Introduction Obesity and type 2 diabetes mellitus management have been transformed by the emergence of incretin-based therapies, such as dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. While these agents facilitate significant weight loss, traditional metrics like body mass index fail to distinguish between the loss of metabolically active visceral fat and the potentially detrimental depletion of lean body mass. This review examines the role of radiology in monitoring the physiological transformations induced by these medications. Methods This narrative review involved a comprehensive search across University of Toronto Library, PubMed, and Google Scholar to investigate the radiological manifestations and complications of incretin therapy. From an initial 210 records, 34 research studies were included after screening for key themes in body composition, gastrointestinal safety, and imaging modalities, including computed tomography, magnetic resonance imaging, and ultrasound. Results The analysis focuses on imaging-based evidence regarding changes in subcutaneous and visceral adipose tissue, alongside the preservation of skeletal muscle integrity. Radiological measurements can fill an unmet need to monitor metabolic health and body composition changes in individuals who require pharmacological intervention. Furthermore, this review identifies imaging markers for treatment-related complications and perioperative applicability. Conclusion Ultimately, this review advocates for a shift from weight-centric to composition-centric management. By integrating computed tomography, magnetic resonance imaging, and ultrasound into clinical workflows, clinicians can objectively quantify tissue quality and distribution. This holistic approach, combining pharmacological intervention with precision imaging and structured nutritional support, ensures that pharmacologically induced weight loss optimizes long-term functional health and patient safety.
This narrative review examines recent scholarship addressing medical trainees from non-traditional science, technology, engineering, and math (STEM) backgrounds and considers how interdisciplinary expertise may influence contemporary medical practice. Recent literature describes increasing recognition of alternative pathways into medicine as clinical care intersects more frequently with quantitative methods, systems thinking, and implementation-focused problem solving. This shift reflects convergence across disciplines and the potential value of combining complementary skill sets to improve patient care and strengthen health system performance. Engineers, for example, bring structured problem solving, quantitative analysis, and technical expertise that can support innovation and interdisciplinary collaboration (Bahadori et al., 2020; Bajwa et al., 2021). However, the transition into medicine from these non-traditional STEM fields is not without challenges. Some entrants may have less exposure to foundational medical sciences. These professionals may lack familiarity with essential subjects like anatomy, physiology, and pharmacology, which are integral to medical practice. Furthermore, the journey involves a significant investment of time and finances, as these professionals often need to complete additional coursework or preparatory programs to meet medical school requirements. Biases against non-traditional applicants may also influence admissions and evaluation. This article examines the benefits and drawbacks of pursuing medicine with a non-traditional STEM background, and it considers how interdisciplinary expertise shapes medical practice and innovation in healthcare. It also discusses implications for admissions, curriculum reform, and institutional support as healthcare continues to evolve.
Growth charts and developmental milestones are ubiquitous tools amongst pediatric care, too readily utilized as objective measures of a child’s health and development. Yet these instruments are not value-neutral – they are products of specific cultural, historical, and socioeconomic contexts, many of which uphold Western and middle-class norms. From motor developmental milestone schedules to speech expectations, what becomes "normal" is too routinely determined without regard for global and cultural diversities of the child. This commentary aims to present some of the origins and applications of growth standards, highlighting how these could give rise to medical overdiagnosis, cultural misinterpretation, and structural inequalities – and most particularly so for Canadian and other immigrants, First Nations, and racialized populations. Drawing on pediatric anthropology, cross-cultural studies, and public health, we document how culturally diverse childcare, language learning, and socialization practices challenge the universality of existing norms. We argue that rigid adherence to standardized milestones risks pathologizing normal variation and eliminates the rich developmental variations amongst children. As a field, pediatrics should transition toward culturally sensitive, equity-informed approaches that embrace, rather than correct, differences. We make a simple call to action: it is time to revolutionize how we define, quantify, and operationalize “normal” to provide more inclusive childcare.
