查看更多>>摘要：The main characteristic of postural orthostatic tachycardia syndrome (POTS) is tachycardia when standing, without a drop in blood pressure. Patients describe lightheadedness and palpitations when upright, particularly when standing, which sometimes leads to syncope. Patients may experience impaired quality of life and functional disability, which can be economically devastating. The syndrome is more common in girls and young women and has been associated with other disorders, like migraine and Ehlers-Danlos syndrome. We discuss the diagnosis of POTS, conditions to consider in the differential diagnosis, associated disorders and the pharmacologic and nonphar-macologic management of patients with POTS, based on original research, narrative reviews and consensus statements (Box 1).
查看更多>>摘要：A 30-year-old woman presented to hospital 8 days after vaccination against SARS-CoV-2 with the second dose of the Moderna mRNA vaccine. One day postvaccination, she noted flu-like symptoms, including chills and nausea. Three days post-vaccination, she developed neuromus-cular symptoms, including progressive bilateral upper and lower limb myalgia and weakness. At 7 days, she noticed cola-coloured urine. She had been vaccinated with the first dose of Moderna mRNA SARS-CoV-2 vaccine 6 months earlier, and had not displayed these symptoms or any complications.
查看更多>>摘要：1. Fluvoxamine may prevent hospital admission in symptomatic adults with COVID-19: Fluvoxamine is a selective serotonin reuptake inhibitor with potential anti-inflammatory and antiviral properties. A meta-analysis of 2196 patients with COVID-19 from 3 randomized controlled trials concluded that fluvoxamine had a high probability of preventing hospital admission or observation in the emergency department for more than 24 hours, compared with placebo. The Ontario Science Table states that fluvoxamine may be considered for mildly ill patients within 7 days of symptom onset. 2. Children and pregnant people have not been studied: Trials primarily enrolled unvaccinated adult outpatients at high risk for serious COVID-19 outcomes.2 For pregnant patients, caution and obstetrical consultation are advised. Fluvoxamine is not recommended for pediatric patients. Patients on a serotonergic antidepressant for a psychiatric condition who are switched to fluvoxamine may experience decompensation in their mental health.
查看更多>>摘要：1. Ritonavir-boosted nirmatrelvir (marketed as Paxlovid) is a Health Canada-approved oral antiviral medication with activity against SARS-CoV-2: Treatment is indicated for adult (> 18 yr) outpatients with nonhypoxic COVID-19 who are at high risk of severe disease progression (e.g., advanced age, comorbidity, unvaccinated or immunosuppressed). 2. Studies recruited primarily unvaccinated participants, predated the omicron variant and have not yet undergone peer review: According to available data, patients with 5% risk of hospital admission have an estimated number needed to treat to prevent 1 hospital admission of 24 (95% confidence interval 22-29).3'4 The most common adverse effects are dysgeusia, diarrhea, vomiting, increased blood pressure and headache.
查看更多>>摘要：A 68-year-old woman presented to hospital after a fall. She had undergone a total thyroidec-tomy more than 20 years previously. Her neurologic examination was normal. Computed tomography scans of her head, done to exclude intracranial bleed, showed symmetric parenchymal calcification in the basal ganglia (Figure 1A) and cerebellum (Figure IB). Given the patient's history of thyroidec-tomy, we suspected hypoparathyroidism and arranged a series of laboratory tests. These showed an ionized calcium level of 0.75 (normal 1.15-1.35) mmol/L, and a phosphate level of 1.51 (normal 0.87-1.52) mmol/L. Her parathyroid hormone level was undetectable at less than 0.6 (normal 1.4-7.6) pmol/L and her thyroid-stimulating hormone level was 0.38 (normal 0.5-5.0) mlU/L. The presumptive diagnosis for the intracranial calcifications was chronic hypocalcemia caused by untreated hypoparathyroidism after total thyroidectomy.
查看更多>>摘要：The past year has been marked by growing friction between pandemic policy and the advice of some vocal front-line health workers. These physicians say they're speaking out because of eroding trust in government decisions. They also see their advocacy as having an impact — even if changes are coming later than they'd like. Others, meanwhile, question if the fracturing of public health messaging is serving Canadians. Early in 2021, relief over the approval of COVID-19 vaccines gave way to frustration over access to the shots. In the spring, Ontario Premier Doug Ford had been easing pandemic restrictions, despite projections showing escalating intensive care admissions, as well as calls for the province to target vaccines to the hardest-hit neighbourhoods.
查看更多>>摘要：New criminal sanctions against intimidating health workers may provide additional legal protections for those facing increasing abuse on the job, including during protests against public health mandates. But so far police do not appear to be enforcing the new rules any more than previous laws on harassment. As of Jan. 16, it became illegal to intimidate people to impede them from providing, assisting or accessing health care services in Canada. Introduced by the Liberal government as part of Bill-C3, the new Criminal Code amendments also make it illegal to obstruct or interfere with a person's access to health care facilities. People who are convicted of either offence will face a maximum sentence of up to 10 years in prison. According to Ian McLeod of Canada's Department of Justice, the amendments "express Parliament's grave concerns about various kinds of aggressive and violent behaviour targeting health care workers and seekers."
查看更多>>摘要：The language and labels that some physicians use to describe patients in medical records often fly under the radar, but they can provide a window into bias in health care.A recent study of the medical records of 18 459 Americans published in Health Affairs found that Black patients were 2.54 times more likely than white patients to have at least one negative descriptor such as "resistant" or "non-compliant" in their files. Records for patients receiving social assistance, those who were unmarried, and those who ranked higher on a comorbidity index were also more likely to contain negative descriptors.
查看更多>>摘要：The founding of the Canadian Medical Protective Association (CMPA) in 1901 was pivotal to Canadian medical malpractice law. At first, the CMPA was a small mutual defence organization that pooled membership fees to cover the costs of physicians facing malpractice litigation. In its early days, the association fiercely protected its members, framing patient-plaintiffs as "unscrupulous charlatans" and refusing to settle any case brought against its members. But by the late 1920s, it took on responsibility for paying damages awarded in lost court cases, and it began settling cases it deemed legally indefensible. At the same time, the organization asked its members to report threats of malpractice litigation (before any litigation had commenced) while also keeping track of trends in successful litigation. With this information, the association was well positioned to warn doctors about interventions that put the public at risk, and that also generated a risk to the association's bottom line. An example of the CMPA's risk- management strategy was its effort from the 1940s to the 1960s to warn practitioners about the dangers of varicose vein treatments.
查看更多>>摘要：The clock shows 3:18. It hasn't read anything different all week. It's a tacky black and white clock, like you find in a dollar store, complete with dead batteries. Where is the nurse? I think it is my fifth night here, or is it my sixth? It doesn't really matter. I haven't left my room since I was admitted. I've barely even left my bed. Finally, the door swings open and the much-too-bright hospital light rushes in. Footsteps are accompanied by the rattle of my pain pills. The wound on my stomach throbs. I resist the urge to open my eyes. Every time I look at my stomach, I feel like I'm going to puke. If I keep them closed long enough, maybe I'll wake up at home.
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