Leech therapy reached its peak in medical practice during the 18th-19th centuries and became a central tool for bloodletting treatments grounded in the theory of the four humors. Leeches were a widely sought medicinal commodity in America and Europe, and their use evolved from a specialized tool to part of a thriving global trade network. Leeches, first described in Greece by Themison (80–40 BCE), were valued for bloodletting due to their ease of use in hard-to-reach places including the mouth, ears, and prostate, as well as in areas at higher risk for bleeding such as hemorrhoidal veins. While not clearly understood at the time, leeches secrete hirudin, an anti-coagulant protein allowing continuous blood flow and reducing the need for multiple incisions. The growing demand for leeches catalyzed the development of leech breeding and trade. As demand outstripped supply, leeches became endangered, driving up their price and prompting innovations in procurement and storage. Importation filled these gaps, and millions of leeches were shipped annually to Western Europe from Hungary and Sweden. This paper explores the interconnectedness between medical practice and economic trends. Drawing on relevant secondary sources, trade journals, and case histories, this paper demonstrates that the demand for leech therapy created an industry that thrived through local development and increasingly sophisticated trade networks. While leeches are bred today in laboratories, continued economic and institutional support has led to the resurgence of “leech therapy” for its use in reconstructive surgery, tissue flap salvage, and the treatment of soft-tissue hematomas.
Post COVID 19 condition (Long COVID) is a chronic condition that occurs after infection with the SARS-CoV-2 virus. The manifestation and timeline are highly variable, encompassing a range of neurological, cardiovascular, and respiratory complaints which persist three or more months after the initial infection. One finding in Long COVID patients has been brain PET hypometabolism involving the bilateral rectus/orbital gyrus, right temporal lobe, bilateral pons/medulla brainstem, and bilateral cerebellum. This finding is highly associated with functional complaints, with relationships identified between specific regions of hypometabolism and patients’ reported symptoms, and may be an important piece of the multiple factors leading to Long COVID. The pathophysiology of Long COVID is still hypothetical and is suspected to include multiple intertwined effects of virally-induced cellular neurological alterations, dysregulated immune response, and persistent and occult viral presence in tissues. This profile is closely shared with post-infectious syndromes from other infections including influenza, the Spanish flu, measles, and others, suggesting a shared pathophysiological axis that may include viral neurotropism, immune dysregulation, and persistent central nervous system dysfunction. Together, this raises the possibility that SARS-CoV-2 may trigger a spectrum of post-encephalitic neurological syndromes in susceptible individuals. Understanding this metabolic footprint within the broader context of post-acute infection syndromes offers a framework for accelerating research into the mechanisms and treatments of long COVID and related post-infectious neurological conditions.
Post-operative hospital readmission rates present a large economic burden on Canadian health systems. The widespread adoption of electronic medical records has opened the door for the use of predictive analytics to identify and manage at-risk patients. This article presents a broad health-economics perspective on the barriers to implementation of predictive analytic models and existing precedents, suggests key potential analytic parameters, and illustrates the value of integrating predictive analytics for the Canadian healthcare system.
Climate change is a global concern that has been noted to contribute to worsening air quality, thus having a direct impact on respiratory health. This study will examine the relationship between wildfires, a consequence of climate change, air quality, and respiratory disease burden over a 17-year period (2006-2023). Through the use of national-level databases such as the Canadian Wildland Fire Information System, the National Air Pollution Surveillance Program, and the Canadian Chronic Disease Surveillance System, we were able to obtain data on specific air pollutants such as fine and coarse particulate matter (PM2.5 and PM10, respectively), the frequency and severity of forest fires, as well as the prevalence and mortality of respiratory disease such as asthma and chronic obstructive pulmonary disease. We identified a strong correlation between forest fires and PM2.5, and PM2.5 and respiratory disease. A weak correlation was noted for PM10, likely due to its limited lung bioavailability. Our findings highlight the urgent need for enhanced public health and environmental policy to implement enhanced wildfire management, stricter air quality regulations, and targeted public health interventions to mitigate these growing concerns over air quality and climate change.
