bluuebunny/crossref_metadata_2025 huggingface dataset:
Extracellular Glycosaminoglycans in Management of Primary Hepatocellular Carcinoma Rather than Alpha Fetoprotein
Authors:   Biochemistry Department, Faculty of Pharmacy, Kafrelsheikh University, Kafrelsheikh, Egypt, NM Abdel-Hamid , SM Abdel-Fattah ,   National Cancer Institute, Cairo University, Cairo, Egypt, MH Nazmy ,   Biochemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt, AS Mahmoud ,   Biochemistry Department, Faculty of Pharmacy, Minia University, Minia, Egypt
Published: February 2021

Objectives: Extracellular matrix (ECM) is an essential player at various stages of carcinogenesis. Current study aims to evaluate diagnostic value of components of ECM, released to the serum, i.e. total glycosaminoglycans (TGAGs), total sialic acid (TSA) and free glucosamine (FGA) in primary HCC patients solely or confounded by other conditions (i.e. diabetes mellitus (DM), hepatitis C virus (HCV) or bilharziasis (B). Design and Methods: Our study was conducted upon 40 HCC patients: 32 (80%) males, 8 (20%) females, among these samples, patients with ascites, single/or multiple HCC lesions, as shown in demographic Table. Results: Liver and renal indices were significantly disturbed in HCC patients. Significant elevations of AFP, TGAGS and FGA, non-significant increases in TSA in HCC patients compared to normal control. These parameters except AFP showed significant persistent higher levels during cancer progression. AFP showed irrelevant changes to the stages of HCC lesion. HCC patients with HCV, DM or B showed significantly higher levels of AFP than with HCC solely. Both TGAGs and FGA showed the highest diagnostic accuracy over AFP, but TSA showed the lowest value. Conclusion: TGAGs and FGA may be regarded as cost-effective and more accurate diagnostic tools during primary HCC progression, whether solely, or commixed by other diseases.
Medical Aspects Taken for Granted
Authors: Qayyum Mohammad Ahad , Sabri Ahmad Ayaz , Aslam Fawad
Published: February 2021

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Is There a Need for Neonatal Screening of Glucose-6-Phosphate Dehydrogenase Deficiency in Canada?
Authors: Leong Aaron
Published: February 2021

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Cheers! The Northern Quebec Experience
Authors: Mathur Mahan
Published: February 2021

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Interventional cardiology: the future beyond the coronaries
Authors: Horlick Eric
Published: February 2021

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Therapeutic cloning: promises and issues
Authors: Kfoury Charlotte
Published: February 2021

Advances in biotechnology necessitate both an understanding of scientific principles and ethical implications to be clinically applicable in medicine. In this regard, therapeutic cloning offers significant potential in regenerative medicine by circumventing immunorejection, and in the cure of genetic disorders when used in conjunction with gene therapy. Therapeutic cloning in the context of cell replacement therapy holds a huge potential for de novo organogenesis and the permanent treatment of Parkinson's disease, Duchenne muscular dystrophy, and diabetes mellitus as shown by in vivo studies. Scientific roadblocks impeding advancement in therapeutic cloning are tumorigenicity, epigenetic reprogramming, mitochondrial heteroplasmy, interspecies pathogen transfer, low oocyte availability. Therapeutic cloning is also often tied to ethical considerations concerning the source, destruction and moral status of IVF embryos based on the argument of potential. Legislative and funding issues are also addressed. Future considerations would include a distinction between therapeutic and reproductive cloning in legislative formulations.
From the Editor’s Desk: Frontiers in medicine: the McGill Journal of Medicine celebrates ten years, and insights into interventional medicine
Authors: Lawler Patrick , Miao Wenya , Williams Patrick
Published: February 2021

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Barrett's esophagitis related bronchoesophageal fistula - the diagnostic value of persistent air leak in the ventilated setting
Authors: Halaweh O , Usmani Saad Z. , Abouasaleh R
Published: February 2021

A case of acquired tracheoesophageal fistula (TEF) is presented in a 44-year-old female who presented with acute respiratory failure due to bilateral aspiration pneumonia. The patient had persistent air leak while on mechanical ventilation and underwent bronchoscopy which revealed the above etiology. Histopathology showed Barrett's esophagitis. The patient underwent primary closure followed by a short course of proton pump inhibitors. There are only two prior reported cases of acquired TEF associated with Barrett's esophagitis. This condition should be taken under consideration when investigating of an explained persistent air leak in a mechanically ventilated patient.
An aide mémoire: working on acute medical assessment units
Authors: Naqvi Naseem
Published: February 2021

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Anthropology speaks to medicine: the case HIV/AIDS in Africa
Authors: Ramin Brodie
Published: February 2021

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International perspective on mixed health care: United Kingdom
Authors: Vallance-Owen Andrew
Published: February 2021

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International perspective on mixed health care: Japan
Authors: Hamada Hisayuki , Lapalme-Remis Samuel
Published: February 2021

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A clinician’s view of public health care in Quebec
Authors: Lapalme-Remis Samuel
Published: February 2021

