38500 (2.9%) were attempted forceps deliveries and 110 987 (8.4%) were attempted vacuum deliveries. The maternal trauma rate following forceps delivery was 25.3% (95% confidence interval [CI] 24.8%-25.7%) and the neonatal trauma rate was 9.6 (95% CI 8.6-10.6) per 1000 live births. Maternal and neonatal trauma rates following vacuum delivery were 13.2% (95% CI 13.0%-13.4%) and 9.6 (95% CI 9.0-10.2) per 1000 live births, respectively. Maternal trauma rates remained higher with forceps than with vacuum after adjustment for con-founders (adjusted rate ratio 1.70, 95% CI 1.65-1.75) and varied by region, but not by level of obstetric care. Interpretation: In Canada, rates of trauma following OVD are higher than previously reported, irrespective of region, level of obstetric care and volume of OVD among hospitals. These results support a reassessment of OVD safety in Canada.
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Understanding and addressing Islamophobia through trauma-informed care

    Arfeen MalickJuveria ZaheerJaveed SukheraZainab Furqan...
    2页
    查看更多>>摘要：The lethality of anti-Muslim hatred in Canada was highlighted in 2021 when 4 Muslim members of a London, Ontario, family were killed in a devastating act of terrorism on June 6, 2021. This was preceded by the 2017 Québec mosque massacre, in which 6 Muslim worshippers were shot and killed. Alongside outpourings of grief across the country after the London incident, many called for the examination of underlying systems and structures of discrimination that create the context in which Islamophobia manifests. For Canada’s medical community, already grappling with increasing calls to address the adverse consequences of multiple forms of racism, more guidance is needed on how to address the impacts of Islamophobia on patients. Muslim people constitute the second largest faith group in Canada and represent diverse communities. Islamophobia is defined as “social stigma toward Islam and Muslims, dislike of Muslims as a political force, and a distinct construct referring to xenophobia and racism toward Muslims or those perceived to be Muslim.” In recent years, the term has garnered critique as potentially euphemizing the issue of anti-Muslim hatred and racism. However, we use Islamophobia in this article as it is the term used most commonly in health literature.
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Household transmission of SARS-CoV-2 from unvaccinated asymptomatic and symptomatic household members with confirmed SARS-CoV-2 infection: an antibodysurveillance study

    Jennifer DawsonLauren DawsonTerry VarshneyCorey Arnold...
    10页
    查看更多>>摘要：Background: Household transmission contributes to SARS-CoV-2 spread, but the role of children in transmission is unclear. We conducted a study that included symptomatic and asymptomatic children and adults exposed to SARS-CoV-2 in their households with the objective of determining how SARS-CoV-2 is transmitted within households. Methods: In this case-ascertained antibody-surveillance study, we enrolled households in Ottawa, Ontario, in which at least 1 household member had tested positive for SARS-CoV-2 on reverse transcription polymerase chain reaction testing. The enrolment period was September 2020 to March 2021. Potentially eligible participants were identified if they had tested positive for SARS-CoV-2 at an academic emergency department or affiliated testing centre; people who learned about the study through the media could also selfidentify for participation. At least 2 participants were required for a household to be eligible for study participation, and at least 1 enrolled participant per household had to be a child (age < 18 yr). Enzyme-linked immunosorbent assays were used to evaluate SARS-CoV-2-specific IgA, IgM and IgG against the spike-trimer and nucleocapsid protein. The primary outcome was household secondary attack rate, defined as the proportion of household contacts positive for SARS-CoV-2 antibody among the total number of household contacts participating in the study. We performed descriptive statistics at both the individual and household levels. To estimate and compare outcomes between patient subgroups, and to examine predictors of household transmission, we fitted a series of multivariable logistic regression with robust standard errors to account for clustering of individuals within households. Results: We enrolled 695 participants from 180 households: 180 index participants (74 children, 106 adults) and 515 of their household contacts (266 children, 249 adults). A total of 487 household contacts (94.6%) (246 children, 241 adults) had SARS-CoV-2 antibody testing, of whom 239 had a positive result (secondary attack rate 49.1%, 95% confidence interval [CI] 42.9%-55.3%). Eighty-eight (36.8%, 95% CI 29.3%-43.2%) of the 239 were asymptomatic; asymptomatic rates were similar for children (51/130 [39.2%, 95% CI 30.7%-48.5%]) and adults (37/115 [32.2%, 95% CI 24.2%-41.4%]) (odds ratio [OR] 1.3, 95% CI 0.8-2.1). Adults were more likely than children to transmit SARS-CoV-2 (OR 2.2, 95% CI 1.3-3.6). The odds of transmission from asymptomatic (OR 0.6, 95% CI 0.2-1.4) versus symptomatic (OR 0.9, 95% CI 0.6-1.4) index participants to household contacts was uncertain. Predictors of household transmission included household density (number of people per bedroom), relationship to index participant and number of cases in the household. Interpretation: The rate of SARS-CoV-2 transmission within households was nearly 50% during the study period, and children were an important source of spread. The findings suggest that children are an important driver of the COVID-19 pandemic; this should inform public health policy.
      原文链接:
    • NSTL