Introduction The care of pediatric patients with burns is unique and involves multidisciplinary collaborations. Patients frequently present to non-designated burn centres which have varied levels of experiences and resources to manage these patients. Varied practices have led to inconsistent pain management, availability of sedated dressing changes, and allied health involvement at our non-specialized burn centre. This study aims to characterize the current pathway for managing children with burn injuries at our centre to identify areas for improvement of community burn management. Methods A chart review of all paediatric burn patients admitted to a paediatric regional referral centre over a 9-year period was conducted. Data regarding patient demographics, injury characteristics, dressing changes, analgesia use, management interventions and burn recovery were collected. Results Of the 94 patients included in the study, the majority presented with primarily partial thickness burns (72.3%), scald burn (60.6%). The average TBSA was 10.4%. Most dressing changes were conducted once daily (76.6%) on the paediatric floor with oral/IV analgesia (80.9%) using Bacitracin and Adaptic (89.4%), Polysporin ointment (9.57%) and Flamazine (14.9%). On average patients had 15.0 dressing changes in hospital. Discussion: Non-designated burn centres frequently care for inpatient paediatric burns however variations in approach can lead to inadequate pain control and avoidable dressing changes. Conclusion This quality improvement project identifies need for standardization of protocols, ensuring adequate pain management and careful selection of dressings as key areas that should be addressed to optimize care for paediatric burn patients at non-designated burn centres in Canada.
Colorectal cancer (CRC) is one of the most prevalent malignancies in Canada and in the world. Orbital metastases of colorectal origin, however, are rare and standard management options have not been determined. A 72-year-old man presented with proptosis of the right eye, diplopia and elevated intraocular pressure. An orbital mass of colonic adenocarcinoma origin was diagnosed which localized to the right greater wing of the sphenoid. The mass caused progressive proptosis, a decline in visual acuity, and a right relative afferent pupillary defect (RAPD). The patient had a history of metastatic colon cancer starting 17 years prior with surgical management of liver and hip metastases as well as radiation therapy to the right hip and right orbit. With the patient’s consent and understanding that it was not an oncologic procedure, palliative orbital decompression was performed to slow the mass effects on his visual system. Upon follow-up, the patient reported improvement of visual symptoms. Orbital metastasis from colon adenocarcinoma is rare, with only 10 reported cases in the literature. To our knowledge, this is the first report of orbital decompression as a palliative treatment for orbital metastasis from colonic adenocarcinoma resulting in patient-reported alleviation of mass-effect symptoms. The clinical impact of this report is to provide evidence of orbital decompression as a possible palliative treatment for similar cases.
The path to the digital health age comes with a 4000-year history, from the first documented clinical medical record as early as 1600 BC to systematically recording case histories for didactic purposes in the 17th century. Today’s internet age marks a pivotal shift in the evolution of electronic health record (EHR) systems, an innovation rooted in centuries of medical documentation. From integrating patient data across healthcare providers to streamlining the delivery of quality care, modern EHRs offer valuable lessons and insights for developing effective management plans. With the emergence of cybercrime in the late 1970s, technology has become more sophisticated and coordinated, and what began as spam transitioned into viruses and malware. Current health data contains sensitive personal and financial information, making it an attractive target for cybercriminals. Active protocols ensure that information from a large health centre is decentralised through blockchain integration, avoiding absolute system shutdown in the event of a cybersecurity breach. Additionally, the overreliance on technology should require a Health Information Exchange committee to prepare for extended power outages or an IT-related outage to ensure that valuable patient information is not lost. This paper explores the emergence and development of the EMR and how a historical perspective can provide management recommendations to protect this system in the digital age.
Objectives To report on 1) the impact of DED on social, mental, and financial well-being, and 2) the use of virtual consultations to assess DED during the COVID-19 pandemic. Design & Methods An exploratory retrospective review of 35 charts. Telephone consultations for patients with DED conducted during the first lock-down period in Ontario in 2020 were reviewed. Results The most commonly reported DED symptoms were ocular dryness, visual disturbances, and burning sensation. The most common dry eye management practices were artificial tears, warm compresses, and omega-3 supplements. 20.0% of charts documented worsening of DED symptoms since the onset of the pandemic and 17.1% reported the lockdown had negatively affected their ability to perform DED management practices. 42.8% of patients reported an inability to enjoy their daily activities due to DED symptoms. 52.0% reported feeling either depressed, anxious, or both with 26.9% of patients accepting a referral to a social worker for counselling support. More than a quarter of the charts recorded financial challenges associated with the cost of therapy, and more than a fifth of patients reported that financial challenges were a direct barrier to accessing therapy. Conclusions Patients living with DED reported that their symptoms negatively affected their daily activities including mental health and financial challenges, that in turn impacted treatment practices. These challenges may have been exacerbated during the COVID-19 pandemic. Telephone consultations may be an effective modality to assess DED symptom severity, the impact of symptoms on daily functioning, and the need for counselling and support.