Pediatric fear is too often dismissed as incidental or behavioural, when in reality, it reflects deeper relational, environmental, and systemic issues embedded in the healthcare experience. Drawing from personal experience, psychological theory, and current clinical literature, this commentary reframes pediatric fear – whether stemming from white coat syndrome, needle-related fear, or separation anxiety – not as irrational overreaction, but as a learned, conditioned response shaped by early encounters with medicine. These fears, frequently dismissed as temporary, carry tangible consequences – ranging from inaccurate clinical assessments and procedural avoidance to long-term impacts on trust, treatment adherence, and future engagement with healthcare. This commentary highlights how caregiver emotion, attachment styles, and racialized assumptions can amplify distress, while pointing to evidence-based interventions such as the Comfort, Ask, Relax, Distract (CARD) system, therapeutic play, and language reframing to reduce anxiety. This perspective also contends that pediatric fear must be recognized as a public health consequence in and of itself – one with physiological, emotional, and intergenerational consequences. Clinical environments must be considered not merely as settings for symptom management, but as spaces that actively foster emotional safety for children and families. To achieve this would transform pediatric practice from simply responding to fear toward first asking not only how to soothe it, but why such fear appeared inevitable in the first place.
Background Understanding the perspectives of Canadian residency Program Directors (PDs) on workforce trends is vital for career guidance and healthcare planning. Methods A nationwide cross-sectional survey of 227 PDs from all medical schools and specialties was conducted in 2022. Response rates were 23% (Royal College of Physicians and Surgeons of Canada) and 24% (College of Family Physicians of Canada). Results Surgical specialties were reported as the most competitive, with continued increases predicted. Medical and Primary and direct-entry specialties had the most favourable job prospects, while surgical and pediatric specialties showed poorer outlooks, often requiring further training or locum work. Retention varied by province, and PDs identified rising healthcare needs and physician retirements as key employment factors. Conclusions This study highlights the mismatch between training pathways and job market realities. Findings can inform physician career counseling and policymaking, emphasizing the need for targeted workforce planning responsive to evolving healthcare demands.
Congenital midline sinus at the columellar base is extremely rare with no well-established incidence; only a few cases have been reported in individual case reports and small series describing nasodermal sinus cyst. Various theories and hypotheses have been proposed, but etiopathogenesis remains uncertain. We report a case of a 3-year-old boy who presented with a sinus opening at the base of the columella since birth associated with minimal, clear, watery discharge following cry and upper respiratory tract infection. Magnetic Resonance Imaging (MRI) scan showed a sinus tract with an opening at the base of the columella of the nose, extending into and ending in the nasal septum measuring 3.5cm in length. Preoperative imaging prior to any surgical intervention is recommended to assess for other associated anomalies in the surrounding structures and to exclude intracranial extension of the sinus tract. Surgical excision was offered; however, the patient’s parents opted for conservative management and follow-up due to the minimal symptoms.
Temporal bone squamous cell carcinoma is a rare, aggressive malignancy often misdiagnosed due to its nonspecific symptoms resembling chronic ear infections. Malignant transformation from long-standing cholesteatoma, though rare, has been reported. Early diagnosis remains challenging due to the tumour’s deep location, histological heterogeneity, and biopsy limitations. A 61-year-old man with a history of childhood cholesteatoma surgery and chronic otorrhea presented with a postauricular ulcer and severe otalgia. Initial biopsy of an external auditory canal mass was inconclusive, delaying diagnosis. Imaging revealed extensive temporal bone destruction and a temporal lobe abscess. A repeat biopsy confirmed temporal bone squamous cell carcinoma, with metastatic spread to the lungs and liver. He received palliative chemotherapy but succumbed to the disease. Chronic inflammation from cholesteatoma may contribute to malignant transformation. Tumour-related inflammation, anatomical constraints, and histological heterogeneity complicate diagnosis. Multiple biopsies are often required, but false negatives are common due to sampling challenges. Advanced imaging techniques, such as apparent diffusion coefficient mapping, may improve lesion characterization and biopsy accuracy. This case highlights the difficulty of diagnosing temporal bone squamous cell carcinoma in patients with chronic ear disease. Persistent otorrhea and otalgia should prompt heightened clinical vigilance. Early intervention, multidisciplinary management, and integrating advanced imaging techniques could facilitate timely diagnosis and improve outcomes.
