bluuebunny/crossref_metadata_2025 huggingface dataset:
PENGARUH EKSTRAK BAWANG PUTIH (Allium Sativum L) TERHADAP PERBAIKAN PROFIL LIPID PADA Rattus norvegicus strain wistar HIPERKOLESTEROLEMIA
Authors: Rinjani Pramitasari Mustika , Riana Ruby , Bahrudin Moch
Published: July 2018

PENGARUH EKSTRAK BAWANG PUTIH (Allium Sativum L) TERHADAP PERBAIKAN PROFIL LIPID PADA Rattus norvegicus strain wistar HIPERKOLESTEROLEMIA. Latar belakang: Hiperkolesterolemia merupakan salah satu faktor resiko PJK dan stroke. Bawang Putih (Allium Sativum L) merupakan bahan alam yang mengandung berbagai senyawa yang memiliki bermacam- macam fungsi, dan kandungan terbesar adalah Allicin. Allicinmempunyai efek cukup poten dalam penurunan kolesterol darah. Bawang Putih (Allium Sativum L) dapat mempengaruhikolesterol dengan menghambat pembentukan kolesterol. Tujuan: Untuk mengetahui pengaruh ekstrak bawang putih(Allium Sativum L) terhadap perbaikan profil lipid darah pada tikus putih (Rattus norvegicus strain wistar) hiperkolesterolemia. Metode & Sampel: Penelitian eksperimental ini dilakukan dengan rancangan post test only radomized control group design. Sampel penelitian dibagi menjadi lima kelompok. Kelompok pertama sebagai kontrol negatif, kelompok dua sebagai kontrol positif dan tiga kelompok lainnya diberikan bawang putih dengan berbagai dosis : 0,05 g/ekor/hari, 0,1 g/ekor/ hari dan 0,2 g/ekor/hari. Hasil & Pembahasan: Dari penelitian ini didapatkan bawang putih menyebabkan penurunanyang bermakna pada kadar kolesterol total, LDL, TG, rasio  LDL/HDL, serta rasio KT/HDL (sig = 0,000). Dosis 0,2 g/ekor mampu menurunkan kolesterol hampir mencapai normal.  Kesimpulan: Bawang putih dapat memperbaiki profil lipiddan pada dosis 0,2 g dapat memperbaiki profil lipid paling besar.
PENGARUH PEMBERIAN AIR SEDUHAN DAUN SIRIH (Piper betle L.) TERHADAP PERBAIKAN HISTOLOGI HEPATOSIT TIKUS PUTIH STRAIN WISTAR (Rattus novergicus strain wistar) YANG TELAH DIINDUKSI PARASETAMOL
Authors: Aisyah Nur , Setiawan Meddy , Aleq Sander Moch
Published: July 2018

PENGARUH PEMBERIAN AIR SEDUHAN DAUN SIRIH (Piper betle L.) TERHADAP PERBAIKAN HISTOLOGI HEPATOSIT TIKUS PUTIH STRAIN WISTAR (Rattus novergicus strain wistar) YANG TELAHDIINDUKSI PARASETAMOL. Parasetamol dapat merusak hepatosit oleh hasil metabolismenya yang reaktif berupa Nasetil- p-benzokuinone imine (NAPQI) dan ion superoksida. Daun sirih diduga dapat memperbaiki kerusakan hepatositkarena mengandung minyak atsiri yang mempunyai aktivitas antioksidan. Tujuan: Membuktikan pengaruh pemberian airseduhan daun sirih terhadap perbaikan histologi hepatosit tikus putih strain wistar yang telah diinduksi parasetamol. Metode penelitian: True Experimental post test only control Design. Dua puluh lima tikus putih strain wistar dengan berat badan masing-masing 150 gram dibagi menjadi 5 kelompok perlakuan. Masing-masing kelompok diberi 375 mg parasetamol peroral selama 4 hari. Tiga kelompok diberi air seduhan daun sirih peroral dengan 3 dosis berbeda. Dosisnya adalah 45 mg, 67,5 mg dan 90 mg selama 12 hari. Hasil penelitian: Uji one way Anova (p=0,000<0,01) menunjukkan ada perbedaan prosentase kerusakan hepatosit yang sangat signifikan pada masingmasing kelompok. Penurunan prosentase kerusakan hepatosit paling signifikan pada kelompok dengan dosis air seduhan daun sirih paling besar (90 mg). Kesimpulan: Pemberian air seduhan daun sirih dapat memperbaiki kerusakan hepatosit pada tikus yang diinduksi dengan parasetamol. Penambahan dosis air seduhan daun sirih menurunkan jumlah kerusakan hepatosit.
PENGARUH PEMBERIAN MINYAK DEEP FRYING TERHADAP PERUBAHAN HISTOPATOLOGI JANTUNG TIKUS PUTIH (Rattus novergicus strain wistar)
Authors: Destrin Nurfadilah Lianda , Adilla Nurainiwati Sri , Agustini S.M
Published: July 2018

