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This article discusses a case of cutaneous mucormycosis in a 66-year-old man who underwent renal transplantation. The patient developed a lesion on his forearm after scraping it on a metal garbage can lid prior to the transplant. Despite initial treatment for cellulitis, the lesion worsened, and a biopsy revealed invasive fungal elements suggestive of Mucorales. The patient was prescribed antifungal therapy and underwent surgical débridement. The article emphasizes the importance of early diagnosis and surgical intervention in treating cutaneous mucormycosis, as antifungal medications alone are often insufficient. [Extracted from the article]

This document is a response to two letters regarding the guideline on the management of alcohol use disorder (AUD). The authors explain that the guideline's caution against prescribing certain antidepressants is based on evidence that these medications are largely ineffective for individuals with AUD and comorbid depression or anxiety. They cite several studies suggesting benefits of selective serotonin reuptake inhibitors (SSRIs), but note that most of these were not placebo-controlled trials. Meta-analyses have found that SSRIs have no effect on depressive symptoms among people with AUD. Additionally, the guideline highlights literature demonstrating that certain antidepressants can increase alcohol use among some patients. The authors conclude that the current evidence justifies the guideline's recommendations. [Extracted from the article]

The Canadian Medical Association Journal (CMAJ) has introduced a new article type focused on trust in healthcare. The decision to focus on trust was prompted by physicians expressing difficulties in establishing and maintaining trust with their patients. The first article in this series discusses a breakdown in trust between a patient's husband and the critical care team, as well as a contrasting positive experience with the rehabilitation team. Trust in healthcare is a relational concept that exists between individuals and organizations, and factors such as transparency, communication, and treatment of patients contribute to building and maintaining trust. The goal of these articles is to shed light on trust in healthcare and help providers and organizations understand how to earn and maintain trust. Patients and caregivers are encouraged to share their experiences, and the journal is committed to a respectful and considerate peer review process for these articles. Guidance for authors interested in submitting articles on trust is available, and assistance is offered for patients who may need help in writing their stories. [Extracted from the article]

This article from the Canadian Medical Association Journal discusses a case of intermetatarsal bursitis (IMB) in a 42-year-old woman with rheumatoid arthritis. The patient presented with pain and swelling in her fingers and left forefoot, and physical examination revealed swelling and tenderness in certain joints. Ultrasonography showed a hypoechoic, Doppler-positive structure in the left second intermetatarsal space, indicating IMB. The article highlights the association between IMB and rheumatoid arthritis, and suggests that metatarsalgia with widened interdigital space between adjacent toes can be indicative of IMB and rheumatoid arthritis. [Extracted from the article]

According to the Canadian Medical Association Journal (CMAJ), there has been an increase in measles cases in Canada, with 40 cases reported by March 2024. Measles can cause complications in 30% of cases, particularly in children under 5 years old. The measles, mumps, and rubella (MMR) vaccine is highly effective and safe, providing over 99% long-term protection. It is recommended that children receive two doses of the vaccine, with the first dose given at 12-15 months and the second after 18 months. The vaccine can also be given to susceptible individuals before travel or known exposure. For adults, the number of MMR doses depends on their risk of exposure and immunization history. Vaccination is preferred over serologic testing for protective measles antibodies. Those born before 1970 and those born between 1970 and 1996 can be given one dose if traveling outside of Canada or to an outbreak location. Military personnel, healthcare workers, and individuals with no immunization records should ensure they have received two doses of the vaccine. [Extracted from the article]

A recent study published in the Canadian Medical Association Journal (CMAJ) found that pharmacogenomic testing, which uses genetic information to guide treatment for major depressive disorder (MDD), is both cost-saving and improves clinical outcomes. However, the affordability of upfront investment in this testing is a major challenge in healthcare systems where funds are already allocated. Access to and public funding for MDD treatment options vary across Canada, so evaluations of the cost-effectiveness of pharmacogenomic testing should consider all available treatment options, not just those locally available. The study's model for assessing the cost-effectiveness of interventions for MDD represents valuable research infrastructure that can support evidence-informed decision-making in healthcare systems. [Extracted from the article]

