This article provides an approach to amenorrhea and is intended for pre-clinical and clerkship medical students. Primary amenorrhea refers to the absence of menarche by 15 years or 3 years post thelarche while secondary amenorrhea is the cessation of menses for 3 months in women with a previously regular cycle or for 6 months in women with previously irregular menses. While amenorrhea can be physiological it can also reflect an anatomical or more complex hormonal problem that students must learn to identify and investigate.
{"title":"Approach to: Amenorrhea","authors":"Sophie Baril","doi":"10.26443/MJM.V19I1.320","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.320","url":null,"abstract":"This article provides an approach to amenorrhea and is intended for pre-clinical and clerkship medical students. Primary amenorrhea refers to the absence of menarche by 15 years or 3 years post thelarche while secondary amenorrhea is the cessation of menses for 3 months in women with a previously regular cycle or for 6 months in women with previously irregular menses. While amenorrhea can be physiological it can also reflect an anatomical or more complex hormonal problem that students must learn to identify and investigate. ","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43420248","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The diagnosis of chest pain is not always due to a cardiac cause such as a myocardial infarction. In fact, non-cardiac causes of chest pain may present with similar signs and symptoms. This article delves into the differential diagnosis of chest pain using an anatomical approach and describes how a thorough history, physical examination as well as specific tests are required to confirm each diagnosis.
{"title":"Approach to: Chest pain","authors":"N. Haghandish","doi":"10.26443/MJM.V19I1.314","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.314","url":null,"abstract":"The diagnosis of chest pain is not always due to a cardiac cause such as a myocardial infarction. In fact, non-cardiac causes of chest pain may present with similar signs and symptoms. This article delves into the differential diagnosis of chest pain using an anatomical approach and describes how a thorough history, physical examination as well as specific tests are required to confirm each diagnosis.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41771286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anisha Arora, A. Adams, B. Lebouché, A. Quesnel-Vallée
This work is licensed under a Creative Commons BY-NC-SA 4.0 International License. AB S T R AC T Canada is a leading nation for international migration, yet fails to adequately respond to the healthcare needs of migrant populations. In this editorial, we explore why this is so. We posit that the reactive approach of the systems and stakeholders responsible for assuring healthcare access during the COVID-19 pandemic has been detrimental to our vulnerable and marginalized populations, and by extension, all citizens. Now, amidst a second wave of COVID-19, we must act – more decisively and compassionately than ever before, with the support of rigorous research and co-designed sustainable strategies. Otherwise, we remain bystanders abetting a system that has failed to effectively address the health needs of those that enter this country seeking a better life.
{"title":"Exploration of Social and Political Factors that Impede Migrant Healthcare Availability and Access in Canada Amidst COVID-19","authors":"Anisha Arora, A. Adams, B. Lebouché, A. Quesnel-Vallée","doi":"10.26443/MJM.V19I1.847","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.847","url":null,"abstract":"This work is licensed under a Creative Commons BY-NC-SA 4.0 International License. AB S T R AC T Canada is a leading nation for international migration, yet fails to adequately respond to the healthcare needs of migrant populations. In this editorial, we explore why this is so. We posit that the reactive approach of the systems and stakeholders responsible for assuring healthcare access during the COVID-19 pandemic has been detrimental to our vulnerable and marginalized populations, and by extension, all citizens. Now, amidst a second wave of COVID-19, we must act – more decisively and compassionately than ever before, with the support of rigorous research and co-designed sustainable strategies. Otherwise, we remain bystanders abetting a system that has failed to effectively address the health needs of those that enter this country seeking a better life.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44055203","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Urinary tract infections (UTIs) are prevalent in the children. Presentation of UTI vary in children of different ages. In infants, who cannot localize symptoms, UTI can present with a fever whereas in older children a UTI can present with urinary symptoms (dysuria, urinary frequency, incontinence). It is important to establish a clear diagnosis in order to treat and resolve the infection with antibiotics therapy to prevent bacteremia, pyelonephritis, and long-tern renal disease. Urine is collected through a mid-stream urine sample, in toilet trained children, via urethral catheterization, suprapubic aspiration and pediatric urine collection bags. Urine analysis and culture are the first-line investigations in children with suspected UTI. Goals of treatment include elimination of infection, relief of acute symptoms, and prevention of recurrent and long-term complications. The Canadian Pediatric Society recommends initial treatment with oral antibiotics for nontoxic children with febrile UTIs. Imaging, such as a renal/bladder ultrasound, may be used.