Pengaruh Pemberian Minyak Deep Frying Terhadap Perubahan Histopatologi Jantung Tikus Putih (Rattus novergicus strain wistar). Latar belakang: Peningkatan harga minyak tiap tahunnya mengakibatkan banyak masyarakat menggunakan minyak goreng berulang kali sehingga mengakibatkan terbentuknya senyawa radikal bebas yang dapat menyebabkan nekrosis sel otot jantung. Tujuan: Penelitian ini bertujuan untuk membuktikan pengaruh pemberian minyak deep frying terhadap perubahan histopatologi jantung tikus putih (Rattus novergicus strain wistar). Metode: Penelitian ini merupakan true experimental menggunakan 20 ekor tikus, yang dibagi menjadi 4 kelompok dan diberi perlakuan selama 28 hari. Kelompok pertama diberikan pakan dan minum, kelompok II, III, IV diberikan 4x, 8x, 16x penggorengan. Tikus diberikan minyak deep frying dengan dosis 0.25 ml/ 100g BB/ hari menggunakan sonde lambung. Setelah 28 hari dilakukan pengambilan jantung tikus dan dibuat sediaan dengan pengecatan Hematoksilin Eosin kemudian dilakukan pengamatan sel nekrosis jantung. Hasil penelitian: Uji one way ANOVA didapatkan nilai sig = 0,000 (p < 0.01), terdapat pengaruh yang bermakna dari penggorengan berulang minyak deep frying terhadap nekrosis sel otot jantung. Uji Korelasi sig (2-tailed) = 0,000 (p < 0.01) dengan uji regresi didapatkan nilai R2 = 0,861, nekrosis sel otot jantung dipengaruhi minyak deep frying sebesar 86.1%. Kesimpulan: Pemberian minyak deep frying berpengaruh bermakna terhadap peningkatan jumlah sel nekrosis pada jantung tikus putih (Rattus novergicus strain wistar).Kata Kunci: minyak deep frying, stres oksidatif, nekrosis sel otot jantung.
HUBUNGAN ANTARA HIPERTENSI DENGAN PENURUNAN FUNGSI KOGNITIF PADA LANSIA
Authors: Wahyuniarti Anisa , Bahrudin Moch , Safithri Fathiyah
Published: July 2018

Hubungan Antara Hipertensi Dengan Penurunan Fungsi Kognitif Pada Lansia. Latar Belakang: Hipertensi merupakan salah satu faktor terjadinya penurunan fungs kognitif. Pada orang lanjut usia terjadi penurunan kapasitas fungsional otak yang akan menimbulkan berbagai gangguan neuropsikologis salah satunya yaitu penurunan fungsi kognitif. Mini Mental State Examination (MMSE) merupakan salah satu cara untuk mendeteksi penurunan fungsi kognitif. Tujuan: Mengetahui Hubungan Antara Hipertensi dengan Penurunan Fungsi Kognitif Pada Lansia. Metode: Analitik observasional dengan pendekatan cross sectional. Besar sampel 63sampel. Dilakukan uji hipotesis Chi-Square untuk menentukan hubungan antar variable,dan dikatakan signifikan bila nilai P < 0,05 Hasil dan Diskusi: Didapatkan penurunan fungsi kognitif pada laki-laki sebanyak 22% sedangkan perempuan 54%, pada umur 60-69 tahun sebanyak 42%, umur 70-74 tahun sebanyak 38% dan pada hipertensi Staduim I sebanyak 20 %, hipertensi stadium II sebanyak 38% sedangkan pada penderita yang tidak hipertensi sebanyak 5%, pada uji Chi Square didapatkan x2 = 0,015 dan p < 0,05 Kesimpulan: Ada hubungan antara hipertensi dengan penurunan fungsi kognitif.Kata Kunci: hipertensi, lansia, penurunan fungsi kognitif.
Löffler’s Endocarditis: First Report of Successful Mitral and Tricuspid Valve Replacements in a Patient with Long-Standing Hypereosinophilia
Authors: Naik, MB, BCh, BAO Neil P. , Iqbal, MBBS, MSc, FRCPC, FACP Sahar
Published: July 2018

Löffler’s endocarditis is a condition that occurs in patients with hypereosinophilic syndrome (HES). First described in 1975, HES is a relatively new syndrome that is characterized by elevated eosinophils with end organ damage. Hypereosinophilia is defined as elevated eosinophils of 1.5 x 109/L for at least one month, or tissue involvement as evidenced by bone marrow section with 20% eosinophils, tissue infiltration, and/or deposition of eosinophil granule proteins in tissue. Prevalence of HES in the United States is estimated to be 0.36–6.3/ 100,000 people, of which Löffler’s endocarditis represents only a fraction of cases. We present a case where a patient presented with palpitations and shortness of breath, with a background of chronically elevated eosinophils. HES was previously diagnosed in this patient due to persistently elevated eosinophils with lung damage (Löffler’s syndrome). On biopsy, she was found to have endomyocardial fibrosis with a thickened endocardium secondary to eosinophils. Echocardiogram showed moderate to severe regurgitation in both mitral and tricuspid valves due to regurgitation secondary to fibrosis. She subsequently underwent a successful dual valve replacement. This is the first case, to our knowledge, where a dual valve replacement was performed successfully in a patient with Löffler’s endocarditis.
A Suspected Case Of Endoscopic Ultrasound Induced Pancreatitis, Without Fine Needle Aspirate
Authors: Abunassar BSc, BA, MD Michael John , Boyle, BN, MD, FRCPC Loree , Chaterjee, MSc, MDCM. FRCPC Avijit
Published: July 2018

A 78-year-old male developed nausea and epigastric pain 8 hours following an endoscopic ultrasound (EUS) procedure. The patient had a history of recurrent pancreatitis, and underwent the EUS procedure with the aim of aspirating a pancreatic cyst. The cyst had regressed in size, in keeping with a pseuodocyst, and was not biopsied. The patient tolerated the procedure well with no immediate complications, and was discharged home in stable condition. Eight hours later, the patient developed acute pancreatitis.
Do The Kind Thing and Do it First
Authors: R M K
Published: July 2018

Over a hundred years ago, Sir William Osler wrote the immortal words: “Do the Kind thing and do it First”. In these few words, he evokes everything from the simplest aspects of caring, to the complex nuances of the patient– doctor relationship. Was he referring to wellness of spirit and being, the treatment of pain and suffering; or the delivery of compassionate care through with an understanding smile or a kind gesture?
An Ambulatory Clinical Teaching Unit: Filling the Outpatient Gap in Internal Medicine Residency Training
Authors: Panju MSc MD Mohamed , Kara MD Ali , Panju MB Akbar , Fulford MD Martha , O'Bryne MB Paul , Haider MD Shariq
Published: July 2018