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Injury Severity Score (ISS) vs. ICD-derived Injury Severity Score (ICISS) in a patient population treated in a designated Hong Kong trauma centre
Authors: Wong Sydney S.N. , Leung Gilberto K.K.
Published: February 2021

Trauma and Injury Severity Score (TRISS) has been the benchmark of mortality riskin trauma centers for over 30 years. TRISS utilizes the Injury Severity Score (ISS) as an index ofanatomical injury. This study investigated the efficacy of a new type of index of anatomical injury called the ICD-derived Injury Severity Score (ICISS) compared to the ISS using a logisticregression analysis and a global chi-square test of the areas under the Receiver OperatorCharacteristic (ROC) curves. We found that the empirically derived ICISS performed as well as the consensus derived ISS with no statistical differences between their respective area under the ROC curves.
Blood substitutes- the polyheme trials
Authors: Apte Sameer S
Published: February 2021

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The Potential Perils of Informed Consent
Authors: Loftus Elizabeth F. , Fries James F.
Published: February 2021

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The Correlation between Phalangeal Quantitative Ultrasonography and Dual Energy X-ray Absorptiometry in Women with Premature Ovarian Failure
Authors: Mann Tandip , McGregor Alison , Patel Rajesh
Published: February 2021

Objectives –With the growing demand for bone densitometry services there is a need for simple, cost-effective and ideally mobile devices which can identify individuals who are at risk of osteoporotic fracture. When new devices are evaluated, it is useful to examine the correlation with the established ‘gold standard’ technique of dual x-ray absorptiometry (DXA). This study examined the correlation between quantitative ultrasound (QUS) measurements performed at the phalanges and conventional DXA measurements of the spine and hip in women with premature ovarian failure – a known risk factor for osteoporosis. Methods - Thirteen white Caucasian women suffering from premature ovarian failure and 19 age- and sex-matched controls were recruited into the study. DXA measurements were performed at the spine and hip, followed by quantitative ultrasonography at phalanges II-V of the non-dominant hand. Results – Significant correlations were observed between the bone transit time (BTT) value from the Bone Profiler and bone mineral density measured at the spine (r=0.66). The spine Z-scores also correlated with many of the ultrasound values (r=0.44 - 0.63). Significant inverse correlations were observed between BMI, weight and ultrasound parameters (r = -0.48 to -0.78). Conclusion – We have reported moderate but significant correlations between phalangeal QUS and DXA parameters. The strongest correlation was observed between BTT and spine BMD, as well as between the Z-scores from the two devices. QUS parameters also demonstrated an inverse correlation with weight and BMI.
A Case Of Atypical Gastric Carcinoma With Osteoclast Like Giant Cells
Authors: Pandit Rahul , Danilova Irina
Published: February 2021

Out of all the different types of neoplasms affecting the stomach, gastric carcinomas with Osteoclast-like Giant Cells (OGC) is one of the most uncommon. Although OGC are typically found in osseous neoplasms and tumors of the tendon sheath, few cases of extra-skeletal neoplasms with OGC have been documented. These typically involve organs such as the pancreas, gall-bladder, kidney, and breast. Even though the role of OGC in histogenesis of such tumors still remains unclear, their presence in extra-osseous neoplasms may indicate a certain level of immune reaction of the host towards the neoplastic transformation of normal tissue. We report a case of a 70-year-old Caucasian female hospitalized for evaluation of epigastric pain. Further examinations including endoscopy and biopsy of the stomach revealed gastric adenocarcinoma with OGC. This report also provides a brief insight into the possible immune reaction in such neoplasms
Placebo: Feeling Better, Getting Better, and the Problems of Mind and Body
Authors: Kihlstrom John F.
Published: February 2021

Over its history, medicine has vacillated between acknowledging placebo effects as important and trying to overcome them. Placebos are controversial, in part, because they appear to challenge a biocentric view of the scientific basis of medical practice. At the very least, research should distinguish between the effects of placebos on subjective and objective endpoints. Theoretically, placebos are of interest because they underscore the other side of the mind-body problem: how mental states can affect physical conditions.
Managing the Psychology of Health Care: What it means and what it is worth
Authors: Shahin Ilan
Published: February 2021

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A McGill Update of Osler’s Bedside Books List
Authors: Liveanu Andrei
Published: February 2021

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Total revision of the hip using allograft to correct particle disease induced osteolysis: A case study
Authors: Taylor Drew W , Taylor Jennifer E. , Raizman Igal , Gross Allan E.
Published: February 2021

ABSTRACT: Total hip replacement is considered to be a highly successful and routine surgery; however, the internal components produce particles through friction and wear in the device. These particles are identified as one of the main reasons for total hip revisions. The generated, biologically active, particles provoke the formation of osteolytic areas through the inhibition of bone formation and increased fluid production. The resulting bone loss can be managed through the use of allograft bone in combination with bone chips and cement. In addition, implants constructed with highly porous trabecular metal can be used to further facilitate rapid and extensive tissue infiltration resulting in strong implant attachment. In this case study we show the use of a tibial allograft coupled with bone chips and cement to cover and support a lytic cyst in the proximal femur, distal to the greater trochanter. Additionally, we detail the use of a trabecular metal cup to halt the migration of the component into the acetabulum and promote greater fixation and bone ingrowth.
Suppressive valacyclovir therapy to reduce genital herpes transmission: Good public health policy?
Authors: Bonnar Paul E
Published: February 2021

