Infective endocarditis (IE) is a serious illness that affects the endocardial surfaces of heart valves, the mural endocardium, and septal defects. It can cause severe complications, such as abscesses, aneurysms, heart failure, renal failure, and sepsis. Right-sided endocarditis is more prevalent in persons who inject drugs, accounting for 10% of all instances of IE. Streptococcus gordonii is a gram-positive bacterium that colonizes the oral mucosa, skin, and gastrointestinal tract. It is an opportunistic pathogen and a rare cause of IE. We describe a case of S. gordonii IE in a 47-year-old man who injected drugs and had a history of prior tricuspid valve IE treated with tricuspid valve replacement and mitral annuloplasty.
UNICEF recently warned that many children and youth in Canada have poor physical health and are struggling to survive. The challenges of income inequality, social exclusion, and poor food quality drive this problem. Physicians can tackle these challenges and boost children’s physical health and survival by working with impacted communities and advocating for policy change. First, physicians should address income inequality by collaborating with other key groups such as social pediatric hubs, social workers, nurses, and food banks, and by advocating for universal basic income to help support families financially. Second, physicians should tackle social exclusion by identifying and remedying direct and indirect forms of discrimination against underserved populations in the healthcare setting, as well as by improving anti-racism education and policies. Finally, physicians should promote food quality by educating the public about quality food resources and collaborating with governments to hold the private sector accountable for food quality deficits.
Nutritional rickets and hypocalcemia are serious but preventable medical conditions with important and potentially long-lasting health implications. Despite well-established recommendations around dietary modification and nutritional supplementation, these diseases remain disproportionately higher among Canadian newcomers. We describe two cases of nutritional rickets and hypocalcemia in adolescent newcomers from East Africa. Both children attended a primary care clinic on arrival to Canada, but neither child was taking appropriate supplementation at the time of diagnosis. Once diagnosed, both patients responded to supplementation but, due to the severity and chronicity of their nutritional deficiencies, required additional medical testing and intervention to achieve adequate management. This case report emphasizes Canadian newcomers as an at-risk group for nutritional rickets and hypocalcemia, and underlines an urgent need for improved awareness, dietary counselling, supplementation, and access to reliable long-term prescription coverage upon arrival to Canada.
Tendinopathies are among the leading causes of Nova Scotia's high rate of disability and the incidence of tendinopathy is increasing in developed nations with aging populations. The considerable impact of tendinopathies may stem from a shortfall of effective treatments. Presently, even the most successful medical interventions cannot fully restore the properties of damaged tendons. This gap signals a need for novel treatments with the potential to improve tissue regeneration. Increased research into treatments involving (i) transcutaneous nitric oxide, (ii) sclerotherapy, (iii) extracorporeal shock wave therapy, (iv) the administration of growth factors, (v) stem cell therapy, and (vi) biomaterials could help reduce individual suffering, strengthen Nova Scotia's workforce, and decrease the portion of the population relying on limited provincial disability payouts and stipends for disabled persons.
The seventh annual Conference of Atlantic Medical Students (CoAMS) was held from April 26-28, 2024, at Dalhousie University in Halifax, Nova Scotia. This student-led initiative brought together over 100 medical students from the four medical school campuses in Atlantic Canada. The goals of the conference were to convene like-minded medical students, encourage networking, stimulate intellectual discourse, and provide learning opportunities through a variety of practical workshops. In this article, we reflect on the importance of this successful weekend to ensure continued enthusiasm for CoAMS amongst medical students in Atlantic Canada.
While the number of females entering medical training has been increasing in recent years, only 30% of surgeons in Canada are women. This discrepancy can be attributed to many aspects, and the lack of representation is a notable barrier that aspiring female surgeons face early in their medical careers. With the growing popularity of virtual platforms, many thread-based discussion websites have placed connecting with like-minded individuals at our fingertips. An accessible platform for women interested in surgery is a natural progression to help bridge the gender gap within the field, and yet it has not been created. While there are many pre-existing women in surgery organizations that promote a mentorship ideology, accessibility is limited by membership fees. A completely free, thread-based platform that connects both prospective and current women in surgery may serve to advance the field through the lens of diversity and collaboration.
Medical students need to begin to learn how to innovate earlier in their training. Hackathons offer opportunities to foster innovation in healthcare. We launched a hackathon for medical students to generate solutions to a real-world surgical problem. We focused on generating solutions to better support more women in surgery, an area of medicine where women remain underrepresented. The goal of our event was to not only generate solutions at a systemic level but within our own medical school, break down barriers for female medical students by allowing them to network with Dalhousie surgeons and better explore potential career goals by attending the event. Attendees reported the event provided an opportunity to build problem solving skills, communication skills and the opportunity to network with like-minded peers. Our hackathon supported idea generation however further emphasis on translation of solutions from idea generation to implementation within our healthcare system is needed.