We are pleased to introduce Volume 103 Issue 2 of the University of Toronto Medical Journal (UTMJ): The Incretin Effect. A natural phenomenon first observed in the early 20th century, the incretin effect has been leveraged to drive the advent of therapies which have transformed the care of patients with metabolic disease and beyond. Since their clinical introduction, these therapies have transcended traditional boundaries in medicine and are continuing to do so rapidly. This era of incretin-based therapies is unprecedented; it represents the brilliance and creativity of leading minds in science, and also marks an important time to center intersecting social determinants of health in academic discourse.
Background Sublingual hematoma, or pseudo-Ludwig’s angina, is a rare but potentially life-threatening condition that mimics Ludwig’s angina. Prompt differentiation between hemorrhagic and infectious etiologies of floor of mouth swelling is crucial for appropriate airway and therapeutic management (Baharloo et al., 2020; Cheng et al., 2021; Marin et al., 2020). Case report We report the case of a 19-year-old male who sustained mandibular trauma in a motor vehicle accident. He presented with progressive submental swelling, muffled voice, and elevation of the tongue, raising suspicion for Ludwig’s angina. Imaging revealed mandibular symphysis and condylar fractures with sublingual hematoma, but no evidence of abscess or gas formation. Flexible endoscopy showed posterior tongue displacement without laryngeal involvement. The patient was managed conservatively with corticosteroids, antifibrinolytics, and antibiotics. Airway intervention was not required. Definitive surgical fixation of mandibular fractures was performed after clinical stabilization. The hematoma resolved completely without complication. Discussion This case highlights the diagnostic challenge in distinguishing pseudo-Ludwig’s angina from true deep neck infections. While both conditions may present with similar clinical findings, imaging and endoscopy play vital roles in guiding management (Alamoudi & Hariri, 2022; Brotfain et al., 2012). Unlike Ludwig’s angina, sublingual hematomas often respond to conservative therapy and rarely necessitate surgical airway intervention unless rapidly expanding or causing obstruction (Lovallo et al., 2013). Conclusion Sublingual hematoma secondary to mandibular trauma should be considered in the differential diagnosis of floor-of-mouth swelling. Early imaging and interdisciplinary evaluation are essential to avoid misdiagnosis and unnecessary invasive procedures.
Type 2 diabetes (T2D) is a heterogeneous metabolic disorder with diverse etiologies, clinical trajectories, and treatment responses. Traditional management strategies adopt a one-size-fits-all approach, primarily focused on lowering hyperglycemia, but this paradigm overlooks important inter-individual differences that influence outcomes and long-term complications. Recent advances in systems biology and computational analytics have enabled novel approaches to disease subtyping, with the aim of stratifying patients into biologically and clinically meaningful groups. This narrative review synthesizes current evidence on clustering methods applied to T2D subtyping. Hard clustering approaches, such as k-means and hierarchical clustering, have most often been used to define phenotypic subtypes based on clinical traits, including age of onset, body mass index, insulin resistance, and beta (β)-cell function. While these models provide discrete categories that can be easily interpreted, they may oversimplify disease heterogeneity. In contrast, soft clustering techniques, including archetype analysis and latent class models, allow individuals to exhibit characteristics across multiple clusters, reflecting overlapping biological pathways. Genetic clustering has further revealed stable, mechanistically distinct endotypes, with potential to guide treatment selection and refine risk prediction. The clinical translation of T2D subtyping holds promise for tailoring interventions to underlying pathophysiology, improving therapeutic efficacy, and reducing adverse outcomes. However, challenges remain, including validation in diverse populations, cost-effectiveness considerations, and the need for prospective clinical trials stratified by subtype. Subtyping represents an important step toward precision medicine in T2D, with the potential to transform clinical care from uniform management to individualized treatment strategies.