The majority of time in a core General Internal Medicine (GIM) residency is spent focusing on inpatient medicine, with relatively little time devoted to ambulatory medicine. The Royal College of Physicians and Surgeons of Canada has mandated an improvement in ambulatory exposure. Unfortunately, most ambulatory experiences tend to lack formal structure, a dedicated educational curriculum, and graduated learner-specific responsibilities. The recent Royal College recognition of GIM as a subspecialty places renewed emphasis on core IM training providing a more comprehensive exposure to outpatient medicine as management of patients with multiple complex conditions may be best managed by a general internist. In July 2015, McMaster University opened an outpatient medicine clinic which is designed to be an Ambulatory Clinical Teaching Unit (A-CTU). The A-CTU provides a structured clinical environment which is focused on the management of medically-complex patients. It uses a multidisciplinary model, graded learner levels of responsibility and a dedicated educational curriculum. The unique structure of the A-CTU allows for the assessment of milestones and EPAs (entrustable professional activities) pertaining to consultation skills and chronic disease management, in keeping with competence by design.
Corrected Calcium Formula in Routine Clinical Use Does Not Accurately Reflect Ionized Calcium in Hospital Patients
Authors: Steen MD Oren , Clase MB MSC Catherine , Don-Wauchope MB.Bch MD Andrew
Published: July 2018

Background: Adjusting total calcium for serum albumin is a common practice among medical practitioners.
Climate Change and Health – Concrete Steps for Physicians and Health Professionals
Authors: Lu MDCM, FRCPC Yidan
Published: July 2018

Climate change poses a great threat to global health in the 21st century. Physicians and health care professionals can take an active role to limit the health impacts of global warming. We must educate ourselves on the health repercussions of climate change, act as role models in our community, and actively promote health at the patient level by encouraging active transport such as walking and biking, and reduced red meat consumption, both of which are health co-benefits in the fight against global warming.
Point-of-Care Ultrasound in Internal Medicine
Authors: Levine Mitch
Published: July 2018

Over the past few decades a variety of technological advances have dramatically change the manner in which physicians practice medicine. Both clinically and administratively the practice of medicine is in evolution – for example; stents instead of surgery and digital health records instead of paper charts. For internal medicine physicians one of the biggest transformations with respect to how we will practice medicine is just on the horizon. The routine use of point-of-care ultrasound (PoCUS) will become an essential skill for the practicing internist. The application for PoCUS in the field of internal medicine is immense – accurately assessing the JVP in critically ill patients, performing arterial and venipunctures, diagnosing pericardial tamponade or determining the likelihood of a pulmonary embolus, or the diagnostic and therapeutic removal of body fluids, to name a few.While some of our colleagues have adopted this technology as an adjunct to the clinical examination or as an aid to conducting bedside procedures most have not adopted this as a routine skill set. Some of the barriers include insufficient training and a lack of readily accessible equipment in all clinical settings. But this will change, and the use of PoCUS will eventually become a required skill of all practicing internists.In the current issue of CJGIM Lewis et al have conducted a needs assessment of PoCUS in answering either a clinical question or in guiding a procedure. As the Royal College of Physicians and Surgeons does not yet require all internal medicine residency programs to provide a formal PoCUS curriculum, the objective of their study was to conduct a systematic needs assessment for the introduction of a PoCUS curriculum to an internal medicine program. The results showed that some internal medicine residents were already using PoCUS yet they had never been formal trained in the skill. One is left to wonder what a similar survey would find if conducted amongst practicing internists.While each residency programs will inevitably develop a PoCUS curriculum for their trainees, it will remain a continuing education challenge for internists already in practice. The importance of this skill cannot be under estimated and it will require the leadership in the internal medicine community to ensure that they create the opportunity for all internists to master the use of PoCUS.
Choisir avec soin : une réalité?
Authors: Levine Mitch
Published: July 2018

Le programme Choisir avec soin vise à favoriser une utilisation plus efficace des ressources en soins de santé. D’une part, le programme invite les patients à aligner leurs attentes sur des données probantes en ce qui a trait aux prestations de soins de santé; d’autre part, il vise à accroître les connaissances des médecins quant aux directives fondées sur des données probantes en ce qui a trait au recours à des examens et traitements. Dans le présent numéro de la RCMIG, une étude nous rapporte que la connaissance que les médecins ont de Choisir avec soin ne s’avère pas très encourageante. En effet, beaucoup de médecins déclarent connaître le programme Choisir avec soin, mais nombre d’entre eux n’auraient qu’une connaissance limitée des messages spécifiques visant à guider leur pratique selon des données probantes. Puisque les résultats de cette étude reposent sur les 33 % de médecins qui ont accepté de répondre, on est en droit de se demander s’il n’y aurait pas une méconnaissance encore plus grande du programme chez les autres (67 %) qui ont décliné de répondre. Malgré cette information pessimiste, je persiste à croire que les médecins ont une pratique fondée sur des données probantes, même s’ils ne connaissent pas en détail les recommandations du programme Choisir avec soin. En effet, l’ensemble de ces recommandations a été élaboré par des sociétés de professionnels représentant différentes spécialités cliniques au Canada. La Société canadienne de médecine interne (SCMI) a formulé cinq principales recommandations à l’organisation Choisir avec soin par l’entremise d’un comité de vingt membres représentant un groupe diversifié d’internistes généraux venant de partout au Canada et reflétant un large éventail de régions géographiques, de milieux de pratique, d’institutions et d’experience1. Vous trouverez ci-dessous la liste des cinq recommandations visant les médecins exerçant dans le domaine de la médecine interne.  Ne recourez pas systématiquement aux études de neuro-imagerie (tomodensitométrie, imagerie par résonance magnétique ou Doppler carotidien) pour l’évaluation d’une simple syncope chez les patients dont l’examen neurologique est normal. N’installez pas ou ne laissez pas en place des sondes urinaires sans avoir une indication acceptable (comme une maladie grave, une obstruction ou des soins palliatifs). Ne transfusez pas de globules rouges selon des seuils d’hémoglobine ou d’hématocrite arbitraires en l’absence de symptômes d’une maladie coronarienne active, d’insuffisance cardiaque ou d’un AVC. En milieu hospitalier, ne commandez pas d’analyses sanguines ou chimiques de façon répétitive lorsque la condition clinique et les tests de laboratoire sont stables. N’effectuez pas systématiquement d’examens préopératoires (comme une radiographie des poumons, une échocardiographie ou un test cardiaque à l’effort) pour des chirurgies à faible risque.Ceci étant dit, comment se porte votre pratique? Mitchell LevineRédacteur en chef, RCMIG
Addressing the Opioid Problem
Authors: Levine Mitch
Published: July 2018