Diagnosis of -gal syndrome has increased among patients previously thought to have idiopathic anaphylaxis.[5] Clinicians should consider -gal syndrome in the differential diagnosis of unusual food or dr... A new onset of reactions to red meat (an uncommon allergen) should alert clinicians to suspect -gal syndrome. The lone star tick ( I Amblyomma americanum i ) is commonly found in the southern United States, but its prevalence in Canada is increasing.[1] The tick's saliva contains a high level of -gal, a carbohydrate antigen also present in nonprimate mammalian cell membranes.[2] Skin and bloodstream exposure to this antigen through a tick bite leads to sensitization to the carbohydrate and, subsequently, to red meat allergy. Management is similar to that of other IgE-mediated allergies Patients with -gal syndrome should avoid all red meat and -gal-containing products, but can safely consume white meat and fish. [Extracted from the article]

Background: The producers of clinical practice guidelines (CPGs) may not disclose industry funding in their CPGs. We reviewed Canadian national CPGs to examine the existence and disclosure of industry-related organizational funding in the CPGs, financial conflicts of interest of committee members and organizational procedures for managing financial conflicts of interest.Methods: For this descriptive study, we searched the asset map of the Strategy for Patient-Oriented Research Evidence Alliance and the CPG Infobase for CPGs published between Jan. 1, 2016, and Nov. 30, 2018. Eligible guidelines had to have a national focus and either a first-line drug recommendation or a screening recommendation leading to drug treatment. One investigator reviewed all CPG titles to exclude those that were clearly ineligible. Two reviewers independently reviewed all remaining guidelines and extracted data. We analyzed the data descriptively.Results: We included 21 CPGs: 3 from government-sponsored organizations, 9 from disease or condition interest groups and 9 from medical professional societies. None of the 3 government-sponsored organizations reported industry funding, and none of their committee members disclosed financial conflicts of interest. Among the 18 disease or condition interest groups and medical professional societies, 14 (93%) of the 15 that disclosed funding sources on websites (3 did not disclose) reported organizational funding from industry, but none disclosed this information in the CPGs; 12 (86%) of the 14 with conflict-of-interest disclosure statements in the CPG (4 did not include disclosures) had at least 1 committee member with a financial conflict (mean proportion of committee members with a conflict 56%); and for all 8 CPGs with identifiable chairs or cochairs (chairs or cochairs not reported for 10) at least 1 of these people had a financial conflict of interest. None of the guidelines described a plan to manage organizational financial conflicts of interest.Interpretation: Canadian CPGs are vulnerable to industry influence through funding of producers of guidelines and through the financial conflicts of interest of committee members. The CPG producers that receive industry funding should disclose organizational financial conflicts in the CPGs, should engage independent oversight committees and should restrict voting on recommendations to guideline panelists who have no financial conflicts. [ABSTRACT FROM AUTHOR]

The article titled "Rendezvous procedure for choledocholithiasis in a Canadian rural surgical service" has been retracted by both the authors and the Canadian Medical Association Journal (CMAJ). The retraction came after a letter of concern was received and the authors reviewed their data, finding that a patient who experienced a serious adverse event had been misclassified. The editors of CMAJ acknowledged that if the data had been presented accurately, the decision to publish the article may have been different. [Extracted from the article]

This article from the Canadian Medical Association Journal discusses the use of hormone therapy in menopausal patients with a history of gynecologic cancer. It highlights the potential benefits of hormone therapy for managing vasomotor symptoms and the increased risks of cardiovascular disease, osteoporosis, and mood and cognition difficulties associated with loss of ovarian function due to cancer treatment. The article recommends systemic estrogen therapy for patients with non-hormone-sensitive cancers, with consultation with the oncology team, and suggests local hormone therapy options for select patients. It also provides guidelines for the use of hormone therapy in patients with specific types of gynecologic cancer, such as cervical and endometrial cancer, and emphasizes the importance of individualized treatment duration. [Extracted from the article]

A recent article in the Canadian Medical Association Journal discusses the importance of considering cerebral venous thrombosis (CVT) as a potential diagnosis for postpartum patients experiencing seizures and headaches. CVT refers to the formation of blood clots in the veins of the brain and is a significant cause of pregnancy-associated strokes. Unlike other types of strokes, CVT often presents with nonfocal symptoms such as headaches and visual changes. Diagnosis of CVT can be challenging and may require specialized imaging techniques. Timely diagnosis is crucial for appropriate management and better outcomes. [Extracted from the article]