Objectives: Some evidence suggests that infants born at later gestational age (GA) are at higher risk of developing neonatal abstinence syndrome (NAS). This systematic review estimated the association between GA at delivery and development of NAS in infants born to women on opioid agonist therapy (OAT). Methods: MEDLINE/PubMed, Scopus, Embase, CINAHL, and the Cochrane Central Register of Controlled Trials were searched from January 2000 to April 2023. Studies reporting data on the association between GA and NAS among pregnant women being treated with OAT were eligible for inclusion. Random effects meta-analysis was used to estimate the mean difference in GA between infants affected by NAS and unaffected infants; odds ratio (OR) for the association between preterm birth and NAS; and OR for the association between gestational week and NAS. Results: Of 966 records identified, 38 studies were eligible for this review. The pooled mean difference in GA between infants affected by NAS and unaffected infants was 0.62 weeks (95% CI: 0.08–1.16, I2=90.7%). The odds of developing NAS were estimated to increase by 3% per gestational week (OR 1.03, 95% CI: 0.997-1.06, I2=84.2%). The OR for the association between preterm birth and developing NAS was estimated to be 0.87 (95% CI: 0.63-1.21, I2=85.7%). Conclusions: The data included in this review demonstrate that higher GA is unlikely to be associated with an increased risk of NAS, although poor study quality and significant study heterogeneity were observed.
Background: Women represent over 50% of medical school classes in Canada, yet only 36.8% of surgical residency applicants identified as female from 1995-2019. One potential explanation for this discrepancy is the lack of work-life balance. Job sharing is an alternative work schedule in which two employees share the responsibilities of one full-time job. Although job sharing is not common in medicine, it may provide a solution to this issue. This paper proposes the implementation of job sharing to increase women representation in surgical specialties and discusses the benefits it would provide to patients, physicians, and the healthcare system. Methods: The authors developed a pitch for job sharing in medicine after conducting a review of the literature as part of their participation in the Cutting Edge Womxn in Surgery Hackathon at Dalhousie University. Results: Job sharing has been successfully implemented in other industries and could have numerous benefits in medicine, such as preventing burnout and increasing women representation in surgical specialties. Physicians who practice job sharing report feeling supported while having improved work-life balance. Conclusion: Job sharing is a promising solution to increase women representation in surgical specialties and prevent burnout among physicians. The implementation of job sharing would benefit patients, physicians, and administration. By targeting excessive workload and promoting work-life balance, physicians can feel more satisfied in their roles and provide higher quality care to their patients. Job sharing warrants further exploration as a potential solution to the underrepresentation of women in surgical specialties and the burnout epidemic in the medical profession.
Background: The Child and Family Traumatic Stress Intervention (CFTSI) is an evidence-based early intervention shown to reduce post-traumatic stress in children and adolescents. This intervention has not been explored in the context of the Canadian healthcare landscape, and more specifically at Child and Youth Advocacy Centres (CYACs); multi-disciplinary service hubs who serve those exposed to trauma. Objective: Examine the feasibility and usefulness of the CFTSI in the context of Canadian CYACs. Methods: A mixed-methods design was utilized, consisting of a validated, nationally distributed online survey which served as an environmental scan, and key informant interviews, which were thematically analyzed. Results: 15 of 29 invited centres participated. Prior to this study, six of 15 respondents had been aware of the CFTSI. Furthermore, two participants reported current use of the CFTSI. Of the 13 centres not using it, 10 expressed that the CFTSI would be an acceptable and relevant intervention at their centre, and there was significant interest in possible future implementation. Interviews with experienced clinicians revealed benefits and challenges of the CFTSI’s format, and the influence of family structure, culture and trauma history on outcomes. Finally, some considerations specific to Canadian centres were uncovered and direction for future research suggested. Conclusion: Our findings collectively underscore the potential of the CFTSI to bolster mental health services, which are a priority area requiring improvement at Canadian CYACs. Additionally, this study highlights benefits and challenges relevant to Canadian practice and wide-spread implementation of the CFTSI in this country.
A 10-month-old infant with Prader-Willi Syndrome presented with a 7 month history of increased work of breathing, wheeze, inspiratory crepitations, and mild hypoxemia. Subsequent investigations including chest CT suggested the diagnosis to be neuroendocrine cell hyperplasia of infancy (NEHI). NEHI is a rare cause of children’s interstitial lung disease. Childhood interstitial lung disease should be considered in an infant with persistent tachypnea, crepitations, and hypoxemia.