At the recent CSIM annual meeting in Toronto the opening plenary session was “The North American Opioid Crisis.” This is a fundamentally important topic for internists. We frequently encounter patients in our clinics and hospitals who have opioid dependency issues and we need to have a compassionate and medically sound strategy to manage the problems before us. We also have the opportunity to help prevent a problem that is often started with a physician’s prescription.
Abstracts from the Rocky Mountain ACP/AMA Internal Medicine Conference – Banff November 16-18, 2017.
Authors: Internal Medicine Rocky Mountain ACP/AMA
Published: July 2018

Abstracts from the Rocky Mountain ACP/AMA Internal Medicine Conference – Banff November 16-18, 2017.
Un temps pour le changement
Authors: Levine Mitch
Published: July 2018

À partir du 1er avril 2018, je me remettrai en tant que rédacteur en chef et le Dr Jim Douketis assumera ce rôle. En outre, le journal a récemment ajouté trois nouveaux rédacteurs adjoints au Comité de rédaction. Je suis confiant que Jim et son équipe apporteront avec eux de nouvelles idées et de l'énergie qui va prendre CJGIM à un nouveau niveau d'activité et d'excellence.
A Case of a Dispensing Error Causing Iatrogenic Orthostatic Hypotension
Authors: Lam Kenneth , Leung Ann , Jamieson Trevor
Published: July 2018

This is a case report of a patient with Parkinson’s disease and orthostatic hypotension who presented with increasing falls. We discovered that there had been a dispensing error where amiloride (Midamor®) was supplied instead of midodrine. The error was uncovered during a medication reconciliation by our pharmacist; the pharmacist noted that the pills were stamped with the wrong number and the patient’s caregiver noted that at the last refill they had, indeed, changed shape. Beyond providing the impetus for a review of orthostatic hypotension, this case also highlights an easily missed cause of an adverse drug event, and highlights the importance of the multidisciplinary team and engaged patients and caregivers.
Abdominal Pain, Hyperkalemia, and Elevated Creatinine after Blunt Trauma: Bladder Rupture and Pseudo–Acute-Kidney-Injury.
Authors: Mirza Reza D , Wong Eric KC , Yang Robert , Clase Catherine
Published: July 2018

A 40-year-old man involved in trauma presented with abdominal pain and ascites. He was referred to nephrology for elevated creatinine and hyperkalemia. Initial imaging showed diffuse free fluid in the abdomen and pelvis without solid organ injury. Paracentesis drained 1.5L of yellow fluid notable for a creatinine of 2259 μmol/L. Intraperitoneal urinary bladder rupture was diagnosed and surgically repaired. Within 24 hours, creatinine had normalized consistent with a presentation of pseudo-acute-kidney-injury. This case and a literature review reveals that this condition is often delayed in diagnosis or misdiagnosed altogether.
Relevant Imaging Presentation of Erdheim-Chester Disease: A case-report
Authors: Jacob Philippe
Published: July 2018

Erdheim-Chester disease (ECD) is a rare non-Langerhans multisystemic histiocytosis. This disorder is characterised by CD68+/CDa1- foamy histiocytes infiltration in tissues, especially bones, retroperitoneum, heart, lung and brain. Clinical manifestations may range from asymptomatic bone lesions to multiorganic symptoms. Bone pain in lower extremities are however the most common symptoms. Typical imaging findings include symmetric dyaphyseal osteosclerosis of long bones, periaortic sheathing (“coated aorta”) and retroperitoneal infiltration (“hairy kidney”). Lung and brain radiological abnormalities may also be seen on imaging screening. BRAF-V600E mutation is associated with around half of ECD patients. Vemurafenib, a mutated BRAF inhibitor, is a promising treatment for patients with this mutation. We present the case of a 60 years old man who arrived with a pathological right humerus fracture, and who was first admitted for a tuberculosis suspicion. ECD was first suspected with imaging screening.
Reflections on Dr. Allan D. Cohen
Authors: Farquhar MD SM Donald
Published: July 2018

Allan Cohen was one of the first faculty colleagues I got to know when I joined the Department of Medicine at Dalhousie as an assistant professor in 1989. Although my family’s roots were in Nova Scotia, I had grown up and completed my medical residency and fellowship training in London, Ontario, and so I had come to Dal “from away,” as Maritimers say. Everything and everyone about the Department of Medicine – except its then head, Dr. George Carruthers, who, like me was also an expatriate Londoner, and had recruited me – were new. For the first few weeks, I confess that I felt like a “fish out of water.”
A Blueprint for Global Health Curriculum Development: The McMaster Internal Medicine Residency Program Experience
Authors: O’Shea MD MPH Tim M. , Kraeker MD MSc Christian B. , Haider MD Shariq , Khalid MBBS Zahira , Chakroborty MBBS MD Amitabha , Leto MD Daniela , Verhovsek MD Madeleine , Rochwerg MD Bram , Manolakos MD Joshua J. , Kronfli MD MPH Nadine , Patel MB Ameen
Published: July 2018

