November/December 2009, Volume 26, Number 11

Dalhousie Emergency Medicine Department
Case of the Month
"My arm is on fire!"

Case in Point
Red,Itchy Chest Papules

Clinical Viewpoint
Assessing Cardiovascular Risk to Optimally Stratify Low- and Moderate-Risk Patients
Ruth McPherson, MD, PhD, FRCPC

Experts on Call
Answers to your questions from our medical experts

• Age Limit for Electroconvulsive Therapy Consideration
• Diagnosing and Treating Bed Bug Bites
• Amyotrophic Lateral Sclerosis
• Reducing Bisphosphonates in Patients with Impaired Renal Function
• Condoms and HPV
• Infected Bee or Wasp Stings
• Remedy for Aphthous Ulcers
• Anticoagulation for Thrombophlebitis of Proximal Great Saphenous Vein
• Follow-Up for Polyarthritis Caused By Parvovirus B19
• Recommended Work-Up for Urticaria
• Treatments for Achilles Tendonitis
• Melatonin for Insomnia
• Keratosis Pilaris
• West Nile Virus
• EKGs for High School Athletes
• Prevention of Chronic Low Grade Allergic Sinusitis
• Topical Treatment for Nail Fungus
• LED Light Therapy for Seasonal Affective Disorder
• Topical Treatments for Basal Cell Carcinoma
• NSAIDs for Shoulder Tendinitis
• Safety of ACE Inhibitor Use in Patients with Mild Aortic Stenosis
• Cause of Plantar Fasciitis
• Diagnosing Burning Mouth Syndrome

What's New in Clinical Research
Use of a New Antihypertensive Agent from a New Class in
Canadian Real-Life Clinical Practice
Andrew Steele, MD, FRCPC; Marie-Claude Laplace, RN, MBA; Denis Vézina, PhD; and Jean-Marie Leclerc, MD

What's Your Diagnosis?
"What is wrong with my eye?"

Endocrine Update
Thiazolidinediones and Bone Disease

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Dry Cough
• Erythematous Pustules
• A Sensitive Tongue
• Numbness of the Fingertips
• Brown Nodule
• Multiple Scratch Marks
• Thick Red Plaques
• Recent Onset Headaches
• Lesions on the Legs
• Right-Sided Numbness
• Papules, Vesicles and Ulcers

Clinical Viewpoint
The New Diabetes Standard of Care: More Than Just Glycemic Control
Advancement in Diabetes Management: A Canadian Diabetes Steering Committee Report
Gary Costain, Jean-Marie Ekoé, Ronald Goldenberg, Philip Hardin, and Linda Sinnaeve

Current Controversies and Therapeutic Update in Fibromyalgia
Heather D. O'Reilly, BSc, BA; Tanis Adey, MD; and Proton Rahman, MD

The American College of Rheumatology classifies fibromyalgia as widespread musculoskeletal pain along with pain on palpation in at least 11 of 18 predefined tender points. Ms O'Reilly, Dr. Adey and Dr. Rahman discuss the symptoms, non-pharmacological treatment options and therapeutic choices associated with fibromyalgia.

An Update on the Treatment Options for Localized Prostate Cancer
Kilian M. Gust, MD; and Alan I. So, MD, FRCSC

With an estimated 192,280 new cases in the US in 2009 and 27,360 prostate cancer deaths, prostate cancer continues to place a large burden on healthcare in the Western world. Up to 15% to 20% of men will be diagnosed with prostate cancer in their lifetime. Dr. Gust and Dr. So give an overview of diagnosis and risk stratification, treatment options, including active surveillance and radiotherapeutic approaches, as well as biochemical outcome after treatment.

Cardiovascular Congress Reporter
ESC 2009: RAS Blockade Across the CV Continuum

Dementia: Diagnosis and Screening Tools
T. Lau, MD, FRCPC, MSc

Already, more than one in five Canadians have someone with dementia in their family. Dr. Lau discusses the different screening tools, including the Mini-Mental State Exam, the Clock Drawing Test and the Montreal Cognitive Assessment. He suggests that when cognitive impairment is suspected based on direct observation, patient report, or concerns raised by family members, it is recommended that clinicians assess cognitive function.

October 2009, Volume 26, Number 10

Dalhousie Emergency Medicine Department
Case of the Month
Agitation in the Overdose Patient: Is it Serotonin Syndrome?

Case in Point
Scaly Hand Plaque

Experts on Call
Answers to your questions from our medical experts

• Therapeutic Approach to Extensive Infantile Seborrhea
• Isolated GGT
ura and Patent Foramen Ovales
• Bisphosphonate Use with Inhaled Corticosteroids
• MMSE vs. MOCA Screening Tests
• Phage Therapy for Bacterial Infections
• Difference Between Ionized and Corrected Calcium
• New Tests for Deep Vein Thrombosis
• Risk of Cytomegalovirus in Pregnancy
• Acute Chronic Sinusitis
• Use of an MRI with Coronary Stents
• Herpes Zoster Without Visible Rash
• Treating Hypertension in Pregnancy
• Poison Ivy Treatment Options
• Massage and Sensory Peripheral Neuropathy
• Asymptomatic High BP Patients Without Clinical Risk Factors
• Medical Conditions that Present as Depression

What's Your Diagnosis?
Excoriated Papules and Plaques

Endocrine Update
Turner Syndrome: Pediatric to Adult Transition

What's New in Clinical Research
Advances in ADHD Treatment
Jacques R. Leroux, MD, CSPQ; Atilla Turgay, MD, FRCPC and
Declan Quinn, MB, ChB, FRCPC

