{"title":"Understanding and Using the Variable Therapeutic Region of Lithium for Bipolar Patients During Aging","authors":"R. Burns","doi":"10.33844/cjm.2022.6025","DOIUrl":"https://doi.org/10.33844/cjm.2022.6025","url":null,"abstract":"the known lithium therapeutic ranges for Old","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"60 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84160592","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}
Thyrotoxic Periodic Paralysis (TPP) is an acute potentially lethal emergency in patients with hyperthyroidism who present with sudden muscle weakness and hypokalemia. It is commonly precipitated by high carbohydrate or high salt content meals, strenuous exercise, stress, trauma, glucocorticoids, epinephrine, alcohol, or respiratory infections. COVID-19 infection or vaccination may represent a novel trigger for TPP. Furthermore, COVID-19 infection or vaccination may incite inflammatory processes leading to thyrotoxicosis, which can manifest as TPP. While COVID-19 causing subacute thyroiditis, euthyroid sick syndrome, Hashimoto’s disease, or Graves’ disease ha ve been well documented in the literature; there have only been six case reports of post-COVID-19 TPP. Notably, all cases thus far have been restricted to male patients, and there is paucity of literature from North America. The purpose of this paper is to outline the first case of post-COVID-19 TPP in a female patient, who presented to the emergency department with acute paralysis and severe hypokalemia (2.2 mmol/L) three months after COVID-19 infection. Investigations in the emergency department showed thyrotoxicosis. She was treated with potassium replacement, which improved her paralysis. Subsequent investigations revealed severe hyperthyroidism from Graves’ disease, which is currently managed with metoprolol and methimazole. Her hyperthyroidism improved without recurrent hypokalemia or paralysis. In addition, we outline the epidemiology, pathophysiology, precipitants, and management of TPP, with a particular focus on COVID-19 infection or vaccination precipitating TPP. We discuss post-COVID-19 TPP cases thus far described in the literature. Knowing that North American COVID-19 infection waves lagged Asia, we could anticipate additional future TPP cases
{"title":"Thyrotoxic Periodic Paralysis in the Post-COVID Era: A Case Report with Literature Review","authors":"C. Gandhi, Mahua Ghosh","doi":"10.33844/cjm.2022.6023","DOIUrl":"https://doi.org/10.33844/cjm.2022.6023","url":null,"abstract":"Thyrotoxic Periodic Paralysis (TPP) is an acute potentially lethal emergency in patients with hyperthyroidism who present with sudden muscle weakness and hypokalemia. It is commonly precipitated by high carbohydrate or high salt content meals, strenuous exercise, stress, trauma, glucocorticoids, epinephrine, alcohol, or respiratory infections. COVID-19 infection or vaccination may represent a novel trigger for TPP. Furthermore, COVID-19 infection or vaccination may incite inflammatory processes leading to thyrotoxicosis, which can manifest as TPP. While COVID-19 causing subacute thyroiditis, euthyroid sick syndrome, Hashimoto’s disease, or Graves’ disease ha ve been well documented in the literature; there have only been six case reports of post-COVID-19 TPP. Notably, all cases thus far have been restricted to male patients, and there is paucity of literature from North America. The purpose of this paper is to outline the first case of post-COVID-19 TPP in a female patient, who presented to the emergency department with acute paralysis and severe hypokalemia (2.2 mmol/L) three months after COVID-19 infection. Investigations in the emergency department showed thyrotoxicosis. She was treated with potassium replacement, which improved her paralysis. Subsequent investigations revealed severe hyperthyroidism from Graves’ disease, which is currently managed with metoprolol and methimazole. Her hyperthyroidism improved without recurrent hypokalemia or paralysis. In addition, we outline the epidemiology, pathophysiology, precipitants, and management of TPP, with a particular focus on COVID-19 infection or vaccination precipitating TPP. We discuss post-COVID-19 TPP cases thus far described in the literature. Knowing that North American COVID-19 infection waves lagged Asia, we could anticipate additional future TPP cases","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"297 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86436540","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}
Pub Date : 2022-07-01DOI: 10.4103/1203-7796.349015
S. Lesperance
{"title":"Message de la Présidente","authors":"S. Lesperance","doi":"10.4103/1203-7796.349015","DOIUrl":"https://doi.org/10.4103/1203-7796.349015","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"27 1","pages":"90 - 90"},"PeriodicalIF":1.1,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42522258","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}
Stuti M. Tanya, Maia A. Idzikowski, Bonnie He, J. Lakoff, Sanjay Sharma