It is widely recognized that climate change can impact human health. Natural disasters, changing weather patterns and increasing pollution can contribute to and worsen human conditions. While many industries have excessive carbon footprints, one industry typically overlooked is the healthcare sector, which is counterintuitively a large CO2 emitter. To reduce emissions resulting from the Canadian healthcare sector, more sustainable practices must be implemented at a systemic level as well as in individual practice by physicians. Implementing more sustainable healthcare practices is both ethically and legally just and may have a positive impact on the health of Canadians.
Ms. A is a 79 year old woman who slipped on her icy driveway and was rushed to the emergency department via ambulance at 9:30 AM. She presents with severe pain on the left hip, swelling, and an inability to bear weight on her left side. She has a history of osteoarthritis, osteoporosis, and is dependent on her cane for mobility. She is currently on alendronate 70 mg PO once weekly. The attending ED physician orders imaging, which reveals a left hip fracture. Consultation with orthopedic service determined that she will be needing a hip replacement and is scheduled for surgery the next day. During surgery, reusable gowns, surgical instruments and drapes were used as per the hospital’s new green initiative. The surgery was a success with no complications. Ms. A was stable post-op, and discharged home after three days. However, she returns to the emergency room five days later with swelling and tenderness around the surgical site. An investigation of her surgical wound revealed a MRSA infection that was tied to a string of similar cases after the implementation of the hospital’s new green initiative. In this paper, we explore the current climate of environmentally sustainable surgical equipment.
Advancements in three-dimensional (3D) printing technology has revolutionized personalized medicine as it relates to surgical procedures. The ability to create custom-designed implants, guides, models, and tools tailored to patient anatomy has improved health and aesthetic outcomes, surgical precision, and healthcare efficiency. Further research will be instrumental in determining adequate quality control measures, assessing outcomes, and improving manufacturing timelines. This article aims to provide a health-economic perspective on the value of 3-D printed surgical implants, guides, and devices for surgical procedures.
This case report summarizes the history of a patient admitted to the Forensic Psychiatry unit with a history of homicidal ideation with intent. Investigations suggested a diagnosis of schizophrenia at the time of the initial assessment of criminal responsibility. However, the patient became symptom-free while in the hospital and abstinent from drugs. As a result, the diagnosis was changed to substance-induced psychosis. We also summarize current medico-legal aspects of criminal responsibility due to psychotic symptoms.
Telemedicine is an emerging tool for overcoming healthcare access barriers, particularly for vulnerable populations in rural and underserved communities. More recently, it has also been investigated as a way to reduce the healthcare sector’s carbon footprint. Evidence suggests that by minimizing travel for in-person visits and reducing resource use, telemedicine can help lower greenhouse gas emissions and contribute to both population and planetary health. A systematic review concluded that telemedicine reduces healthcare’s carbon footprint, suggesting its potential role in achieving a net-zero healthcare system. However, delivering on the promise of a greener healthcare system is complex, as it depends on numerous interrelated factors. While telemedicine has the potential to reduce carbon emissions by decreasing patient travel and optimizing resource use, its actual impact depends on multiple factors, such as the mode of transportation replaced (e.g., public vs. private transit), the energy consumption of powering digital infrastructure such as data servers, and the types of clinical encounters for which telehealth is accessible. For instance, telemedicine may be widely used for prescription renewals or follow-up visits but less applicable for acute or complex care—meaning that if patients must still travel for certain inquiries, the overall emissions reduction may be smaller than anticipated. While this paper acknowledges telemedicine’s potential to improve care access, its primary focus is on evaluating its environmental implications. This paper will analyze the advantages and limitations of telemedicine in reducing greenhouse gas emissions and examine feasibility and potential unintended environmental consequences.
Today, nitroglycerin is a compound that is used clinically to treat acute angina pectoris. The process includes pharmacologically converting nitroglycerin into nitric oxide which causes vasodilation of the coronary arteries. While nitroglycerin has been used since the 1880s, the precise mechanisms of this compound were not uncovered until nearly 100 years later. This paper will briefly explore the discovery of nitric oxide and its uses throughout history, and conclude with a discussion of the agent’s clinical significance today.