{"title":"Approach to: Pediatric urinary tract infection (UTI)","authors":"Maria Giannoumis","doi":"10.26443/MJM.V19I1.312","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.312","url":null,"abstract":"Urinary tract infections (UTIs) are prevalent in the children. Presentation of UTI vary in children of different ages. In infants, who cannot localize symptoms, UTI can present with a fever whereas in older children a UTI can present with urinary symptoms (dysuria, urinary frequency, incontinence). It is important to establish a clear diagnosis in order to treat and resolve the infection with antibiotics therapy to prevent bacteremia, pyelonephritis, and long-tern renal disease. Urine is collected through a mid-stream urine sample, in toilet trained children, via urethral catheterization, suprapubic aspiration and pediatric urine collection bags. Urine analysis and culture are the first-line investigations in children with suspected UTI. Goals of treatment include elimination of infection, relief of acute symptoms, and prevention of recurrent and long-term complications. The Canadian Pediatric Society recommends initial treatment with oral antibiotics for nontoxic children with febrile UTIs. Imaging, such as a renal/bladder ultrasound, may be used.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49385077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The intersection of art and science is a space useful not only to communicate scientific concepts to the general public but also to allow those of us studying biology in depth to view our work in a different light. I myself enjoy playing with the universality of anatomy, that is its bits and pieces that compose every human being. In mixing these with an array of mediums, colours, and textures, I hope to evoke a multiplicity of emotions in the viewer.
{"title":"Paper People","authors":"Claire L Chabot","doi":"10.26443/MJM.V19I1.869","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.869","url":null,"abstract":"The intersection of art and science is a space useful not only to communicate scientific concepts to the general public but also to allow those of us studying biology in depth to view our work in a different light. I myself enjoy playing with the universality of anatomy, that is its bits and pieces that compose every human being. In mixing these with an array of mediums, colours, and textures, I hope to evoke a multiplicity of emotions in the viewer.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47001907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Acute vision loss is the temporary reduction of visual acuity or visual field, lasting from a few minutes to a few days. The etiologies of acute vision loss may be divided into anterior segment disease, retinal disease, optic nerve disease, or neurovascular disease. It is recommended to refer all presentations of acute vision loss for ophthalmologic consultation; however, the primary care physician plays an important role in determining the urgency of referral. The following article describes an approach to narrowing the differential diagnosis of acute vision loss, using relevant ocular history and physical exam findings. The features of common eye disorders relating to acute vision loss and their treatments are also discussed.
{"title":"Approach to: Acute vision loss","authors":"S. Santhakumaran","doi":"10.26443/MJM.V19I1.492","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.492","url":null,"abstract":"Acute vision loss is the temporary reduction of visual acuity or visual field, lasting from a few minutes to a few days. The etiologies of acute vision loss may be divided into anterior segment disease, retinal disease, optic nerve disease, or neurovascular disease. It is recommended to refer all presentations of acute vision loss for ophthalmologic consultation; however, the primary care physician plays an important role in determining the urgency of referral. The following article describes an approach to narrowing the differential diagnosis of acute vision loss, using relevant ocular history and physical exam findings. The features of common eye disorders relating to acute vision loss and their treatments are also discussed.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44820867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Type 2 Diabetes Mellitus (T2DM) is a chronic and insidious disease that is on the rise worldwide. Diabetes pharmacotherapy is complex and varied, and recent studies of novel antihyperglycemic drugs have raised important considerations for the management of T2DM. This review provides an overview for the diagnosis of T2DM, glycemic targets for individuals with a T2DM diagnosis, and outlines a general approach to the management of T2DM, with an emphasis on how to select the appropriate pharmacotherapy using a fictional case as an example. Hypoglycemia, a complication of pharmacotherapy, macrovascular and microvascular disease resulting from T2DM, and other forms of diabetes mellitus are also briefly reviewed.