Genital herpes is a widespread sexually transmitted infection caused by the herpes simplex viruses (HSV). Suppressive valacyclovir therapy has been shown to significantly reduce HSV transmission. The benefits and costs of using valacyclovir to reduce transmission in couples discordant for genital herpes will be analyzed in order to better inform decision-making. By reducing transmission, the physical and psychological harms of living with symptomatic genital herpes will be prevented while saving on certain healthcare costs. However, the large number needed to treat and the low symptomatic rate among infected individuals may outweigh these benefits. The costs of trying to achieve a significant reduction in incidence include the psychological harms of identifying asymptomatic individuals through a large screening program and the economic costs of the antiviral agent and screening. When these issues are weighed, the high economic costs render a program to reduce incidence unfeasible. Nevertheless, it is clinically important to consider the consequences of transmission at an individual level. The specific circumstances that influence the decision to use suppressive therapy are identified.
Disseminated Coccidioidomycosis with Clinically Evident Splenomegaly in an Immunocompetent Host, First Case Reported in the literature
Authors: Bird Garrett R , Libke Robert D , Billelo John F , Parks Nancy A , Pollard John S
Published: February 2021

Coccidioidomycosis is a dimorphic fungus endemic to the southwestern United States, Central and South America. We report a case of a previously healthy person who presented with respiratory failure and disseminated Coccidioidomycosis who eventually had a fatal outcome. Coccidioidomycosis, or “Valley Fever” has been called the “great imitator” (1) as it can have a wide variety of clinical presentations. This case is unique as it represents the first described case of an immunocompetent host with rapidly progressing, disseminated coccidioidomycosis with clinically apparent splenomegaly and hepatomegaly.
Pancreatic β-Cell Mass as a Pharmacologic Target in Diabetes
Authors: Hanley Stephen
Published: February 2021

While the prevalence of maternal While the prevalence of diabetes mellitus reaches epidemic proportions, most available treatments still focus on the symptoms of the disease, rather than the underlying pathology. Types 1 and 2 diabetes have in common a deficit in β-cell mass. In type 1 diabetes, auto-immune β-cell destruction leads to an absolute deficit in β-cells, while in type 2 diabetes, insulin resistance and β-cell dysfunction cause a functional deficit. More recently, however, it has been suggested that type 2 diabetes is also marked by an absolute deficit in β-cell mass, although a causal relationship has not yet been established. Overall β-cell mass reflects the balance between the dynamic processes of β-cell expansion, through proliferation and neogenesis, and β-cell loss via apoptosis. Given that β-cell mass can be modified significantly by altering the rate of any of these mechanisms, therapies that modulate β-cell expansion and loss have garnered recent interest. We review herein the current therapeutics under investigation as modulators of β-cell mass dynamics, and the basic research that supports these novel therapeutic targets.
Book Review: The Brain Atlas: A Visual Guide to the Human Central Nervous System
Authors: Lapalme-Remis Samuel
Published: February 2021

3rd ed. Thomas A. Woolsey, Joseph Hanaway, Mokhtar H. Gado.
Trauma in Tanzania: Researching Injury in a Low-Resource Setting
Authors: Mukhopadhyay Baijayanta , Boniface Respicious , Razak Tarek
Published: February 2021

The prevalence of surgical trauma as a global public health hazard has been severely neglected. Trauma surgeons in Uganda and Canada have developed the Kampala Trauma Score (KTS), a trauma severity index specific to east African contexts. Hospitals in Tanzania have begun to use this tool to measure their own trauma management protocols in order to measure the validity of this index regionally. This study sought to enhance analysis of data collected through the KTS, by highlighting the efficacy and the lacunae of this registry through evaluation of the data quality of one ongoing round of data collection at an orthopaedic emergency room in Dar es Salaam, Tanzania. The data was screened for missing values that would have impact on prediction of clinical evolution and also analysed for contradictory evidence. Interviews were conducted with data collectors on the main challenges involved in data gathering and analysis for this project. Analysis of the initial round of data collection confirms road accidents cause the most trauma in Dar es Salaam, with pedestrians being particularly  vulnerable. However, critical sources of information such as serious injury scores and two-week follow- up were inconsistently recorded, thereby limiting outcome measurement. The lack of research  resources, both financial and human, had a major impact on the ability to sustain the data collection. While the results of this study demonstrate the public health value of having a mechanism to record trauma, research capacity must be supported in low-resource settings in order to enhance clinical care to accident and injury patients.
Sensory Characteristics in ASD
Authors: Stewart Mary E , Russo Natalie , Banks Jennifer , Miller Louisa , Burack Jacob A
Published: February 2021

In this paper, we review evidence regarding differences in the types of sensory experiences  of persons with ASD with respect to both unisensory and multisensory processing. We discuss self- reports, carer questionnaires as well as perceptual processing differences found in the laboratory.  Incoming information is processed through one or more of our senses and fundamental differences in the processing of information from any sensory modality or combination of sensory modalities are likely to have cascading effects on the way individuals with ASD experience the world around them, effects that can have both positive and negative impact on a individual with ASD’s quality of life.
America College of Physicians, Internal Medicine Conference 2010
Authors: Kitchlu Abhijat
Published: February 2021