Although 10% of patients who are pregnant report having a penicillin allergy,[1] after evaluation, 83%-95% of these patients can safely receive penicillin.[2],[3] Penicillin allergy delabelling is associated with the prevention of antibiotic resistance and I Clostridium difficile i infection caused by other antibiotics, and with substantial savings in health care costs.[2] Delabelling provides a direct benefit for the pregnant person and neonate A penicillin allergy label has been associated with adverse obstetric outcomes, including higher rates of cesarean delivery and wound infections and longer hospital length of stay.[1] It is also associated with an inappropriate choice of antibiotic prophylaxis for patients who screen positive for Group B I Streptococcus i ,[1],[4] leading to an increased risk of early onset neonatal Group B I Streptococcus i disease.[5] Delabelling has been shown to increase the use of appropriate antibiotics during labour and delivery.[3] Penicillin allergy reported during antenatal care should prompt referral to allergy delabelli... Penicillin allergy delabelling during pregnancy is available in an outpatient setting at any stage of pregnancy. Most patients with penicillin allergies can safely receive cefazolin for cesarean delivery and Group B I Streptococcus i prophylaxis. [Extracted from the article]

The Canadian Medical Association Journal (CMAJ) has issued a correction notice regarding errors in their September 25, 2023, issue. The correction includes the correction of incorrect references, the inclusion of missing information, and the correction of inaccurate statements in various sections of the journal. The errors have been rectified, and the corrected version is available on the CMAJ website. [Extracted from the article]

The article present a case study of a 75-year-old man was brought to the emergency department by his wife after he ingested an overdose of hydromorphone with the intent of ending his life. Topics discussed include diagnosed with metastatic pancreatic adenocarcinoma one month ago; improvement in pain and dyspnea with titration of opioids and drainage of large, malignant pleural effusions; and involvement of the complexity in the assessment for medical assistance in dying (MAiD).

This patient presented to us before the current epidemic of mpox, which should now be considered in the differential diagnosis of patients with similar lesions. A 21-year-old woman presented to the emergency department with a 2-week history of lesions on her left hand. Lesion swabs were negative for HSV 1, HSV 2 and VZV via polymerase chain reaction (PCR) and bacterial culture. [Extracted from the article]

The article discusses guidelines for chronic kidney disease management that were developed by the Canadian Society of Nephrology. The guidelines explains key aspects of the management of the disease to promote shared care for these patients by general practitioners and specialists. In particular, these guidelines are for the care of patients who are not undergoing dialysis. The authors offer recommendations from the guidelines on aspects of management of chronic kidney disease. These include strategies for treatment, targets for different abnormalities and frequency of follow-up based on the evidence available.

Abstract Background The Canadian and American Diabetes Associations recommend the use of an oral glucose tolerance test to screen for abnormal glucose tolerance among women with polycystic ovary syndrome when their fasting plasma glucose level is 5.7 mmol/L or more (Canadian guideline) and 5.6 mmol/L or more (American). Our objective was to determine the predictive value of 5.6 mmol/L as a fasting plasma glucose cutoff for detecting abnormal glucose tolerance in women with polycystic ovary syndrome, and then to define the optimal cutoff for this population. Methods An oral glucose tolerance test was administered to 105 consecutive women with polycystic ovary syndrome referred to an academic reproductive endocrine clinic. We calculated sensitivity, specificity and likelihood ratios. Results The sensitivity of a 5.6 mmol/L cutoff was 48% (95% confidence interval [CI] 30%-67%); its specificity, 98.7% (95% CI 96.1%-100%). With this cutoff, 52% of women with polycystic ovary syndrome whose glucose tolerance is abnormal would be missed. The prevalence of abnormal glucose tolerance was 28%, with a positive predictive value of 93% (95% CI 81%-100%) and a negative predictive value of 83% (95% CI 76%-91%). The likelihood ratio for a positive test was 36.7 (95% CI 5.0-267), and for a negative test, 0.5 (95% CI 0.4-0.7). The optimal fasting plasma glucose cutoff value was 5.0 mmol/L, with a 79% sensitivity (95% CI 65%-94%) and 66% specificity (95% CI 55%-77%). If this cutoff were used, 24% of women with abnormal glucose tolerance would still be missed. Interpretation The Canadian and American recommendations - of screening for abnormal glucose tolerance with an oral glucose tolerance test only when the results of a fasting plasma glucose test are 5.7 mmol/L (or 5.6 mmol/L) or more - are inappropriate for women with polycystic ovary syndrome. We therefore recommend that all women with polycystic ovary syndrome have an oral glucose tolerance test. [ABSTRACT FROM AUTHOR]

