UBC Medical Journal

Rapid induction of buprenorphine/naloxone from methadone using a micro-dosing approach for opioid use disorder treatment in an inpatient setting: a case report

Hannah James — 2021-11-07

Background and purpose: Opioid agonist therapies such as methadone and buprenorphine/naloxone (BUP/NX, trade name: Suboxone) are essential treatment options for those with opioid use disorder. Markedly different pharmacological properties between the two treatments render the transition from methadone to first-line BUP/NX opioid agonist therapy challenging. Current guidelines recommend complete cessation or tapering of methadone before starting BUP/NX induction to prevent the onset of precipitated withdrawal. However, cessation or tapering of methadone is often poorly tolerated by patients.

Methods: Clinical Case Report

Results: This case describes a patient who was successfully transitioned from methadone to BUP/NX using a rapid five-day micro-dosing induction technique that required no preceding cessation of methadone and caused no clinically significant precipitated withdrawal symptoms during treatment.

Conclusion: This case report presents a novel case which until now, has not been described in the literature and provides an approach to address shortcomings in current BUP/NX induction guidelines.

A mixed presentation of septic pelvic thrombophlebitis: A case report

Gabriel Ning Chan — 2021-11-07

Background: Septic pelvic thrombophlebitis (SPT) is a rare postpartum complication that is often difficult to diagnose and can be life-threatening. There are two types of clinical presentations of SPT described: ovarian vein thrombosis (OVT) and deep septic pelvic thrombosis (DSPT).

Case: Here we present a case of a 26-year-old woman who presents 13 days postpartum with a mixed picture of OVT and DSPT. She presented to our hospital with fever and abdominal pain with extensive laboratory work-up that did not identify a cause. She was treated with antibiotics and anticoagulation and made a full recovery.

Conclusion: This case highlights the various ways in which SPT can present, complicating the diagnosis. This is of particular importance given that SPT is a predominantly clinical diagnosis.

Medicine of the Future

Emily Leung — 2021-11-07

Antihypertensive therapy in acute ischemic stroke

Alexander Friedmann — 2021-11-07

Ischemic stroke causes an acute hypertensive response in 60–80% of patients and is independently associated with poorer functional outcome. Despite the many advances in acute ischemic stroke (AIS) management, the use of antihypertensive therapy remains a controversial topic lacking consensus in several clinical settings. The use of antihypertensive agents and approach to blood pressure (BP) management will be discussed in the context of patients who are ineligible for acute reperfusion therapies and patients eligible for thrombolytic and endovascular reperfusion therapies. Consensus guidelines recommend active treatment for BP greater than 220 mmHg systolic, or 120 mmHg diastolic, unless the patient receives a thrombolytic in which case BP must be maintained below 185/110 mmHg. For endovascular therapy, it is recommended to reduce SBP to 140–180 mmHg. Intravenous labetalol and dihydropyridine calcium channel blockers (nicardipine and clevidipine) are good choices for therapy as they result in less BP variability, resulting in better outcomes.

Dyspepsia: a review of investigations and management for pre-clinical medical students

Igor Sljivic — 2021-11-07

Dyspepsia is a common symptom encountered in the community setting with a large differential diagnosis and a heterogeneous pathophysiology. Due to its prevalence, dyspepsia is responsible for substantial health care costs in Canada and significantly affects quality of life. We present here a practical, evidence-based approach to dyspepsia with the goal of providing medical students with efficient guidelines to develop effective investigation and treatment plans in a clinical setting.

A literature review of impact of social determinants of health on preventative oral health program design in remote communities: A focus on Spiti Valley, India

Shiny Sachdeva — 2021-11-07

Background and purpose: Dental caries is the most prevalent pediatric illness worldwide. It results from a complex interplay between biological and social determinants of health (SDH). The purpose of this review is 1) to understand the social determinants of health impacting dental caries burden in remote communities, using Spiti Valley, India as an example; 2) to understand the importance of using SDH to inform preventative oral health program (OHP) design, and lastly; 3) to provide best practice guidelines for implementing OHPs in remote communities worldwide.

Methods: MEDLINE and PubMed databases were searched for English-language articles describing oral health programs implemented in remote communities around the world. Articles pertaining to OHPs that used preventative interventions to address pediatric dental caries in remote communities were included. Articles were excluded if the study sample included special needs children, and if the program lacked preventative interventions.

Results: Remote communities around the world share many SDH factors, such as low income, limited education, limited availability and access to oral healthcare services, nutritious foods, clean water, and electricity. These factors are key to informing OHP design, and when addressed appropriately, can reduce a community’s dental caries burden.

Conclusion: There is a continued need for preventative OHPs in remote pediatric caries burden remains high despite caries prevention strategies, that continue to contribute towards dental caries formation.

Advancing the treatment of opioid use disorder in British Columbia

Paxton Bach — 2021-11-07

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Same disease, similar measures, varied outcomes: Research to improve understanding of why results in curbing COVID-19 have been so different across jurisdictions around the world?