Precision medicine seeks to tailor care such that patients receive individualized treatment based on their specific presentation, biology, and risk factors. Artificial intelligence, defined as the field of computational systems that perform tasks requiring human-like intelligence, such as prediction, pattern recognition, and decision-making, is revolutionizing precision medicine through enhanced diagnostic accuracy, optimized treatments, and improved health outcomes. However, the benefits of artificial intelligence can only be realized if clinicians understand the technology’s limitations and strengths, and if developers appreciate the clinical, systemic, and workflow contexts in which their tools were developed and will be introduced. Without this mutual understanding, risks include automation bias, exacerbations of existing healthcare inequities, breaches of patient privacy, and ethical dilemmas that may erode trust in healthcare systems. To address these challenges, the Temerty Centre for Artificial Intelligence Research and Education in Medicine at the University of Toronto has developed an interdisciplinary educational team and mandate. The mandate is organized into three guiding domains—principles, topics, and methods—that together provide a structured yet adaptable approach to artificial intelligence education. This commentary presents the rationale for this mandate and discusses its implications for precision medicine. Central to the mandate are commitments to formal, integrated training across disciplines, an emphasis on the ability to critically appraise artificial intelligence tools, and the delivery of interactive, evolving educational programs that are tailored to professional roles. As artificial intelligence continues to shape the landscape of healthcare, interdisciplinary and adaptive education will be critical to ensuring ethical artificial intelligence deployment and use, continued patient-centered care, and personalized medicine.
Canada faces a critical paradox in healthcare: while physician shortages escalate, thousands of qualified, internationally trained medical graduates (IMGs) residing in Canada remain sidelined. This underutilization of talent persists despite the rising demand for doctors, particularly in rural and underserved regions. Structural barriers such as restrictive residency quotas, inconsistent provincial licensing systems, and concerns about training variability impede IMG integration. Although IMGs undergo rigorous credential assessments, bridging programs, national licensing exams, and supervised practice readiness pathways, they remain disproportionately excluded from licensure compared to Canadian medical graduates (CMGs). Critics often cite issues of patient safety, communication barriers, and legal liability; however, evidence indicates that IMGs who pass Canadian regulatory filters perform comparably to domestically trained physicians. Programs like Practice-Ready Assessment (PRA) and national exams ensure competency and support public trust. Furthermore, language proficiency and cultural training are now mandatory in many provinces, facilitating equitable care delivery. Despite these safeguards, IMGs are restricted to less than 10% of residency positions, contributing to underemployment and exacerbating physician shortages. Policy reforms such as expanding residency capacity, implementing alternative licensure pathways, and recalibrating perceptions of IMGs can bridge the workforce gap without compromising quality or fairness. This commentary suggests that leveraging IMGs is a practical strategy for sustainable healthcare delivery. Embracing IMG integration upholds Canada’s multicultural identity and enhances the health system’s resilience. With thoughtful policy design and cultural change, Canada can convert this latent talent into a driving force for equitable, high-quality care nationwide.
Background Agitated adult trauma patients are common in Canadian emergency departments. Cooperation and monitoring constraints can delay essential imaging and risk missed injury. Objective To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation. Methods Narrative review using targeted searches of guideline/agency sources and peer-reviewed trials/meta-analyses on agitation control, extended Focused Assessment with Sonography in Trauma (eFAST), and selective versus whole-body computed tomography (CT). Outputs were a conceptual evidence map and a worked case. Results Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST-positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioural control creates a one-trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up-front imaging approach: selective CT once cooperation returns and injuries localize, or whole-body CT when multi-region injury is likely or unreliability persists. The scanner-side bundle includes named monitoring responsibility, an airway plan, and dose-optimized protocols. Downstream steps include interventional radiology--supported non-operative strategies for eligible solid-organ injury, a 24-48 hour tertiary trauma survey, and a structured psychiatry handoff to limit re-sedation. Conclusions In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline-aligned behavioural control may improve safety and throughput. For clinicians, the framework clarifies roles. For patients, it may shorten time to definitive imaging and reduce complications. Prospective, multi‑centre evaluation aligned with local policy is needed to measure effects on time‑to‑CT, adverse events, and missed injuries.