Some specialists and family doctors in Ontario are locked in a standoff over who should take responsibility for contacting patients about appointments. Dr. Adam Stewart, a family doctor in Madoc, Ont., is one of many referring physicians who welcomed the new rules. The ordering physician is responsible for follow-up if they give the requisition to the patient, but if the physician sends the requisition to the facility, the facility is responsible for follow-up. [Extracted from the article]

Presents the guidelines developed by the Working Group on Hypercholesterolemia and Other Dyslipidemias for the management and treatment of dyslipidemias in Canada. Factors influencing risk assessment; Diagnosis of asymptomatic atherosclerosis; List of lipid-lowering medications.

In Canada, 4%-5% of non-Aboriginal preschool children suffer from iron deficiency anemia, compared with a prevalence of between 14% and 24% in First Nations and Inuit infants and children. Longitudinal studies have indicated that children who were anemic in early childhood continue to have poor cognitive and motor development and depressed school achievement into middle childhood. There are 3 interventions that if implemented successfully are likely to prevent anemia. These include dietary diversification to foods with more bioavailable iron; fortification of foods targeted to full-term infants and children; and supplementation of the individual. To prevent the development of anemia, the Canadian Paediatric Society and the American Academic of Pediatrics recommend exclusive breast-feeding for at least 4 months and the introduction of iron-containing complementary foods and foods containing ascorbic acid, which enhance iron absorption, at the age of 4-6 months.

Presents a study conducted by the Canadian Infectious Disease Society to research the epidemiology of Candidemia, bloodstream pathogens. Methods; Results; Interpretation.

States that the Canadian Society of Nephrology endorsed a policy document entitled `Principles of End Stage Renal Disease Care' (ESRD). Recommendations for management of ESRD; The potential benefits of early referral to a nephrologist for patients with elevated levels of serum creatinine; Guidelines for referral; Preparation for dialysis and transplantation.

The article reports that the Canadian Medical Association (CMA) cannot use the proceeds from its sale of MD Financial Management to set up a pension plan for its members, despite calls for such a move from some Canadian doctors. It mentions that CMA stated that lack of an employer–employee relationship means there is no legal basis for a pension plan.

The article reports on the closure of the Motherisk, a program that provides information about the safety of medications and substances during pregnancy. The Hospital for Sick Children (SickKids) cited the lack of funding as the reason for the shutdown. If offers information about a proposed service for expectant mother after the closure of the Motherisk program in Canada.

The article announces the appointment of the Ann Collins as the Canadian Medical Association's president for focusing on the health of seniors, youth and physicians.

The article focuses on the need for change in recruitment rules for physicians in New Brunswick, Canada inorder to encourage doctors to practice medicine in rural areas in the region. It talks about the New Brunswick government changing the billing and medical payment system to promote physicians to practice medicine in rural ares.

The article discusses the role of online medical technology for any physician's medical practice. It informs that online resources such as clinical reference tools, journals, medical databases and clinical practice guidelines keep one updated. Also presented is information about such resources developed by the Canadian Medical Association (CMA).

The article offers information on the Physician Office Systems Program (POSP), an electronic medical records program (EMR), in Canada. It informs that a discussion is being made by the Alberta Medical Association (AMA) with the government regarding the implementation of an EMR strategy for funding arrangements for physicians.

The article reports on the difference of medical complaint mechanisms, such as the implementation and the degree of transparency, among European countries. According to the author, European systems leave first contact in the hands of local physicians or administrators. However, the rest of the process varies from country to country like France, it involves both the national medical association and state institutions while in Denmark, the system is simpler with fewer avenues for achieving resolution.