This case report describes a 32-year-old female who presented with severe dyspnea and exertional intolerance to an emergency department in a rural area of Nova Scotia. The diagnosis was made by corroborating the value of the erythrocyte sedimentation rate, the level of N-terminal prohormone of brain natriuretic peptide, and a transthoracic echocardiogram, which respectively showed an inflammatory pattern, myocardial strain, and classic sonographic findings consistent with constrictive pericarditis. The patient was treated with oral colchicine, naproxen, and prednisone resulting in complete resolution of laboratory and sonographic abnormalities. Availability of echocardiography in a rural setting can promptly and definitively diagnose and rule out many structural and functional disorders of the heart, including rare pathologies such as constrictive pericarditis.
A trip to any emergency department (ED) across the country is usually associated with long wait times that can sometimes stretch over a full day or a night. Recently, wait times have been increasing to a distressing rate and emergency medicine teams having been sounding the alarms. Despite the growing population and the increased demand on emergency departments due to the extreme shortage of family physicians, emergency medicine remains under serviced1. While doctors, nurses and the entire interprofessional health team continue to deliver their best efforts to care for patients in timely matter, the lack of resources and space hurdle their efforts. The impact of ED wait times begins with a concerning percentage of patients leaving without being seen by a healthcare team member. A cohort study from the major emergency departments in Ontario showed that 4.2% of patient visiting EDs across Ontario between 2003-2007 left without being seen2. The same study showed that longer wait times were associated with higher risk of adverse events and/or being admitted to the hospital. Depending on the acuity of the presentation, wait times can vary significantly with higher acuity patients typically seen sooner. However, resources do not exist to monitor patients’ conditions during extended wait times, and changes in acuity have become an increasing issue. Finally, the location of emergency departments contributes to different wait times. A retrospective study of wait times in rural and urban EDs in Ontario revealed that rural emergency departments tend to have shorter wait times3. However, it is important to highlight that large urban centers regularly receive higher acuity transfers from smaller rural EDs which contribute to increasing wait times. Several strategies have been proposed to reduce wait times in EDs. These strategies have been mostly focused on increasing the capacity, decreasing wait time for results after intake and decreasing intake. Several trials across the country showed some degrees of success of these strategies including introduction of satellite health clinics for patients returning to the ED for follow up in British Columbia4. A similar study conducted in Saskatchewan showed a positive impact of the reduction of physician reassessment time on wait times in the ED5. Finally, a study by Wong et al. showed that many patients prefer to access after-hours family medicine practices over EDs, therefore reducing the demand of patients with lower acuity presentation on EDs6. Despite these proposed solutions, wait times continue to increase in EDs across the country. The response to this demand continues to fall short and a system-wide solution is increasingly needed to enhance patient outcome and prevent physician burnout.
The slit lamp is an essential tool for the diagnosis of common eye pathology. Despite many eye conditions presenting initially to primary care, medical students do not typically receive formal training with the slit lamp in standard medical education curriculum. This guide provides a consistent, systematic framework that may be used by students and clinicians when approaching a slit lamp examination. Additionally, suggestions intended to optimize examination outcomes are described. It is our hope that this guide serves to enhance medical student comfort and proficiency with eye examinations, be it in an ophthalmology clinic, primary care, or emergency department setting.
Anthracycline induced cardiotoxicity is a well-recognized complication in pediatric oncology. The use of the cardio-protective drug dexrazoxane has gained traction despite its unclear efficacy and toxicity. A retrospective, population-based study was completed using chart and database information on children treated with anthracycline at the IWK Health Centre from 2009-2015 (n=178). The efficacy of dexrazoxane was defined as a lack of undesirable deviations in identified cardiac parameters on echocardiogram. Toxicity of dexrazoxane was defined as chemotherapy delays from any of decreased absolute neutrophil count (ANC), decreased platelets, increase in viral/bacterial episodes and febrile neutropenia (FN) episodes. Patients were stratified into groups based on the total amount of anthracycline received and whether they received dexrazoxane. Regardless of anthracycline dose, we found no significant relationships regarding cardiac function in the untreated and dexrazoxane treated groups. However, we found that patients who were treated with >250mg/m2 of anthracycline and received dexrazoxane experienced significantly more platelet delays but no cardiac benefit (p=0.007). When classified by diagnosis, we also found that dexrazoxane treated patients diagnosed with low-risk acute lymphocytic leukemia (LR-ALL) were likely to experience a delay in treatment due to both low ANC (p=0.0001) and the development of FN (p=0.02) whereas high-risk acute lymphocytic leukemia (HR-ALL) patients were likely to experience treatment delays due to thrombocytopenia (p=0.03), low ANC (p=0.0001) and FN (p=0.0001). Despite finding no significant differences regarding the efficacy of dexrazoxane as a cardio-protectant, we have shown that its use induces non-cardiac toxicities in children with cancer that contribute to treatment delays.