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Severe emphysematous cystitis: Outcome after seven days of antibiotics
Authors: Sereno Maria , Gomez-Raposo Cesar , Gutierrez-Gutierrez Gerardo , Lopez-Gomez Miriam , Casado Enrique
Published: February 2021

We present the case of a 70-year-old woman with emphysematous cys- titis. She was a diabetic patient and she was on chemotherapy treatment for a breast  cancer. She complaint of severe asthenia and pain in her right lower extremity, but no fever or urinary symptoms. A computed tomography (CT) scan was suggestive of severe emphysematous cystitis. Emphysematous cystitis is a rare clinically entity, more commonly seen in diabetic, immunocompromised patients. A conservative  treatment approach using antibiotics and bladder catheterization is typically suc- cessful, with a complication rate less than 20%.
Engineering Alloplastic Temporomandibular Joint Replacements
Authors: Sinno Hani , Tahiri Youssef , Gilardino Mirko , Bobyn Dennis
Published: February 2021

Temporomandibular disorders (TMd) are part of a heterogeneous group of pathologies that manifest with a constellation of signs and symptoms. They are the most frequent cause of chronic orofacial pain and are prevalent in 12% of the general population. despite the debilitating nature of these disorders, there is no standardization for treatment of the diseased temporomandibular joint (TMJ). In this  review, we present an overview of the functional anatomy of the TMJ and the engi- neering concepts that must be understood to better understand the indications for  surgical management, the types of available treatments and the requirements for reconstruction. A comparison is made of the clinical outcomes with autogenous versus alloplastic reconstruction, including a history of alloplastic materials and the design features of currently available implants. Emphasis is made on material selection, modulus, stiffness, notch sensitivity and modularity. for the treatment of TMd, engineered TMJ alloplastic replacements have had considerable promise with additional room for improvement using new materials and recent design concepts.
An Examination of the factors Contributing to Poor Communication Outside the Physician-Patient Sphere
Authors: Taran Shaurya
Published: February 2021

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Kienbock’s disease and juvenile idiopathic arthritis
Authors: Desy Nicholas M , Bernstein Mitchell , Harvey Edward J , Hazel Elizabeth
Published: February 2021

Kienbock’s disease or osteonecrosis of the lunate is an uncommon cause of wrist pain. Though there have been several reports of cases in patients with various rheumatologic diseases, the precise etiology has currently not been established. We report a case of Kienbock’s disease that occurred in a patient with juvenile idiopathic arthritis. To our knowledge, this is the first case report with an association between these two conditions.
Medical Education for Exploration Class Missions: NASA Aerospace Medicine Elective at the Kennedy Space Centre
Authors: Stewart Gregory E , Drudi Laura
Published: February 2021

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Human Space Exploration: The Next Fifty Years
Authors: Williams David R , Turnock Matthew
Published: February 2021

Preparation for the fftieth anniversary of human spacefight in the spring of 2011 provides the space faring nations with an opportunity to refect on past achievements as well as consider the next fifty years of human spacefight. The International Space Station is a unique platform for long duration life science research that will play a critical role in preparing for future human space exploration beyond low earth orbit. Some feel the future path back to the Moon and on to Mars may be delayed with the current commitment of the united States to support the development of human-rated commercial spacecraft. others see this as a unique opportunity to leverage the capability of the private sector in expanding access to  space exploration. This article provides an overview of the past achievements in hu- man spacefight and discusses future missions over the next ffty years and the role  space medicine will play in extending the time-distance constant of human space exploration.
Privatization in Canada? Not Yet
Authors: Bozzo Anthony
Published: February 2021

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When can you conclude death?
Authors: Watts Evan
Published: February 2021

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Immunization programs: The Role of Pharmacists in British Columbia, Canada
Authors: Fletcher Alexandra , Marra Fawziah , Bartlett Gillian , Kaczorowski Janusz
Published: February 2021

PURPOSE: In 2009, pharmacists in British Columbia were given the right to become certified in vaccine-administration. While the uptake of this new activity was impressive, there is still a need to better understand current and expected involvement of pharmacists in immunization activities. Our objective was to identify pharmacist and pharmacy characteristics associated with being certified to immunize. METHODS: The cover letter and web-link to a 42-item survey was emailed to British Columbia Pharmacy Association (BCPhA) registered pharmacists. Consent was provided electronically. Respondents’ demographic and practice site characteristics were summarized with descriptive statistics. Multivariate logistic regression was used to examine pharmacist and pharmacy characteristics associated with being certified to administer. FINDINGS: The current analysis was restricted to community pharmacists (n=551) of the 663 pharmacists who responded. Overall, 71.3% (393/551) of respondents were certified to administer. The most commonly provided vaccine was influenza (464 [84.4%]). The majority (445[80.8%]) were also interested in administering non-vaccine injectables. Pharmacists who had been in practice for fewer years were more likely to be certified. Job position was related to certification; both managers and owners were more likely than staff to be certified. With respect to pharmacy type, chain and foodstore pharmacies were both more likely than independent pharmacies to employ certified pharmacists. CONCLUSION: The majority of community pharmacists are involved in immunizations and this involvement is associated with specific pharmacist and pharmacy characteristics. This information can be used to better encourage more pharmacists to become immunizers. KEYWORDS: Pharmacists, vaccination, primary prevention, community health services.
Letter from the Editors
Authors: Sterling Lee , La Selva Rachel , Shao Shawn (Zhuo)
Published: February 2021