The National Cancer Institute defines personalized medicine as, “a form of medicine that uses information about a person’s own genes or proteins to prevent, diagnose, or treat disease…. Also called precision medicine.” Although this may seem like a new form of medicine, examples of precision medicine can be found throughout history. In this article we discuss examples of precision medicine found in the Corpus Hippocraticum and compare how the ancient idea of the term has changed with evolving technology, including the development of the Human Genome Project and the introduction of artificial intelligence (AI) into medical practice.
Climate change is an emerging public health crisis that extends beyond systemic diseases to greatly impact ocular health. Increasing ultraviolet (UV) radiation exposure, worsening air pollution, and the accumulation of environmental toxins are contributing to a rise in cataracts, dry eye syndrome (DES), and pterygium. Additionally, climate change is accelerating the spread of infectious eye diseases such as trachoma, onchocerciasis, and fungal keratitis, particularly in vulnerable populations with limited access to healthcare. Diagnosing climate-driven ocular diseases presents unique challenges, as early-stage manifestations are often subtle and overlap with other systemic or age-related conditions. Recent advancements in ophthalmic diagnostics, including AI-assisted imaging, anterior segment optical coherence tomography (AS-OCT), tear fluid biomarkers, and public health campaigns, offer promising solutions for early detection and monitoring of ocular diseases. AI-driven deep learning models have demonstrated potential in detecting cataract changes and environmentally related corneal pathologies with high accuracy. Furthermore, portable imaging technologies have been shown to facilitate screening in underserved regions most affected by climate change. This review explores the intricate relationship between climate change and ocular diseases, focusing on the diagnostic challenges posed by environmental factors and innovations aimed at enhancing patient outcomes. Addressing these issues through improved diagnostic strategies, global health policies, and interdisciplinary collaboration is essential to mitigate the long-term ocular health impacts of climate change.
Once on fertile lands, the Aamjiwnaang First Nation now resides amidst over 60 petrochemical facilities that produce hazardous air pollutants including sulfur dioxide, fine particulate matter, and benzene. Chronic exposure to these toxins has been linked to respiratory illnesses, increased cancer risk, and a significantly skewed sex ratio. Despite numerous environmental infractions and associated health impacts, regulatory enforcement and protections have remained inconsistent. Legal challenges mounted by Aamjiwnaang residents, invoking Charter and constitutional rights, have highlighted the selective application of environmental protections. Although lawsuits brought attention to the issues, outcomes have often been delayed or symbolic, with few systemic changes. Recent incidents, including the 2024 benzene leak from INEOS Styrolution, reinvigorated calls for action. In response, the federal government initiated a pilot project in 2025 addressing environmental racism in partnership with the Aamjiwnaang. This paper explores how Canadian and international legal frameworks, namely, the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), can be employed to uphold environmental justice. Drawing from twelve of the most recent articles about the “Chemical Valley” at the time of writing and five government/Nation reports, we highlight how UNDRIP articles 24.2, 29.2, and 29.3 affirm Indigenous peoples’ rights to health, consultation in legal matters that pertain directly to them, and protection from environmental hazards—rights which have been repeatedly jeopardized for the Aamjiwnaang. We assert that Canadian governments must be continually pressured to enforce and update environmental legislation in order to ensure improved health equity and to uphold Indigenous rights.
The historical narrative of medicine recognizes the connection between public water infrastructure and health outcomes, ranging from antiquity to the present day. Over three thousand years ago, the Indus Valley Civilizations utilized reservoirs and pipes to separate drinking water and wastewater. In Ancient Greece, reference guides for physicians such as the Hippocratic Corpus’ Airs, Waters, Places describe the qualities of natural water sources and their effects on local inhabitants. In comparison to those ancient cultures, Dr. John Snow and his contemporaries traced the cholera epidemics in the latter half of the nineteenth century through London, England via contaminated water wells. At the advent of industrialization, the analytical study of disease and public health by the Victorians brought attention and credibility to water as both an agent for disease prevention and disease transmission. Upon entering the twenty-first century, the connections between physicians, water, and public infrastructure have grown increasingly complex; while sophisticated wastewater tracking is used to predict virus outbreaks, accessibility to clean freshwater is increasingly threatened. This article will examine the enduring connections between clean water and public health, as well as the role of the physician as a health expert and advocate for accessible and durable water infrastructure.
This submission is a commentary, and as per UWOMJ guidelines no abstract must be provided.