The Canadian residency match process has been dramatically restructured due to COVID-19. The impact of these changes on specialty choice and access to career-development opportunities among Canadian medical students remains largely unknown. The objective of this study was to assess whether students’ strategy and level of confidence entering the Canadian residency match have changed as a result of the pandemic. A 28-item online survey was distributed to Canadian medical students from the classes of 2021-2024, as well as the class of 2020 graduates planning to enter the 2021 CaRMS (Canadian Resident Matching Service) match. The survey was developed based on existing literature and included questions on demographics, access to educational opportunities, and personal strategies for matching. Descriptive statistics, t-tests, and Spearman’s correlations were used to analyze the data. Eleven percent of respondents reported a change in specialty preference due to COVID-19. Forty-three percent of respondents reported changing their strategy for the CaRMS match. Respondents interested in a surgical specialty were more likely to report a change in their match strategy ( p = .0150), including applying to more programs ( p = .0012) and exploring other specialties ( p = .0118). Clerks were also more likely to report a change in their matching strategy ( p = .0195) and specialty choice ( p = .0194) compared to pre-clerks. Medical students felt that COVID-19 negatively impacted their ability to access scholarly opportunities and confidence regarding the match, which may have long-term implications
{"title":"Changing Attitudes Toward Specialty Choice and the CaRMS Residency Match During COVID-19: A Cross-sectional Pilot Study of Canadian Medical Students","authors":"Stuti M. Tanya, Maia A. Idzikowski, Bonnie He, J. Lakoff, Sanjay Sharma","doi":"10.33844/cjm.2022.6019","DOIUrl":"https://doi.org/10.33844/cjm.2022.6019","url":null,"abstract":"The Canadian residency match process has been dramatically restructured due to COVID-19. The impact of these changes on specialty choice and access to career-development opportunities among Canadian medical students remains largely unknown. The objective of this study was to assess whether students’ strategy and level of confidence entering the Canadian residency match have changed as a result of the pandemic. A 28-item online survey was distributed to Canadian medical students from the classes of 2021-2024, as well as the class of 2020 graduates planning to enter the 2021 CaRMS (Canadian Resident Matching Service) match. The survey was developed based on existing literature and included questions on demographics, access to educational opportunities, and personal strategies for matching. Descriptive statistics, t-tests, and Spearman’s correlations were used to analyze the data. Eleven percent of respondents reported a change in specialty preference due to COVID-19. Forty-three percent of respondents reported changing their strategy for the CaRMS match. Respondents interested in a surgical specialty were more likely to report a change in their match strategy ( p = .0150), including applying to more programs ( p = .0012) and exploring other specialties ( p = .0118). Clerks were also more likely to report a change in their matching strategy ( p = .0195) and specialty choice ( p = .0194) compared to pre-clerks. Medical students felt that COVID-19 negatively impacted their ability to access scholarly opportunities and confidence regarding the match, which may have long-term implications","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"78 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2022-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83605584","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}
Pub Date : 2022-04-01DOI: 10.4103/1203-7796.341029
Gabe Woollam
{"title":"Message du president. Une réflexion","authors":"Gabe Woollam","doi":"10.4103/1203-7796.341029","DOIUrl":"https://doi.org/10.4103/1203-7796.341029","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"27 1","pages":"50 - 50"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42057656","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}
{"title":"Pathological fractures leading to the incidental diagnosis of rickets","authors":"M. Abrahim","doi":"10.4103/cjrm.cjrm_18_21","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_18_21","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"27 1","pages":"69 - 71"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48919634","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}
{"title":"Why COVID-19 could be a boon for rural patient transfers","authors":"C. Wilson","doi":"10.4103/cjrm.cjrm_71_21","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_71_21","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"27 1","pages":"77 - 78"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46079740","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}
{"title":"Wave theory of rural medicine","authors":"P. Hutten-Czapski","doi":"10.4103/cjrm.cjrm_5_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_5_22","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"27 1","pages":"47 - 47"},"PeriodicalIF":1.1,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41807483","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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