To our readers, We are immensely proud to present this special issue of the McGill Journal of Medicine (MJM) focused on primary care in Quebec. In recent years the healthcare system in Quebec has gone through massive shifts, many of which have been focused on the role of family physicians and the organization of primary care within the province. These changes reflect a new understanding of the key importance of the previously ignored entry point into our advanced and increasingly complicated healthcare system.In this issue we have sought to bring together diverse perspectives in the ongoing conversation regarding the future of primary care in Quebec. We are proud to present reviews, editorials, original research, artwork and reflections from authors including Dr. Howard Bergman, the Chair of the Department of Family Medicine at McGill, as well as medical and nursing students. A special thank you to Dr. Gillian Bartlett-Esquilant, the Research and Graduate Program Director for the Department of Family Medicine, and Dr. Charo Rodriguez, Director of the McGill Family Medicine Educational Research Group, for contributing an editorial highlighting the importance of primary care research. The above editorials are only a subset of the many other fascinating pieces we are proud to publish in this Issue.This special issue would not have been possible without the incredible effort of the MJM 2016-2017 editorial team. Our editors, section editors, and web developers have worked incredibly hard to bring this project to fruition. As the MJM begins a third year after relaunching in 2015, we hope this Issue stands as a testament to its bright future. We hope you enjoy reading this issue, we have certainly enjoyed putting it together.Best, Lee H. Sterling, Editor-in-Chief, 2017-2018 Rachel La Selva and Shawn Zhuo, Editors-in-Chief, 2016-2017
A Reflection on Longitudinal Family Medicine
Authors: Smith Alyssa , Shum Lucy , Johnson Burnett
Published: February 2021

During their first year of medical school McGill students take part in the Longitudinal Family Medicine Experience program. This unique program pairs each student with a practicing family medicine physician across the island of Montreal and allows students to shadow and experience firsthand a primary care practice. Throughout approximately a dozen half-day sessions during their first year, students are exposed to the entire spectrum of family medicine practices; in the emergency department, Centres locaux de services communautaires (CLSCs), labour and delivery rooms, home visits and refugee clinics. This unique, integrated program was designed in tandem with McGill medical school’s new curriculum to allow early exposure to the depth and breadth of community practice and family medicine.Each year as they complete their LFME sessions students complete a reflective essay looking back on their experiences and highlighting personal learning points. Below are three examples of these essays which have been chosen to highlight the diverse nature of family medicine.
Did I do no harm? The Physician as Healer: Physician Perspective
Authors: Bastrash Marie-Pier
Published: February 2021

A reflective essay based on a true patient interaction during Marie-Pier's Third Year Pediatrics rotation. Through the narrative, she explores the concept of non-maleficence, doubt, guilt and responsability in patient outcomes. Physicians aim to Do No Harm, but is that ever possible?
Canada versus the World: The Validity and Usefulness of Ranking Healthcare Systems by Country
Authors: Cartman Gabriel
Published: February 2021

Various organizations have attempted to formally evaluate and compare the performance of national healthcare systems. In this commentary, I argue that fundamental methodological issues annul many of their conclusions, and question the usefulness and implications of such rankings, before suggesting possible alternatives.
Neurotized latissimus dorsi flap: functional lower limb coverage in subacute trauma reconstruction
Authors: Kvann Julie Chakriya , Thibaudeau Stephanie , Azzi Alain Joe , Zadeh Teanoosh
Published: February 2021

AbstractIn the reconstruction of the mangled lower extremity, muscle flaps are well known for their reliable use in soft tissue coverage, however very few reports document their functional reconstruction potential as neurotized muscle flaps. This case illustrates that free neurotized latissimus dorsi flaps are a good option for long-term functional reconstruction in the mangled lower extremity. Our report is the first case in the literature to date describing a subacute reconstruction with a functional latissimus dorsi in lower extremity trauma.
Impact of a family medicine-based transitional care intervention on readmission and length of stay: a pilot study
Authors: Arsenault-Lapierre Genevieve , Kremer Bernardo , Sourial Nadia , Gagnon Justin , Ladores Mina , Vedel Isabelle
Published: February 2021

