The Northern Ontario School of Medicine (French: École de médecine du Nord de l'Ontario) is a medical school in the Canadian province of Ontario, created through a partnership between Laurentian University in Sudbury and Lakehead University in Thunder Bay. Mandated both to educate doctors and to contribute to care in Northern Ontario's urban, rural and remote communities, the Northern Ontario School of Medicine has campuses in both Sudbury and Thunder Bay.The school is known for its small class size, its distributed model of education, heavy emphasis on enabling technologies, problem-based and self-directed learning, and early exposure to clinical skills. The school describes its campus as "Northern Ontario". This is evidenced by the close relationship between the school and various communities and First Nations throughout the region. All students complete a month-long placement in an Aboriginal or Métis community in May of their first year. In second year, they travel to smaller communities for two, month-long placements (one in the fall and the other in the winter). The third year is clerkship and is spent living in one of the medium-sized communities for the entire year. The fourth year of studies is completed in Sudbury or Thunder Bay.In 2021, following the 2021 Laurentian University financial crisis, NOSM became an independent institution, which will retain collaborative relationships with both Laurentian and Lakehead but will be funded directly by the provincial government as a standalone university. The school also accepts donations from the public, health care agencies, local governments, foundations and corporations. Donors can choose to support a particular area of the school's development, including social accountability, research capacity, human resource planning and innovation in education. Some of NOSM's largest donors include AstraZeneca, Barrick Gold, BMO Bank of Montreal, Bristol Myers Squibb, CTV, Eli Lilly, Fidelity Investments, HSBC Bank Canada, Hydro One Inc., Royal Bank of Canada, Scotiabank, City of Greater Sudbury, Sun Life Assurance Company of Canada, TD Bank Financial Group, City of Thunder Bay, and Wyeth Canada.
To evaluate the effect of intraoperative administration of 1 g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024–June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88 min [IQR 70–127]) and shortest in Group 3 (55 min [IQR 39–69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6–7.7
BACKGROUND:Fluoropyrimidines are among the most useful drugs in oncology with an established record of efficacy and safety. A minority of oncology patients bear genetic variants with reduced activity of the main enzyme catabolizing these drugs, dihydropyrimidine dehydrogenase (DPYD) and may be prone to severe or even lethal adverse effects. PATIENTS AND METHODS:We reviewed the records of gastrointestinal and breast cancer patients treated in our cancer center for the identification of cases that had DPYD genetic testing for variants and received treatment with fluoropyrimidines. The records of patients fulfilling these criteria were retrieved, and the prevalence of the different variants and their clinical implications and outcomes were recorded. RESULTS:The overall prevalence of four common DPYD variants was 7.3% (10 of 137 patients). Most prevalent variant was the haplotype HapB3 (five patients, 3.6%), followed by the DPYD p.D949V variant (3 patients, 2.2%), while one patient each (0.7%) had the two null variants DPYD*2A and DPYD*13. CONCLUSION:A sizable minority of oncology patients bear variants of DPYD with reduced activity and may be at increased risk of fluoropyrimidine toxicities if treated at full doses. However, variability within the same genotype exists.
Purpose Prune Belly Syndrome (PBS) is a rare congenital malformation complex characterized by cryptorchidism, urinary tract abnormalities and deficiency of the abdominal wall musculature. Although advances in neonatal and reconstructive care have substantially improved survival, the long-term risk of malignancy in this population remains poorly defined. We report a novel case of early-onset metastatic bladder carcinoma in a patient with PBS and perform a systematic review of all tumors described in association with the syndrome. Methods A systematic literature review was performed according to PRISMA guidelines and registered in PROSPERO (CRD420251072086). Databases searched through April 2025 included PubMed, Embase, Web of Science, ClinicalTrials.gov, Cochrane, and SciELO. Reported tumor cases in PBS patients were identified and classified as either PBS-associated or not. We additionally describe a new case of invasive bladder carcinoma. Results Seventeen studies comprising 20 patients met inclusion criteria. Tumors directly related to the genitourinary tract accounted for half of the cases. Bladder carcinoma was the most frequent neoplasm (35%), followed by hepatoblastoma (25%). Bladder tumors occurred at markedly younger ages and often presented as advanced diseases. Our index case involved a 33-year-old man with PBS who developed metastatic muscle-invasive urothelial carcinoma and died shortly after diagnosis. Discussion Improved survival in PBS has led to recognition of new late complications, including malignancy. Tumorigenesis may be influenced by chronic urinary stasis, infection, catheterization, cryptorchidism, and underlying genitourinary developmental abnormalities. These findings should be interpreted as hypothesis-generating given the limited number of reported cases. Conclusion Although uncommon, malignancies in PBS may occur earlier and behave more aggressively than in the general population. Given the current level of evidence, careful long-term follow-up with clinical awareness is warranted, rather than routine invasive screening for all patients.
BACKGROUND:Several studies have highlighted higher rates of adverse outcomes such as superficial surgical site infection (SSI) in Indigenous populations. However, there is a paucity of literature amalgamating reports of SSI in these populations compared with other ethnic and racial groups. The aim of this review is to highlight the incidence of SSI in Indigenous populations in the United States and Canada compared with non-Indigenous patients. METHODS:Based upon systematic assessment of relevant articles found in Scopus, PubMed, and PubMed Central, a state-of-the-art review was conducted. Studies in English that were cohort, cross-sectional, case-control, or randomized controlled studies on human beings of all ages and genders were included. Studies that were reviews, case series, case reports, editorials, letters to editors, animal studies, or studies that did not examine SSI as a direct outcome of surgical procedure were excluded. RESULTS:We retrieved 1,718 articles, 9 of which were included for review. The most reported adverse surgical infection was superficial SSI. Five studies reported statistically significant increased risk of superficial SSI in Indigenous populations compared with White patients. Increased rates of deep incisional SSI for Indigenous populations compared with White patients were statistically significant in two of three studies looking at this outcome. As it relates to organ-space SSI, two studies reported statistically significant increases for Indigenous patients of the three studies reporting this parameter. CONCLUSION:There are statistically significant differences in the incidence of SSI for Indigenous patients, particularly when compared with their White counterparts.