Medical schools and residency programs are increasingly active within the realm of global health. Surveys suggest that most medical schools participate in global health–related activities, although the goals and scope vary widely.1 Studies from Yale and Duke Universities showed that internal medicine residents who travelled abroad on a clinical elective gained knowledge in tropical medicine, tended to favour more general specialties, and worked more often with other marginalized populations.2,3
Knowledge as Practice: Rethinking Medical Education
Authors: Kuper MD DPhil Ayelet
Published: July 2018

There is a long tradition of general internists being involved in medical education as teachers, educational administrators, and, increasingly, medical education scholars and researchers. In recent years, the medical education journals have contained rather lively and impassioned debates about the best ways in which to carry out that sort of research. During the first years of the 21st century, editorial debates in the top journals in the field (e.g., Medical Education, Academic Medicine, Advances in Health Sciences Education) were divided on such basic issues as these: (1) What are the most important research questions that medical education research should be addressing?1–3 (2) Who is the target audience of that research – the deans and course directors and clinical teachers, or other researchers in the field?3,4 (3) Which research methodologies should be used?5–10 These issues were also discussed at conferences, in meetings, and informally among colleagues.
The Pathognomonicity of Gottron’s Sign
Authors: Babcock BSc Heather M. , Osman MD PhD Mohammed S. , Kwok MD Tiffany , Chihrin MD Stephen , Keeling MD MSc Stephanie O. , Majumdar MD MPH Sumit R.
Published: July 2018

This article presents the case of a previously healthy 43-year-old female who presented with a 3-month history of progressive, symmetrical, bilateral, proximal muscle weakness accompanied by a violaceous-to-erythematous rash involving her hands, arms, thighs, chest, and face. She had conspicuous non-edematous periorbital violaceous patches with telangiectasia and prominent warm violaceous macules overlying the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Muscle biopsy confirmed dermatomyositis. Gottron’s sign is the most specific cutaneous finding of dermatomyositis and is present in at least 70% of patients. The lesions begin as non-palpable flat macules or patches (Gottron’s “sign”) or are firm and raised (Gottron’s “papules”), but the lesions eventually coalesce into raised non-blanching plaques that occur over bony prominences – typically the MCP, PIP, and/or distal interphalangeal joints. Gottron’s sign (and papules) are pathognomonic for dermatomyositis, although some other conditions may have similar presentations. Gottron’s sign must always be explained, as dermatomyositis may be primary or secondary to malignancy or other connective tissue diseases, and none of the conditions that make up the differential diagnosis are benign.
Medical French and Medical English: General Language Skills for a Bilingual Country/Langage médical francophone et anglophone: habiletés de communication médicales attendues dans un pays bilingue
Authors: Smith MD Katherine E. , LeBlanc MD Francois , Cardinal MD Pierre , Brindley MD Peter G.
Published: July 2018

It has been argued that Canada contains two solitudes, based primarily upon its European founding languages: English and French.1,2 Bringing these solitudes closer requires effort and empathy. It also requires common words and phrases. This is the goal of this modest language primer for acute care practitioners. Many medical practitioners treat language-discordant patients and families (both within Canada and worldwide).Interpreters can be invaluable, and can avoid the loss of confidentiality that occurs if we rely upon family members. However, the unusual hours and time pressures of acute care medicine mean that we cannot assume translators will always be available. Moreover, patients who use translators are often less satisfied with their care, may be less informed when providing consent, and may demonstrate less outpatient compliance.Therefore, it is important that front-line practitioners have basic language skills. Empathy is integral to patient-focused care. Canadian and American data suggest that when we cannot communicate in a patient’s native language, we treat that patient differently.
A Serological Storm
Authors: Wong MD Bertha , Bagovich MD Maria , Blasutig PhD Ivan , Carette MD MPhil Simon
Published: July 2018

This article describes a patient presenting with a sensory polyneuropathy and multiple autoantibodies, leading to the diagnosis of hepatitis C virus (HCV) infection. His widely positive autoantibody profile in the absence of clinically significant rheumatic disease illustrates the importance of interpreting autoimmune serology in the appropriate clinical context and the concept of HCV being a non-specific activator of the immune system. In addition, it highlights the importance of considering untreated HCV infection in the differential diagnosis of rheumatic complaints, particularly if the workup reveals multiple autoantibodies, as HCV is a potentially severe and life-threatening disease, which can be appropriately managed with effective antiviral therapy.
Adherence to Guidelines for Cardiac Catheterization Referrals and Secondary Prevention Strategies in Patients with Non-ST Segment Elevation Acute Coronary Syndromes
Authors: Haroun MD Michelle J. , Shroff MD, Anjali , Manolakos Joshua J. , Natarajan MD MSc Madhu K. , You MD MSc, John , Patel MD Ameen
Published: July 2018

Background: Previous studies have demonstrated higher referral rates for invasive procedures among patients admitted with acute coronary syndromes (ACS) to hospitals with catheterization facilities compared to those without. Studies have also reported underuse of evidence-based medical therapies and cardiac rehabilitation programs post myocardial infarction. We evaluated referral patterns for cardiac catheterization and use of secondary prevention strategies in current practice.Methods: We conducted a retrospective study of 397 patients with non-ST segment elevation ACS, comparing angiography referrals at a hospital with on-site catheterization facilities (Site A, n = 194) versus a hospital without (Site B, n = 203). We also recorded the use of secondary prevention strategies including discharge medications, referrals to smoking cessation programs and cardiac rehabilitation.Results: There was no significant effect of on-site angiography on the decision to manage patients invasively (adjusted OR for on-site angiography 1.49 95% CI 0.92-2.44, p = .11), or wait times for cardiac catheterization (Site A 1.9 days vs. Site B 2.2 days, difference −0.3 days, 95% CI −0.83 to 0.55, p = .70). However, at the time of hospital discharge, less than 70% of patients were prescribed dual antiplatelet therapy and only 13% of patients were referred for cardiac rehabilitation.Conclusion: These observations suggest that in contemporary practice in a Southern Ontario community, the availability of on-site percutaneous coronary intervention does not influence referral rates or wait times for cardiac catheterization. However we did observe significant underuse of cardiac rehabilitation programs and certain medical therapies. This suggests that despite improvements in access to invasive procedures, there remain important gaps in secondary prevention of coronary artery disease, which represent opportunities to improve quality of care in these patients.
Expert Consensus on a Canadian Internal Medicine Ultrasound Curriculum
Authors: Arishenkoff MD Shane , Blouw MD Marcus , Card MD Sharon , Conly MD John , Gebhardt MD Colin , Gibson MD Neil , Lenz MD Ryan , Ma MD Irene W. Y. , Meneilly MD Graydon S. , Reimche MD Leanne , Schaefer MD Jeffrey , Sochocki MD Michael , Zamke Kelly
Published: July 2018