Transitional care interventions, often led by hospital specialists, have mixed impact on reducing readmissions. Interventions led by family physicians may be more promising. The objective of this study was to evaluate the impact of a family-medicine-based intervention in reducing the incidence of emergency department (ED) visits, hospital readmissions and the length of stay (LOS) of older patients. A quasi-experimental pilot-study was conducted at a Family Medicine Group (FMG) in Montreal. Thirty-five patients discharged from the FMG-affiliated hospital between July 2014-2015 were compared to 68 historical controls discharged from the same hospital one year prior. Inclusion criteria were: 65+ years, rostered at FMG, high-risk of readmission; and discharged to home/senior residence. Patients’ charts were reviewed to determine a composite outcome of all-cause rates of acute hospital use (ED visit/hospital readmissions) and LOS at 30, 60, 90 and 180-days post-discharge. We found no statistically significant differences in acute hospital use rates between groups. LOS was statistically significantly shorter at 90- and 180-days for patients compared to controls: Incidence Rate Ratio (95% Confidence Interval) at 90-days: 0.66 (0.64-0.69) and at 180-days: 0.49 (0.43-0.55). Our study provides support to the impact of a family-medicine-based transitional care intervention in reducing the LOS of vulnerable older patients readmitted to hospital.
The role of probiotics in inhibition mechanism of methicillin-resistant staphylococcus aureus
Authors: Abbasi Mahsa , Dolatabadi Samaneh , Ghorbannezhad Ghazaleh , Sharifi Fatemeh , Rahimi Hamid Reza
Published: February 2021

ABSTRACTMethicillin-resistant Staphylococcus aureus (MRSA) is a hospital-acquired pathogen with high prevalence across the globe. It raises a serious health concern due to its resistance to antibiotic agents, in particular, β-lactam, carbapenem, and penem. This pathogen causes various medical conditions, namely endocarditis, osteomyelitis, pneumonia, toxic shock syndrome (TSS), and food poisoning. Strains of lactic acid bacteria (LAB) such as Lactobacillus sp. and Bifidobacterium sp. inhibit pathogenic bacteria through competition for nutrients and adhesion sites, production of antimicrobial substances, and enhancement of immune system. The present hypothesis describes that these probiotics prevent the growth of MRSA by producing inhibitory agents like bacteriocin, lactic acid, acetic acid, propionic acid, hydrogen peroxide, and the intestinal pH reduction. Given an increasing resistance to antibiotics and its adverse effects, the use of other alternatives seems necessary. These beneficial bacteria and their metabolites which are available in the market as tablets, capsules, and powders can widely establish control over the growth of MRSA.
Women in Medicine: Dr. May Cohen, aka “The Gender Lady”
Authors: El Jaouhari Sara
Published: February 2021

Some of the greatest strides seen in Canadian women’s health and in gender equity in medicine can be attributed to Dr. May Cohen: an unyielding activist who dedicated her life’s work to advocacy. From spearheading the development of the first Women’s Health Office at McMaster University to serving as President of the Federation of Medical Women in Canada, her career is a testament to what can be achieved with a strong social conscience and unwavering determination.
Women in Medicine: Dr. Liane Feldman
Authors: Penta Ruxandra , Babinski Melanie
Published: February 2021

Dr. Liane Feldman (MDCM, FACS, FRCS) has been making waves in the world of surgery through her accomplishments, innovative research and mentorship for over 30 years. From her beginnings in the Cognitive Science department at Brown University to her current position as Edward W. Archibald Professor, Dr. Feldman discusses her path to becoming the first woman Surgeon-In-Chief of the MUHC.
Evaluating Uncertainty in Dengue Seroprevalence in the Absence of a Gold Standard Diagnostic Test
Authors: Baker Tess , Wolfson David B.
Published: February 2021

Background: Shortly after the introduction of the first licensed vaccine against dengue fever (Dengvaxia), a serious outcome was attributed to the vaccine: vaccinated individuals without a previous dengue infection were at increased risk of developing severe dengue if subsequently infected by a heterologous serotype. In response, the World Health Organization recommended vaccination in regions where the seroprevalence of dengue is at least 50% and, ideally, greater than 70%. Hence, accurate estimates of regional seroprevalence are crucial for both population vaccination strategies and test-then-vaccinate decisions at the individual level. Currently, estimates of seroprevalence are based on surveys, using screening tests for previous dengue exposure. These estimates must consider the sensitivity and specificity of the tests, which depend on identification of those who have been exposed, ostensibly through a test, regarded as the gold standard. There is, however, no easily accessible gold standard test for dengue.

Methods: We propose an approach to estimate the seroprevalence of dengue that does not require a gold standard test by modeling: (i) the uncertainty in the sensitivity and specificity, and (ii) the uncertainty in the “true” disease prevalence.

Results: Through simulations, we demonstrate the effect of these extra sources of uncertainty on post-test estimates of dengue seroprevalence. Our simulations show, for example, that in a population of 1 million it is possible to overestimate or underestimate the number who are truly seropositive by as much as 76,000.