Sexism is one of the most important issues facing the medical profession. '"[2] Using the example of a patient assuming a female physician to be a nurse, the authors suggest strategies to address sexism in the health care workplace, which they intended to be both humourous and helpful. And, as has been pointed out in some responses to the article, female physicians face many more important and ingrained manifestations of sexism within the medical profession itself and in society.[3] This article appears to make light of those problems. [Extracted from the article]

The position on the physician's responsibility for determining when cardiopulmonary resuscitation (CPR) can be withheld without consent that is set forth in the article by Downar and colleagues published in I CMAJ i [1] was adopted as Canadian Medical Association policy in 1994 (updated in 1995) in a joint statement with the Canadian Nurses Association and the Catholic Health Association of Canada, with input from the Canadian Bar Association.[2] It reads in part, "People who almost certainly will not benefit from CPR are not candidates for CPR, and it should not be presented as a treatment option." Do physicians require consent to withhold CPR that they determine to be nonbeneficial?. [Extracted from the article]

Presents views on whether contraindications to metformin therapy are warranted for certain patients with type 2 diabetes. Effectiveness in the treatment of type 2 diabetes; Background on case reports showing the occurrence of lactic acidosis among diabetic patients taking metformin; Drugs that can lower blood glucose concentrations in patients with contraindications to metformin.

Presents the recommendations of the Canadian Task Force on Preventive Health Care against the use of hormone replacement therapy for the primary prevention of myocardial infarction and death from cardiovascular disease. Potential benefits and potential adverse effects of hormone therapy; Women who are advised to avoid hormone therapy; Medical associations which offered similar recommendations.

The article offers information on resignation of the Canadian Medical Association from the World Medical Association along with an expected association of euthanasia based concerns between both medical societies with resignation. The topics addressed include details on doctor Lawrence Loh, who an adjunct professor at the Dalla Lama School of Public Health in Toronto, Canada and opinions of both societies on the topic of euthanasia.

The article announces the appointment of Gigi Osler as the president at the Canadian Medical Association (CMA).

The article reports on the concerns raised by the Ontario Medical Association (OMA) over the role of the Canadian Medical Association (CMA) as a federal advocate for physicians. OMA states that the CMA has abandoned its role and OMA will no longer enroll members for joint CMA membership. OMA president Dr. Nadia Alam explains that physicians feel betrayed because of the lack of consultation over CMA's proposed bylaw changes and decision to sell financial services company MD Financial Management.

The article discusses the plans of the Canadian Medical Association (CMA) to eliminate its General Council "Parliament of Medicine". Topics discussed include information on the Health Summit to be held in Winnipeg, Manitoba on August 20–22, 2018; the comments of Brian Brodie, chair of the CMA board of directors; and the relationship between the CMA and the provincial representative medical associations along with the information on the CMA's code of ethics.

The article focuses need to raise awareness to improve education about chronic pain and pain management and veterinary students receive more education on pain assessment. It mentions importance of early intervention in cases of acute pain and access to services such as physical therapy and psychological treatment for people with persistent pain. It also mentions rise in risk of anxiety and depression.

The article talks about the mental health of physicians and discusses whether provincial medical associations in Canada are focusing on it or not. Topics discussed include the prevalence of burnout, depression and suicide among physicians; the extended health insurance provided by the Ontario Medical Association (OMA) to physicians; and the views of Bruce Palmer, chief of member services at the OMA, on it.

A reprint of the article "Is it ever ethical for doctors to diagnose patients they haven't examined?," by Allison Motluk, which appeared on the website cmajnews.com on January 23, 2018, is presented. It discusses the importance of proper psychiatric evaluations before psychiatrists offer professional opinions about mental state of political figures such as U.S. President Donald Trump and North Korean leader Kim Jong-un.

The article reports that major medical associations in many countries are making efforts to attract young physicians. Dean West, president of Association Laboratory Inc., a consulting company for professional associations, says that choices of specialist organizations and advocacy groups for physicians have risen over the last few decades.

The article reports that medical associations in some countries have experienced modest growth as a result of physician advocacy and digital innovation. Nearly eighty percent of Canadian physicians are members of the Canadian Medical Association. Australia's national medical association has almost thirty thousand members.

Physicians who practise alternative medicine are paying close attention to the case of an Ontario physician who was found guilty of professional misconduct. The College of Physicians and Surgeons of Ontario says it is simply doing its job. [ABSTRACT FROM AUTHOR]

The article focuses on the Canadian Medical Association's (CMA) annual general council meeting held in Quebec City, Quebec, wherein panelists discussed disability insurance for medical students. Topics discussed include reasons why medical students do not obtain disability insurance, the need for medical students to be educated about their insurance choices, and the possibility of disability and sickness during medical training.