Ultrasonography is increasingly used at the bedside. In the absence of an already developed curriculum appropriate for Canadian internal medicine training programs, 13 representatives from internal medicine programs in five Western Canadian provinces met for 2 days to develop and propose a consensus-based internal medicine curriculum for training in the bedside use of ultrasonography in a Canadian health care context.All 13 had had interest or leadership role in those programs. The curriculum’s content was based on three overarching principles agreed upon by the group: (1) content should be selected on the basis of clinical or educational need; (2) content should be feasible (i.e., both cognitive and technical components of the curriculum could be reasonably taught and learned in a competency-based manner while minimizing potential risks to patients); and (3) content should be evidence based. A consensusbased curriculum of 16 proposed topics is to be considered for the core internal medicine residency training program (postgraduate year [PGY] 1 to PGY 3), and 22 topics are to be considered for general internal medicine subspecialty training programs (PGY 4 to PGY 5).
Cannabinoid Hyperemesis Syndrome: Rare or Underdiagnosed?
Authors: Au Selena , Rezaie Ali
Published: July 2018

A 38-year-old male presented to the emergency department with severe acute-on-chronic abdominal pain. For the previous 20 years, he had experienced daily sharp epigastric pain with generalization to the entire abdomen. The pain typically began late in the morning and could last from hours to days. It was associated with nausea, vomiting, diaphoresis, and occasionally fever, diarrhea, and fatty or bloody bowel movements. These symptoms were not associated with food consumption. Over the previous five years, the patient had lost over 20 kg in weight and had noticed a marked decline in his performance at work and in the quality of his leisure time. He found symptom relief by smoking rolled marijuana cigarettes (“joints”), which he had been using three times per day since his teens. His pain crises were alleviated only with soaking in a tub of “scalding hot” bath water which he drew up ritualistically every morning. The patient’s symptoms had previously been investigated by his family physician, who suspected acute intermittent porphyria (AIP), but it is unclear what medical diagnostics had been performed. Quetiapine (50 mg qhs) had been prescribed and started one year prior to presentation, but during a review of systems, the patient denied having had any psychiatric symptoms. His medical history was significant only for smoking and lactose intolerance. Review of systems and family history were negative for autoimmune, infectious, malignant, or inflammatory bowel disease. When questioned as to why he chose to come to the emergency department just then, the patient replied that his family physician had suggested that he present during one of the more severe pain crises in order to allow laboratory work-up to confirm the diagnosis of AIP. At the time of presentation, the patient had been ill for the previous four days. On examination, the patient was febrile (38.6oC), hypertensive (195/113), and markedly dehydrated. He was of thin habitus and had normal results on cardiorespiratory examination. His abdomen was nondistended but diffusely tender. Abdominal rigidity with guarding was noted by the emergency physician but was absent on reassessment by internal medicine. The patient’s laboratory investigation results were consistent with a stress response and dehydration, including hemoglobin = 193 g/L, white blood cell count = 20 × 109 g/L, creatinine = 164 μmol/L, and lactate = 2.7 mmol/L. Liver enzymes and the results of tests of hepatic synthesis were normal. Urine porphobilinogen at the time of crisis was negative for AIP. Upon a review of the literature, a diagnosis of cannabinoid hyperemesis syndrome was made. To rule out other organic etiologies, the patient underwent abdominal computed tomography, which was unremarkable. Upper gastrointestinal endoscopy with gastric biopsies revealed no pathology.
APRESENTAÇÃO: POLÍTICAS DE QUALIFICAÇÃO E O ESVAZIAMENTO DO DIREITO À EDUCAÇÃO
Authors: Lima Marcelo
Published: July 2018

A partir do ano de 2018 a Revista Trabalho Necessário passou a editar números temáticos coordenados por grupos de pesquisa associados ao NEDDATE, considerando sua afinidade com a linha editorial da revista, - o materialismo histórico. Assim, como meio de veiculação e mediação do pensamento crítico em relação ao mundo do trabalho, à formação humana e as relações históricas entre trabalho e educação, os números vêm sendo constituídos por artigos de autores convidados, vinculados a temática específica, além de artigos de demanda espontânea.
O PROJOVEM URBANO COMO POLÍTICA DE INVISIBILIDADE DA CLASSE TRABALHADORA
Authors: Bilio Rafael , Rummert Sonia Maria
Published: July 2018

Este artigo trata, à luz do materialismo histórico, do programa denominado ProJovem Urbano (PJU), que visa atender jovens com idade entre 18 e 29 anos, alfabetizados, mas que não concluíram o 9ª ano do Ensino Fundamental. Nesse contexto, evidenciamos que o PJU está inscrito em um processo de intensificação das políticas focais de gestão da pobreza e de invisibilidade da classe trabalhadora, a partir de uma miríade de programas compensatórios de atenuação do desemprego e amortização de conflitos sociais na sociedade brasileira. Para as finalidades desse artigo, utilizaremos o relatório de gestores que contém a análise de cento e oitenta e um questionários aplicados aos gestores do programa que estavam exercendo ou haviam exercido o referido cargo.
A TRAJETÓRIA DO PRONATEC E A REFORMA DO ENSINO MÉDIO: ALGUMAS RELAÇÕES COM A POLÍTICA DE EDUCAÇÃO PROFISSIONAL MUNDIAL
Authors: Silva Danilma
Published: July 2018