Conclusions: Current estimates can substantially overestimate or underestimate the true probability of previous exposure when these extra sources of variability are not accounted for.
A Brief History of the McGill Faculty of Medicine
Authors: M.W. Leong Renata
Published: February 2021

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From Notion to Reality: The Creation of a New Student Medical Journal
Authors: E. Lim Jonathan
Published: February 2021

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Commentary on MJM Focus (Vol. 1, No. 2): Surgery for Temporal Lobe Epilepsy
Authors: Black Peter
Published: February 2021

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Elucidating Angiogenesis: The Role of Basement Membrane Proteolysis and Endothelial Cell Motility and Proliferation
Authors: Goldenberg Neil
Published: February 2021

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Atypical Presentation and Intraoperative Complication in a Case of Aortic Dissection
Authors: Ma Felix , Morin JF
Published: February 2021

A 68-year-old man, ex-smoker, with a history of hypertension, hypercholesterolemia, and intermittentclaudication secondary to severe aorto-iliac occlusive disease, was evaluated by a cardiologist for exertionalright-shoulder pain of one year's duration. The pain would typically last approximately five minutes andresolve with cessation of activity. He experienced no similar episodes at rest. There was no retrosternal chestpain, shortness of breath, orthopnea, paroxysmal nocturnal dyspnea, palpitations, transient ischemic attacks,syncope, or pre-syncope. His medications included Norvasc, Prinivil, Novoflupam, Nitrospray, Novo-Timol,Pravacho, Entrophen, and Tylenol. Family history was positive for coronary artery disease.

On physical examination, the patient was in no apparent distress with a blood pressure of 160/80 in both armsand a regular pulse of 70. There was a left carotid bruit. Femoral pulses were nearly absent bilaterally. Heartsounds were normal, with no murmurs, and there were no signs of heart failure. EKG showed normal sinusrhythm and no evidence of ischemia or previous infarction. However, thallium scan revealed a fixed deficit inthe inferior wall territory.
Educating Tomorrow's Cardiac and Thoracic Surgeons in Canada: An Evolving Process
Authors: Mulder David S.
Published: February 2021

Societal (1), technological, organizational (2), and educational developments during the past ten years havebrought about increasing pressures for change in the graduate medical education of cardiac and thoracicsurgeons (3). These changes effectively lengthened their training to eight years and created a double standardfor the education of a thoracic surgeon. A task force mandated by the Royal College of Physicians andSurgeons of Canada nucleus committees in both cardiac and thoracic surgery, with the support of theCanadian Society of Cardiovascular and Thoracic Surgeons, addressed these issues and made the followingrecommendations: cardiac surgery and thoracic surgery should each become a primary specialty with its ownnucleus committee. Each specialty would require six years of training, with the possibility of obtainingcertification in both specialties after an additional eighteen months of training. Each specialty could also beentered after the completion of full training in general surgery. In addition, the task force urged thedevelopment of a curriculum to guide educational objectives in each specialty. These changes promise tocreate a flexible, shorter, and more focused program for cardiac and thoracic surgeons in both university andcommunity settings.
Cardiac Doppler Flow Velocities in Fetuses of Well- Controlled Insulin-Dependent Diabetic Mothers
Authors: Plourde Gilles
Published: February 2021

The advent of Doppler echocardiography has permitted noninvasive examination of the fetal heart. In this study, computer-assisted cardiac Doppler flow velocity waveform (DFVW) analysis was used to determine whether diastolic dysfunction is manifest in the fetuses of diabetic mothers. Diastolic atrioventricular (AV) valve flow was measured in the fetuses of 40 women with well-controlled insulin-dependent diabetes mellitus (IDDM) at 18 to 22 weeks (timepoint A) and 30 to 35 weeks (timepoint B) gestation. These subjects were compared to 40 age-matched pregnant non-diabetic controls, and their maternal glycosylated hemoglobin HbA1c fractions (%) were measured to gauge the adequacy of glycemic control. HbA1c fractions showed no statistically significant difference between timepoints A and B (4.85 ± 0.2% and 5.16 ± 0.3%, respectively), and demonstrated a well-controlled diabetic state.At timepoint A, the peak velocity of rapid ventricular filling [E (cm/s)] through both AV valves, the peak velocity of atrial contraction [A (cm/s)] through the tricuspid valve, and the flow integral measurement for atrial contraction [AI (cm)] through the tricuspid valve were significantly (p < 0.05) higher than those measured in the controls. Peak velocities of atrial contraction and rapid ventricular filling (A and E, respectively) for both valves, as well as the flow integral of rapid ventricular filling (EI) for the tricuspid valve, were significantly (p < 0.05) higher in fetuses of diabetic mothers at timepoint B than in controls. Overall, despite the fact that both IDDM and non-diabetic mothers showed significant (p < 0.05) fetal increases in rapid ventricular filling (E) between the two timepoints, the ratios E/A and EI/AI for both valves were not modified in the two study groups at either gestational age. These results therefore substantiate rare previous findings that only peak velocity of rapid ventricular filling (E) is increased, despite expected changes in E/A and EI/AI ratios, with gestational age. Furthermore, the results of the present study suggest that fetal diastolic function is not adversely affected in well-controlled maternal IDDM.
Evidence for a Novel Key Regulatory Step in the Triglyceride Synthetic Pathway of Human Adipose Tissue
Authors: Baldo Allain , Dardano Nicholas , Sniderman Allan , Cianflone Katherine
Published: February 2021