    What the U.S. overturning Roe v. Wade means for Canada

    Lauren VogelDiana Duong
    2页
    查看更多>>摘要：The United States Supreme Court may soon strike down its landmark ruling in Roe v. Wade, ending constitutional protections for abortion, according to a draft decision leaked to Politico. The ruling would mean that states can decide whether and how to restrict abortion — or ban it outright. Nearly two dozen Republican-led states are expected to issue immediate bans, 13 of which have “trigger laws” on the books that would automatically kick in once the Supreme Court overturns Roe v. Wade. Abortion will probably remain legal in Democrat strongholds. At least a dozen states, including California, have passed laws protecting access. Canadian experts say that striking down Roe v. Wade is a devastating setback to reproductive rights with potentially wide-reaching implications. Outlawing abortion won’t stop people from terminating pregnancies, but it will make it riskier and more expensive, said Roopan Gill, an obstetrician-gynecologist with Médecins Sans Frontières and the University of Toronto. “The people who are going to suffer most from this are not wealthy, white, cis-hetero women. It’s going to be Black women, people of colour, people with low-socioeconomic status, LGBTIQ.”
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Shifting from cytology to HPV testing for cervical cancer screening in Canada

    Emily DelperoAma Selk
    3页
    查看更多>>摘要：Infection with high-risk strains of the human papillomavirus (HPV) is a known prerequisite for developing cervical cancer. Soon, a test for high-risk strains of HPV will replace the Papanicolaou (Pap) test for routine cervical cancer screening in Canada. Unlike the Pap test, which requires a cytopathologist to detect precancerous cervical cells, testing of a cervical sample for HPV subtypes uses polymerase chain reaction (PCR). Australia, the Netherlands and the United Kingdom have adopted the HPV testing model for cervical screening, and it is also endorsed by the American Cancer Society. A recent review by the Canadian Agency for Drugs and Technologies in Health considered available evidence; its report concluded that HPV PCR testing of cervical samples is better at detecting precancer or cancer than Pap testing and would decrease the overall cost of screening. However, shifting to this new screening modality will mean overhauling existing algorithms for age and screening intervals, changing resource allocation and educating physicians and patients. We discuss why and how cervical screening will need to change in Canada with the adoption of the new test. Current screening approaches acknowledge that Pap testing has a high specificity of 96.8%4 but a low sensitivity (55.4%), which means that screening misses almost half of existing abnormalities. A short interval for repeat testing (every 2-3 years, starting between the ages of 21 and 25, depending on the province) mitigates harm, as subsequent testing is likely to detect previously missed pathology in populations with relatively high disease prevalence.
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Heart block in a 60-year-old man with undiagnosed cardiac sarcoidosis

    Ashar PirzadaAndrew D. Moeller
    4页
    查看更多>>摘要：A 60-year-old man presented to the emergency department after a brief syncopal episode without a prodrome. The patient was alert and oriented after the episode, and witnesses reported no seizure activity. He had no history of syncope, but did have a history of hypertension and left nephrectomy (he was an elective donor). His only medication was amlodipine 5 mg/d orally. He had no allergies and was a half-pack-per-day smoker. He did not use marijuana, alcohol or illicit drugs. His heart rate was 35-40 beats/min and blood pressure was 190/80 mmHg. His temperature, oxygen saturation and respiratory rate were normal, as was the remainder of the physical examination. An electrocardiogram (ECG) showed 2:1 atrioventricular (AV) block with left bundle branch block (Figure 1). No previous ECGs were available. Chest radiograph was normal. The patient had a normal complete blood count, electrolytes, renal function, liver enzymes and thyroid-stimulating hormone level, which ruled out electrolyte abnormalities and thyroid disease as a cause of heart block. High-sensitivity troponin-T levels were mildly elevated (23, 60, 84 [reference range 0-14] ng/L). We admitted him for further investigations including C-reactive protein levels, immunoglobulins, vasculitis panel, blood cultures and Lyme serology, and all were negative. Thus, we considered it unlikely that his heart block was caused by infectious or autoimmune diseases (Box 1).
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc

    Trial of labour after caesarean delivery

    Elizabeth MiazgaEliane M. Shore
    1页
    查看更多>>摘要：1 Trial of labour after cesarean (TOLAC) is a safe alternative to repeat cesarean delivery Pregnant people who have had a previous cesarean delivery can have a TOLAC or an elective cesarean. For patients with high likelihood of vaginal birth after cesarean (VBAC), TOLAC is the recommended mode of delivery. A tool to calculate likelihood of VBAC is available (https://mfmunetwork. bsc.gwu.edu/web/mfmunetwork/vaginal-birth-after-cesarean-calculator). 2 Three-quarters of people who attempt TOLAC will have a VBAC1 Vaginal birth after cesarean is more likely in patients with a previous vaginal delivery (83%) or VBAC (94%).1 In comparison, the probability of vaginal delivery in a primiparous term patient in Canada is 76%.4 Induction of labour decreases likelihood of VBAC, but is safe with mechanical cervical ripening, oxytocin and amniotomy. 3 Uterine rupture is a rare complication of TOLAC Uterine rupture at the site of the uterine scar complicates 0.47% of TOLAC attempts.1 Risk of rupture increases with 2 or more cesarean deliveries (1.6%), less than 18 months between deliveries (4.7%), or induction of labour (1.2%). 4 Hospital-based care is required for TOLAC Continuous fetal heart monitoring is required during active labour. The most common sign of uterine rupture is an abnormal fetal heart tracing, particularly complicated variable, late or prolonged decelerations.1,2 If uterine rupture is suspected, an emergency laparotomy and urgent delivery are required. Therefore, onsite surgical and anesthesia teams are needed to support TOLAC.
      原文链接:
    • NSTL
    • Cma-Canadian Medical Assoc