As reflexões aqui apresentadas fazem parte das discussões desenvolvidas no âmbito mais geral sobre o Pronatec (Programa Nacional de Acesso ao Ensino Técnico e ao Emprego). Esta atividade contempla várias dissertações e teses e busca compreender o sentido, o papel do Programa e as contradições que se apresentam com a implementação e as transformações no decorrer da sua trajetória. Assim, levantamos que, no atual momento, o Pronatec encontra-se aliado à Reforma do Ensino Médio e em coerência com as políticas de educação profissional a nível mundial. Portanto, evidenciamos uma maior consolidação da dualidade estrutural da educação.
A RELAÇÃO ESTABELECIDA ENTRE A FORMAÇÃO PROFISSIONAL E O ENSINO REGULAR: FALAM OS JOVENS APRENDIZES
Authors: Almeida Angelita , Leão Inara
Published: July 2018

Este artigo tem por objetivo demonstrar como as atividades do Programa do Jovem Aprendiz tiveram influências na escola regular. Uma das condições para que o aprendiz participe do Programa, é estar matriculado no ensino fundamental, médio ou técnico, o que implica em uma tripla jornada diária. Neste estudo optamos pelo referencial teórico metodológico do materialismo histórico dialético, por oferecer subsídios para pensar a sociedade e os meios de produção em sua totalidade, pelas suas contradições e historicidade. Procuramos abarcar os mecanismos que fizeram e fazem com que esta formação se mostre como difusora da ideologia que garante a reprodução de uma classe social subordinada ao capital.
MUTIRÃO, TRABALHO E FORMAÇÃO HUMANA: FORJANDO NOVAS RELAÇÕES ENTRE O SABER E O PODER
Authors: Horta Carlos Roberto
Published: July 2018

O trabalho focalizou práticas de formação profissional e de formação políticaorganizadas e dirigidas por trabalhadores e militantes que se juntavam a eles, em umatrajetória de solidariedade e resistência no chão de fábrica e com uma históriaconhecida no meio operário.
VOLATILIDADE DA TAXA DE CÂMBIO REAL EFETIVA E EXPORTAÇÕES BRASILEIRAS
Authors: Corrêa Karen Dias , Vasconcelos Claudio Roberto Fóffano , Lima Júnior Luiz Antônio
Published: July 2018

Este trabalho tem como objetivo analisar o efeito de longo prazo da volatilidade da taxa de câmbio real efetiva sobre os produtos básicos, semimanufaturados e manufaturados exportados do Brasil para os principais parceiros econômicos, sendo estes Estados Unidos, União Europeia e Mercosul. A literatura teórica é controversa com relação aos efeitos esperados da volatilidade sobre as exportações. O presente estudo avança em relação à literatura empírica reunida aqui em duas direções: na metodologia de mensuração empregada na volatilidade e na categoria de produtos utilizados. Para tanto, foi empregada a abordagem de cointegração via modelo ARDL, teste de Fronteira de Pesaran, Shin e Smith (2001). Os principais resultados são que há evidência de que a volatilidade tem um impacto negativo sobre as exportações brasileiras com destino ao Mercosul. Quanto às exportações para os Estados Unidos, os resultados são contraditórios, dado que apresentaram uma relação negativa entre a volatilidade e exportações dos produtos manufaturados e semimanufaturados e uma relação predominantemente positiva na análise desagregada em capítulos da NCM. Por fim, para a União Europeia, apenas na análise desagregada ocorreu a relação estatística de longo prazo entre volatilidade e exportações. Neste caso, a predominância das relações foi negativa.
EFICIÊNCIA E CONVERGÊNCIA DA INOVAÇÃO: UM ESTUDO DO PROGRESSO TECNOLÓGICO PARA PAÍSES DESENVOLVIDOS E EM DESENVOLVIMENTO
Authors: Alves Frederick Fagundes , Madeira Soraia Araújo , Sousa Lucas Vitor de Carvalho
Published: July 2018

Essa pesquisa visa analisar os níveis de eficiência técnica para países desenvolvidos e em desenvolvimento na geração de progresso científico e tecnológico para os anos de 2000 e 2010. Mais especificamente, pretende-se verificar a produtividade total dos fatores (PTF) por meio do índice de Malmquist e mensurar a convergência da eficiência dos países para grupos mais eficientes através do data envelopment analysis (DEA) e cadeias de Markov. Os resultados mostram que grande parte dos países é ineficiente tecnicamente no período analisado e aproximadamente 61% apresentaram aumento na produtividade, sendo que as mudanças no processo produtivo de uma mesma tecnologia foram mais expressivas. Pode-se notar que mais da metade dos países convergirão para a classe mais eficiente em gerar progresso científico e tecnológico. Conclui-se que não necessariamente os países mais desenvolvidos serão os mais eficientes e produtivos em gerar progresso científico e tecnológico.
ESTIMAÇÃO DAS IMPORTAÇÕES INDIRETAS DO COMPLEXO INDUSTRIAL QUÍMICO BRASILEIRO NOS ANOS 2000
Authors: Moreira Thiago Moraes , Ribeiro Luiz Carlos Santana
Published: July 2018

