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.