{"title":"Approach to: Type 2 diabetes management","authors":"S. J. Wang","doi":"10.26443/MJM.V19I1.323","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.323","url":null,"abstract":"Type 2 Diabetes Mellitus (T2DM) is a chronic and insidious disease that is on the rise worldwide. Diabetes pharmacotherapy is complex and varied, and recent studies of novel antihyperglycemic drugs have raised important considerations for the management of T2DM. This review provides an overview for the diagnosis of T2DM, glycemic targets for individuals with a T2DM diagnosis, and outlines a general approach to the management of T2DM, with an emphasis on how to select the appropriate pharmacotherapy using a fictional case as an example. Hypoglycemia, a complication of pharmacotherapy, macrovascular and microvascular disease resulting from T2DM, and other forms of diabetes mellitus are also briefly reviewed.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42738243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There are two commonly accepted ways to conceptualize intelligence. One involves competency in certain skills, such as problem-solving. The other, more abstract – dare I say innate – view holds that being good at a specific task is an insufficient condition for intelligence. Historically, the medical and artificial intelligence communities have grappled for position vis-à-vis these philosophies, with each side staking its claim for the more “authentic” definition of intelligence. This dispute has endured, for the most part, unresolved since the advent of artificial intelligence and its first foray into healthcare applications in the early 21st century. What is occurring when data scientists leverage massive quantities of data to replicate complex clinical decision-making, while still failing to teach a machine to correctly think about disease? This simultaneously validates imitative capacity as a metric for intelligence (machines can learn from infinite correct or incorrect diagnoses, farmore than any human physician can absorb throughout an entire career) and preserves the medical profession’s breadth of clini-
{"title":"On the Measure of Intelligence During the COVID-19 Pandemic","authors":"C. Chartier","doi":"10.26443/MJM.V19I1.828","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.828","url":null,"abstract":"There are two commonly accepted ways to conceptualize intelligence. One involves competency in certain skills, such as problem-solving. The other, more abstract – dare I say innate – view holds that being good at a specific task is an insufficient condition for intelligence. Historically, the medical and artificial intelligence communities have grappled for position vis-à-vis these philosophies, with each side staking its claim for the more “authentic” definition of intelligence. This dispute has endured, for the most part, unresolved since the advent of artificial intelligence and its first foray into healthcare applications in the early 21st century. What is occurring when data scientists leverage massive quantities of data to replicate complex clinical decision-making, while still failing to teach a machine to correctly think about disease? This simultaneously validates imitative capacity as a metric for intelligence (machines can learn from infinite correct or incorrect diagnoses, farmore than any human physician can absorb throughout an entire career) and preserves the medical profession’s breadth of clini-","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43698810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart Failure (HF) affects more than 650,000 Canadians (3.6% of Canadian adults above age 40). Even with recent advances in the diagnosis and treatment of this disease, HF remains among the five most common causes for hospitalization in Canada, with a readmission rate above 30% at the 1-year mark. Despite the significant economic and clinical burden of this disease, there is limited awareness among healthcare providers, healthcare system managers, and governments regarding the current HF epidemic and available therapies. This article reviews the definition of HF and the approach to evaluating a patient with suspected HF, focusing on the different presentations of HF, the clinical significance of ejection fraction, and the usefulness of BNP as a marker of cardiac function.
{"title":"Approach to: Heart failure","authors":"D. Hansen","doi":"10.26443/MJM.V19I1.518","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.518","url":null,"abstract":"Heart Failure (HF) affects more than 650,000 Canadians (3.6% of Canadian adults above age 40). Even with recent advances in the diagnosis and treatment of this disease, HF remains among the five most common causes for hospitalization in Canada, with a readmission rate above 30% at the 1-year mark. Despite the significant economic and clinical burden of this disease, there is limited awareness among healthcare providers, healthcare system managers, and governments regarding the current HF epidemic and available therapies. This article reviews the definition of HF and the approach to evaluating a patient with suspected HF, focusing on the different presentations of HF, the clinical significance of ejection fraction, and the usefulness of BNP as a marker of cardiac function.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48078651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Red eye is a common symptom that presents in primary care practice, and may be accompanied by pain, irritation, or discharge. It is a sign of ocular inflammation, often involving the anterior segment of the eye. Most causes of red eye are benign; however, the primary care physician must identify when urgent referral to an ophthalmologist is required. This may be achieved through targeted questioning regarding the chronicity, intensity of pain, vision changes, and associated symptoms. The following article outlines an approach to identifying the cause of red eye using history and physical exam findings. Common features of red eye disorders and their respective treatment modalities are discussed.
{"title":"Approach to: Red eye","authors":"S. Santhakumaran","doi":"10.26443/MJM.V19I1.196","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.196","url":null,"abstract":"Red eye is a common symptom that presents in primary care practice, and may be accompanied by pain, irritation, or discharge. It is a sign of ocular inflammation, often involving the anterior segment of the eye. Most causes of red eye are benign; however, the primary care physician must identify when urgent referral to an ophthalmologist is required. This may be achieved through targeted questioning regarding the chronicity, intensity of pain, vision changes, and associated symptoms. The following article outlines an approach to identifying the cause of red eye using history and physical exam findings. Common features of red eye disorders and their respective treatment modalities are discussed.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44795493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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