O objetivo deste artigo é estimar as importações brasileiras indiretas de químicos para os anos de 2000, 2005 e 2009. Utilizaram-se dados de matrizes de insumo-produto nacional e internacional, em particular os coeficientes de demanda intermediária por produtos químicos das atividades econômicas. Estimativas como esta são úteis no sentido de melhor mensurar o tamanho do mercado potencial de produtos químicos deslocados pelas importações brasileiras totais, não se limitando apenas às importações diretas. Este mercado potencial corresponderia ao somatório das importações diretas e indiretas, sendo estas últimas referentes aos produtos químicos que se encontram incorporados em toda a pauta de importação brasileira. Ambas as estimativas apresentaram valores crescentes das importações brasileiras indiretas de químicos ao longo dos anos, sendo que a obtida por meio da base internacional apresentou valores relativamente menores. Esta diferença sugere defasagem da estrutura produtiva brasileira, em particular no que diz respeito à eficiência no uso dos insumos químicos. Percebeu-se ainda queda significativa no peso relativo das importações brasileiras com origem nos Estados Unidos, principalmente na primeira metade da década, concomitantemente a um expressivo aumento da participação chinesa.
Trasplante hepático en mayores de 65 años de edad: experiencia en el Hospital Pablo Tobón Uribe, Medellín, Colombia 2004-2010
Authors: Muñoz Maya Octavio Germán , Ovadía Laura , Saavedra Yesid , Restrepo Juan Carlos , Yepes Carlos , Santos Óscar , Marín Juan Ignacio , Hoyos Duque Sergio Iván , Guzmán Carlos , Mena Hurtado Alvaro , Correa Gonzalo
Published: July 2018

El trasplante hepático se ha extendido a personas mayores de 65 años de edad, quienes anteriormente eran excluidas de los protocolos debido a la mayor morbilidad y mortalidad asociadas con la edad. Este estudio tuvo como objetivo identificar la supervivencia y las complicaciones en pacientes mayores de 65 años de edad sometidos a trasplante de hígado. Se analizaron historias clínicas de pacientes mayores de 65 años de edad trasplantados en el período comprendido entre septiembre de 2004 y noviembre de 2010, en el Hospital Pablo Tobón Uribe de Medellín, Colombia. Se estudiaron 27 pacientes con una edad promedio de 67 años. La supervivencia postrasplante en ellos fue del 85,2%, 70,4% y 63% a los 30 días, al año y a los 5 años, respecti- vamente. Se evaluaron las complicaciones postrasplante, siendo las más frecuentes el sangrado masivo y las infecciones nosocomiales. La principal causa de muerte fueron los eventos cardiovasculares. En conclusión, la selección adecuada de los pacientes permite a aquellas personas mayores de 65 años convertirse en candidatos a trasplante hepático, con una buena supervivencia actuarial a 5 años y una mejor calidad de vida.
Erradicación del Helicobacter pylori: encuesta realizada por la Asociación Colombiana de Gastroenterología
Authors: Goméz Zuleta Martín Alonso , Ruíz Oscar , Páramo Hernández David , Albis Rosario , Sabbagh Luis Carlos
Published: July 2018

El objetivo de este estudio es presentar los resultados de una encuesta enviada por Internet para conocer cuáles son las estrategias y esquemas utilizados por los miembros de la Asociación Colombiana de Gastroenterología (ACG) para la erradicación y diagnóstico de la infección por Helicobacter pylori a la luz del Consenso de Maastricht IV. Se tomó información de manera prospectiva entre diciembre de 2013 y mayo de 2014, teniendo como herramienta de recolección un cuestionario virtual disponible en la página oficial de Internet de la ACG. La encuesta fue respondida por 114 médicos, de los cuales 60 (52%) fueron internistas y gastroenterólogos ubicados en las principales ciudades del país. Los resultados mostraron una adherencia del 61% (n = 71) de los encuestados a las recomendaciones de Maastricht para el esquema de erradicación de primera línea, y para la segunda línea la adherencia es del 66% (n = 76). Otro aspecto de la encuesta para destacar, y que está en contraste con las recomendaciones de Maastricht, es el hallazgo de que la prueba diagnóstica predilecta de los encuestados para evaluar la erradicación (antígenos fecales monoclonales o test de urea en aliento) fue la endoscopia digestiva alta más biopsia (Giemsa), siendo la escogida por el 63% (n = 72) probablemente por su disponibilidad y costo en nuestro país. Los resultados de la encuesta muestran cuáles son los esquemas de tratamiento preferidos, por los pro- fesionales que contestaron la misma, para la erradicación del Helicobacter pylori; esto permitió evaluar la aceptación y adherencia de las recomendaciones sobre los esquemas de tratamiento del Consenso, aunque llama la atención, en contraste, cómo el seguimiento de la erradicación se realiza mediante endoscopia.
La biopsia hepática en niños, experiencia de 5 años en un hospital pediátrico colombiano
Authors: Martínez Baquero Diana Lucía , Jaramillo Barberi Lina Eugenia
Published: July 2018

Objetivo: evaluar la distribución por frecuencia de las enfermedades hepáticas que justificaron el estudio por biopsia en pacientes pediátricos colombianos. Metodología: se evaluaron las biopsias de hígado realizadas durante 5 años en un hospital pediátrico y se agruparon las enfermedades hepáticas por diagnóstico y edad. Resultados: se encontraron 182 estudios histopatológicos de 168 pacientes, 14 de ellos contaban con 2 procedimientos; 53,6% fueron niños y 46,4%, niñas. El grupo de edad con más biopsias fue el de los lactantes menores y la colestasis fue en ellos la indicación más frecuente del estudio. Los grupos de enfermedades más diagnosticadas fueron los procesos inflamatorios (30,2%), las anormalidades de la vía biliar (26,4%), las enfermedades tumorales (14,9%) y los trastornos metabólicos/de depósito (9,3%). Los porcentajes restantes correspondieron a entidades infrecuentes y biopsias normales. Conclusión: la biopsia hepática es una herramienta útil y práctica en el diagnóstico de la enfermedad hepática pediátrica cuando se combina con datos clínicos y de laboratorio. En nuestro estudio, los procesos inflamatorios, las anormalidades de la vía biliar y las enfermedades tumorales fueron las categorías más diagnosticadas.