The triglyceride (TG) synthetic pathway is believed to be regulated at the level of the rate-limiting enzyme acyl-CoA:1,2-diacylglycerol O-acyltransferase (DGAT). Recent reports using rat hepatic tissue suggest a kinase-dependent mechanism for the regulation of DGAT activity. To examine this process further, the present study investigates the regulatory mechanisms involved in the modulation of DGAT in human adipocytes. Adipocytes were fractionated into a microsomal fraction containing DGAT and a cytosolic fraction containing a putative regulatory kinase. DGAT activity was determined bymeasuring the incorporation of 14C-oleoyl-CoA into TG with exogenously supplied 1,2-dioleoyl-sn-glycerol. Kinase activity was assayed by addition of the cytosolic fraction in the presence of Mg2+ and ATP. The results indicate a significant inhibition of human adipose tissue DGAT activity by as much as 43% (avg: 17.5% ± 10.4%, p < 0.01) via a mechanism consistent with a phosphorylation event. Partial purification of the putative cytosolic kinase was achieved by multidimensional chromatography. This study thus provides evidence for a novel and key regulatory step in the human TG biosynthetic pathway. Further research is necessary to determine whether the model outlined here is a physiologic conduit through which extracellular hormones exert a regulatory influence on TG synthesis.
Reversible Neonatal Cholestasis Following In Utero Exposure to Valproic Acid
Authors: Chang Douglas G , Stein Martin , Sine David , Yeung David , Mannino Frank
Published: February 2021

Valproic acid (VPA) is a branched-chain carboxylic acid with broad anticonvulsant activity. Its spectrum of activity is thought to be mediated by combined molecular effects on intercellular Na+ currents, neuron K+ channels, and inhibition of gamma-aminobutyric acid (GABA) transaminase (1,2). VPA is metabolized in the liver by cytochrome P-450 oxidase. Hepatotoxicity related to valproate therapy has been reported in certain individuals and appears to be caused by the accumulation of toxic metabolites, which may include 4-en-valproate (3). The hepatotoxicity has been ascribed to an inherited or acquired deficiency in the cytochrome P-450 enzyme-dependent beta-oxidation pathway, and is inducible by other drugs such as phenobarbital or phenytoin (4). Fatal hepatic failure can result, with a disproportionately large number of such cases observed in patients less than two years old with neurologic abnormalities, severe seizures, and multiple anti-epileptic drug therapy (3,5,6,7). However, neonatal hepatic toxicity in humans coincident with intrauterine VPA exposure has rarely been reported (8,9,10); these cases were never reversible, andconfounding etiologic variables could not be excluded. In pregnancy, VPA readily crosses the placenta and accumulates with fetal blood concentrations greater than those in the mother (11). It is a known human teratogen primarily associated with neural tube developmental defects such as spina bifida. A specific "fetal valproate syndrome," marked by fetal growth deficiency, developmental delay, and an increased incidence of craniofacial, cardiovascular, and digital abnormalities, has also been reported (1,3,12,13,14). Furthermore, a dose-dependent relationship in the occurrence of major malformations and minor anomalies has been suggested (15). Major malformations reported include persistent patent ductus arteriosus, trigonocephaly, aplasia of the first ribs, dysplasia of the sternum, meningomyelocele, aplasia of the radius, and congenital hip dislocation. Minor malformations included brachycephaly, dysmorphic facial features, long thin fingers, and inverted or accessory nipples. The teratogenic potential is thought to be mediated by a secondary zinc deficiency induced by complexing with VPA (16), as well as by inhibition of microsomal epoxide hydrolase (17), which may enhance the teratogenic potential of concomitant anticonvulsant therapy. Numerous animal models have been developed for the study of VPA. VPA has been shown to have equal teratogenic potential as trimethadione in mice (18). Skeletal abnormalities, delayed parturition, and postnatal growth (5) have been reported in both mice and rats receiving VPA. In addition, Paulson and Paulson (19) noted defects of the palate, eyes, heart, and limb buds in animal models. Animal models for a VPA-associated cholestasis, however, are lacking.
Health Care Access and Utilization by Homeless Adolescents in New York City
Authors: Irwig Michael S.
Published: February 2021

To date, little data has been collected from homeless adolescents regarding their access to, and utilization of, health care. In this study, 68 adolescents aged 16-25 were interviewed after being randomly selected from among those who came to a drop-in center for homeless youth in New York City in July 1996. The interviews followed a standardized questionnaire designed to collect demographic information as well as to assess past and current use of medical services. Prior to homelessness, 68% of subjects had been utilizing medical services on a regular basis, and the principal sources of care were as follows: hospital clinics, 51%; community health centers, 33%; and private physician offices, 22% (with more than one facility utilized in some cases). By contrast, 90% of participants reported having received care during homelessness, 68% of whom obtained regular health care at shelters, 32% at drop-in centers, and 25% at hospital clinics. Despite the fact that 42.4% of the sample was covered by health insurance at the time of interview, only 10% of subjects reported having ever been denied health care at any facility visited. Taken together, these findings suggest that, in the population studied, an increase in the percentage of adolescents regularly utilizing medical services occurs upon homelessness, coincident with a shift in utilization from hospital clinics and community health centers to shelters and drop-in centers. These results clearly warrant further study on the access and utilization of health care by homeless adolescents. If substantiated, the present findings call fo renewed efforts toward optimizing health care delivery to homeless adolescents at shelters, drop-in-centers, and other such facilities where these individuals utilize medical resources most frequently.
Advances in Cancer Gene Therapy
Authors: Yu Ming
Published: February 2021

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