Peter Berman — 2021-11-07

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The medicine of the future in the light of a pandemic and a hidden pandemic

Reinhard Michael Krausz — 2021-11-07

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Gender affirming surgery: The future lies in data

Emma Loy — 2021-11-07

In 1957, a great plastic surgeon wrote on gender-affirming surgery, "The surgeon is concerned with the plastic provision of a functioning organ of reasonable form ... The ethical problem of thus directing gender must, in the first instance, rest with the philosopher."¹ Since then, the philosophers have spoken, and the verdict is out: gender-affirming surgery is shown to alleviate some or all of the stress associated with gender dysphoria.² The field of gender-affirming surgery has a rich history of progress, but the field lags due to a lack of high-quality research on surgical techniques and outcomes data.

An interview with Dr. Jerilynn Prior: progesterone and the future of women’s health research

Sewon Bann — 2021-11-07

Women’s health research and education covers a wide variety of health concerns and often estrogen is the focus in understanding and treating these conditions. Progesterone, however, plays an essential and often underrepresented role in the complex system of women’s reproductive health. In this article, we learn about progesterone from Dr. Prior, an international expert in the endocrinology of women’s reproduction whose lifelong research has helped us better understand the role of progesterone for women and the exciting ways it can help women in clinical practice.

Biological hurdles to pancreatic islet transplantation: where are we at, and where are we going?

Amardeep Sekhon — 2021-11-07

Pancreatic islet transplantation has garnered increasing interest over the last two decades due to its promise in treating type 1 diabetes mellitus (T1D), an autoimmune condition that targets and destroys insulin-producing β-cells, which are necessary for the adequate regulation of blood glucose levels. Despite its promise, many obstacles still stand in its way before it can finally be used as a curative therapy for T1D, ranging from donor paucity to the need for immunosuppression. Nonetheless, recent advances in regenerative medicine and xenotransplantation may be a solution to these biological hurdles, owing to their potential as sources of long-lasting β-cells. This commentary aims to discuss some of the various biological hurdles preventing the widespread application of human pancreatic islet (HPI) transplantation, and the various research efforts attempting to address these issues.

New health-focused smartwatches represent a possible paradigm shift for disease screening, but at what cost?

Ryan Chow — 2021-11-07

Smartwatches, like the Apple Watch, are a class of wearable devices that are growing in popularity. These devices possess sensors capable of collecting physiologic measurements like heart rate/rhythm data, electrocardiogram (ECG) tracings, and oxygen saturation levels. Industry-sponsored research is currently being conducted to investigate the possibility of smartwatches as disease-screening tools. However, the research methods and pervasiveness of these devices may result in an undue burden on the medical system, such as increasing the rate of false positive screening of relatively rare diseases. The purpose of this commentary is to summarize the technologic benefits of these devices whilst also drawing attention to the potential pitfalls of current commercially-driven research.

A palliative approach to care: lack of practice standards in sharing goals of care conversations

Sydney Sparanese — 2021-11-07

As Canadians continue to live longer and acquire multiple comorbidities, it is more crucial to integrate palliative care services throughout the illness trajectory and across care settings. This has been further underscored by the COVID-19 pandemic, which has expediated the need for goals of care (GOC) conversations and advance care planning due to illness severity and mortality in vulnerable populations. Here, we comment on the qualitative results of a recent quality improvement project investigating the current state of documentation and workflow practice standards for GOC in the Vancouver Coastal Health Authority and propose key opportunities for improvement.

Vaccination fascination: exploring unintended consequences of sharing COVID-19 vaccination status on social media

Crystal McLeod — 2021-11-07

During the introduction of the SARS-CoV-2 vaccine to Canada, social media platforms saw an influx of healthcare professionals sharing their vaccination status with family, friends, and community. This trend, intended to promote vaccine uptake and reduce hesitancy among the broader public, may have the potential to precipitate unintended consequences as immunization rollout continues. This commentary seeks to discuss these potential consequences drawing on past research of healthcare professionals’ social media use, the impact of social media upon the COVID-19 pandemic, and vaccination programming.

Vaccines for cocaine addiction: Where we’re going and why doctors should pay attention

Lauren Gorfinkel — 2021-11-07

Pharmaceutical options for stimulant and cocaine use disorders are profoundly lacking. To date, trials of numerous drug classes, including antidepressants, antipsychotics, psychostimulants, anticonvulsants and dopamine agonists, have been unsuccessful. However, research in this area is rapidly evolving, and yields interesting and varied results. The current article gives an overview of one of the latest pharmacotherapy modalities for cocaine use disorder: the cocaine vaccine.

Microbiome modulation through fecal microbiota transplant: A strategy to overcome melanoma immunotherapy resistance

Rebecca Zhuang — 2021-11-07

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Effects of the COVID-19 pandemic control measures on the human microbiome

Maggie Hou — 2021-11-07

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Applying machine learning to abstract screening: Reducing the workload associated with systematic reviews

Iman Baharmand — 2021-11-07

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Presumed consent in organ donation: The next step for Canada?

Wajid I Khan — 2021-11-07

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The mouse is mightier than the pen

Braedon Ronald Paul — 2021-11-07

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