Purpose Insulin resistance (InRs) and oxidative stress (OS) have been linked to diabetic complications. Additionally, patients with diabetes mellitus (DM) may develop hepatic problems, which may be attributable to the treatment or the disease itself. Therefore, a therapeutic strategy that halts InRs and OS, while protecting the liver, is crucial. This study aims to investigate the effects of the addition of dapagliflozin to metformin on InRs, glycemic control, OS, and liver function in patients with type 2 DM. Methods This retrospective cohort study enrolled 117 participants in Mosul, Nineveh province, Iraq, from October 2023 to April 2024. This sample was comprised of three groups. The control group included 48 healthy individuals; the metformin group (DM+MET) included 39 patients, and the metformin and dapagliflozin group (DM+MET+DAPA) included 30 patients. Results The DM+MET+DAPA group was associated with higher serum insulin and InRs than the DM+MET group (p<0.001 and 0.05, respectively). Dapagliflozin was not associated with disruption of liver function tests. Conversely, a significant decrease in AST levels (p<0.01) was observed compared to metformin alone. Analysis of OS markers revealed a significant increase in malondialdehyde level and a decrease in total antioxidant capacity (p<0.01) in dapagliflozin users compared to the DM+MET group. Conclusion Adding dapagliflozin to metformin did not improve insulin sensitivity in patients with type 2 DM who are beyond the early stage of the disease, possibly due to deteriorated OS. However, the apparent reduction in AST and neutral effect on other liver function parameters suggest dapagliflozin as an add-on therapy to metformin in diabetic liver diseases. However, prospective validation of these results is warranted.
Background As an academic teaching hospital and Learning Health System (LHS), Women's College Hospital (WCH) is building education scholarship (ES) capacity to improve its health professions education. We assessed WCH ES projects to establish an activity baseline and inform these efforts. Methods We retrospectively reviewed ES projects in WCH's Research Ethics Board (REB) and Assessment Process for Quality Improvement Projects (APQIP) databases from January 2019 to December 2024. Thematic and numerical analyses characterized ES activities. Results From a total of 1,137 REB and APQIP submissions (913 and 224 respectively), 234 ES projects were retrieved and 47 underwent data extraction. Most submissions were MD-led (32/47, 68%), while projects led by other professions increased from 1 in 2019 to 4 in 2024. APQIP ES submissions increased from 1 to 11 between 2019-2024. Program development/evaluation (40%) and needs assessments (40%) were the majority of innovation and research submissions, respectively. Most submissions were survey (16/47, 34%) and mixed methods studies (8/47, 17%). Physicians and trainees (26/47, 55%) were most frequently the primary educational target audience, with family medicine (9/26, 35%) being the most prevalent target specialty. Conclusion Study findings suggest ES submissions are increasing and analyzing submission data is a useful metric to inform initiatives to track and augment ES productivity, enhance ES capacity, and build an ES community of practice.
We present a rare case of a 39-year-old male with metastatic nodular melanoma arising from a longstanding chest wall lesion. Initially noted in childhood as a 1 & times; 1 cm swelling, the lesion remained quiescent for decades before undergoing rapid enlargement and ulceration following blunt trauma during a futsal game. Examination revealed a fungating mass measuring 12 & times; 12 cm with axillary lymphadenopathy. Contrast-enhanced computed tomography revealed a polypoidal mass confined to the cutaneous layer without muscle or thoracic involvement, with indeterminate findings in the lung and liver. The patient underwent wide local excision with a 2 cm margin, axillary lymphadenectomy, and reconstruction with a pedicled transverse rectus abdominis flap. Histopathology confirmed nodular melanoma with a Breslow thickness of 30 mm, Clark level V, lymphovascular invasion, and metastatic spread to three lymph nodes (tumour-node-metastasis stage pT4b pN2b). This case illustrates the potential role of trauma in accelerating melanoma progression and emphasizes the importance of aggressive management for advanced melanoma with atypical presentations.
Lung cancer is a leading cause of cancer-related mortality globally, with most patients being diagnosed at advanced stages. While bone metastasis is common, the presentation of a solid long bone tumour as the first sign of lung adenocarcinoma is unusual. This single-case report describes a 66-year-old female who presented with gradual onset of right knee pain following a fall six months ago. Magnetic resonance imaging (MRI) of the right knee revealed a destructive lesion at the distal femur. Bone biopsy confirmed metastatic adenocarcinoma originating from the lung, with epidermal growth factor receptor (EGFR) exon 19 deletion gene mutation identified. The patient showed significant improvement following a combination of targeted therapy and radiotherapy. Follow-up computed tomography (CT) revealed a reduction in the size of the primary tumour and regression of the bone lesion, rendering the patient symptom-free.
Background Widespread inequities persist in health services, education, and research. There is therefore a growing need to support health education students in understanding and engaging in anti-oppressive research and initiatives. However, few studies explore factors that support learners in applying an anti-oppressive lens to their scholarly and community engagement efforts. With the goal of empowering learner-led interventions, students organized the "2021 Anti-Oppression in Health Care and Sciences Learner-Led Symposium," inviting University of Toronto Faculty of Medicine learners to present their work. This study explores the perspectives of health education students on the impact of a learner-led symposium on anti-oppression in health care and sciences. Methods This study uses a qualitative evaluation approach within a constructivist paradigm. Semi-structured interviews with student symposium attendees were conducted. Transcripts were analyzed using descriptive thematic analysis. Results Analysis of eight interviews revealed that respondents face barriers in their educational environments that reduce student engagement in anti-oppressive initiatives and research. The Symposium helped to address these barriers by providing supportive communities with a shared understanding of anti-oppression, enabling interdisciplinary dialogue, creating a safer anti-racist space, and formally acknowledging the value of student-led anti-oppression work. Conclusions The Symposium helped to mitigate barriers to engaging in anti-oppressive research and initiatives for the interviewed students. Continued annual anti-oppression symposia held by the faculty are recommended. Further research is needed on broad, long-term strategies and structural changes to better support student anti-oppressive research and initiatives.
Congenital sternoclavicular dermoid sinus, also known as sinus sternoclavicularis, is a rare congenital head and neck lesion commonly found adjacent to the level of the sternoclavicular junction. It has a left-sided predominance and typically presents as a cutaneous pit that may discharge or, in some cases, develop into an abscess. Sinus sternoclavicularis has been reported to be a part of the fourth branchial sinus anomaly. The fourth pharyngeal sinus accounts for 1-2% of branchial cleft anomalies and classically presents with a sinus opening, cystic swelling, fistula, thyroiditis or thyroid abscess. Treatment typically entails the excision of the whole fistula tract following imaging. Our case entails a toddler who presented with recurrent discharging sinus and swelling over the sternoclavicular region and her management. We advocate early surgical intervention, including excision of the sinus tract, to prevent scarring and tissue adhesion.
Hidradenocarcinoma is an exceptionally rare malignancy of skin appendages, often posing significant diagnostic challenges. We report the case of a young woman presenting with a right-sided neck swelling, five months after excision of a scalp mass that was initially diagnosed as a benign nodular hidradenoma. Biopsy of the neck lesion reported as metastatic carcinoma, prompting a re-evaluation of the scalp specimen. A second diagnosis of hidradenocarcinoma was made. The patient underwent a modified radical neck dissection followed by adjuvant radiotherapy. This case underscores the importance of revisiting histopathological diagnoses in cases of regional malignancy and highlights the critical role of a multidisciplinary approach in managing rare skin appendage tumours.