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Lower Extremity Tingling
• Erosive Pink Area
• Facial Lesion
• A Light Patch
• Two Openings at the Tip of the Genital Area
• Fatigue, Fever and Dry Cough

Oral Lesions: When to Treat, Biopsy, or Ignore
Eli Whitney, DDS, FRCD(C)

Oral mucosal disease, including gingivitis and periodontitis, is increasing as the population ages and there are more individuals with a lifetime exposure to unhealthy habits (tobacco and excessive alcohol), comorbid medical conditions and ploypharmacy. Dr. Whitney's article gives an overview of different kinds of oral lesions, including traumatic buccal mucosal lesons, ulcerative conditions, oral lichenoid lesions, oral candidasis, oral precancer and oral squamous cell carcinoma.

What's New in Clinical Research
Memantine in Alzheimer's Disease: Prolonging Time to Nursing-home Admission
Rémi W. Bouchard, MD

September 2009, Volume 26, Number 9

Dalhousie Emergency Medicine Department
Case of the Month
Everything From the Knees to the Nipples

Case in Point
Brown Hairy Area

Experts on Call
Answers to your questions from our medical experts

• Prevention of Androgenetic Alopecia
• Nitro Spray for Anal Fissures
• Transcranial Magnet in Depression
• Remedies for Sore Nipples Due to Breastfeeding
• How to Diagnose Celiac Disease
• Bone Mass Protection Regimen
• Relationship Between CHF and OSA
• Fibromyalgia and Depression
• Excessive Diaphoresis
• Familial Adenomatous Polyposis
• Pathogenesis of Syndrome X
• Use of Corticosteroids in COPD
• Treating Paronychial Infections
• New Treatments for Gout
• Recommendations for SBE Prophylaxis
• Risk of Recurrence of Depressive Disorder
• Best Treatment for Sinus Pain
• Vitamin D Recommendations
• Diagnosing Rhinorrhea
• Malaria Prophylaxis
• Causes of Fetal Tachycardia in Pregnancy
• Endocardial Strep Infection
• Tinea Pedis Between Toes
• Success Rate of Venom Immunotherapy With Allergy Injections

What's Your Diagnosis?
Blue-Black Discolouration

Endocrine Update
PCOS and Fertility Issues: Management of Subfertility

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Swollen Elbow
• Sudden Loss of Vision
• Reddish-Brown Lesions
• A Light Patch
• Leg Size Asymmetry
• Papule and Nail Deformity
• Pruritic Rash
• Right-Sided Weakness
• Hypopigmented Patches
• Folded Ear

Managing Challenging Cases in Hypertension
Lydia Hatcher, MD, CCFP, FCPC

Hypertension affects nearly half of North Americans > 50-years-old. We now know it requires not only management of the BP itself but involves lifestyle changes that can be very challenging for both patients and physicians to optimize. Dr. Hatcher's article is a detailed look at a patient who has hypertension. The suggested diet and lifestyle modifications are included, as well as the patient's plan for management of her hypertension.

Controlling the Overactive Bladder in the Elderly
Leo Winter, MD, FRCS(C)

Loss of urine control in the elderly is a common problem. Estimates of its prevalence range between 15% and 30% in both men and women > 65-years-of-age. Dr. Winter gives an overview of the overactive bladder, including factors that aggravate it and lifestyle changes to improve it. The article details a case of incontinence, including the patient's management and follow-up.

What's New in Clinical Research
Comparative Efficacy of Newer Antidepressants for Major Depression: A Canadian Perspective
Sidney H. Kennedy, MD, FRCPC; and Sakina J. Rizvi, HBSc

The HPV Vaccine in Men
Stephen D. Shafran, MD, FRCPC

HPV is a DNA virus which is transmitted by direct contact of skin or mucosal surfaces. There are many > 100 HPV genotypes. Approximately 40 HPV genotypes cause anogenital infection. Dr. Shafran explains that although the HPV vaccine is currently officially approved only for women in Canada (and the US), the notion of trying to prevent an STI by immunizing only one gender is irrational. He believes that immunizing only females for HPV infection is a mistake and that males should be vaccinated against HPV as well.

August 2009, Volume 26, Number 8

Dalhousie Emergency Medicine Department
Case of the Month
"I've stabbed myself!"

Case in Point
Sweaty Palms

Experts on Call
Answers to your questions from our medical experts

• Treatment of Warts
• Wolff-Parkinson White Syndrome
• Swimming After a Ruptured Eardrum
• Screening for Osteoporosis in Post-Menopausal Women
• Testing for Celiac Disease
• Atelectasis and Post-Operative Fever
• Oral Allergy Syndrome
• Lactose Intolerance vs. Milk Protein Allergy in Infants
• Treating Plantar Warts
• Diagnosing MI in the Post-Operative Period
• Male Pattern Baldness
• Elevation of Troponin Level
• Nicotine Effects
• Sore Throats
• Moderate and Severe Mitral Stenosis
• Infectious Mononucleosis During Pregnancy
• Low-Dose Metformin to Prevent Type 2 Diabetes

What's Your Diagnosis?
Excruciating Pain in the Foot

Endocrine Update
Endocrinological Evaluation of Pituitary Masses

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Lumps in the Lower Chest
• Dry, Craked Skin
• A Hyperpigmented, Linear Patch
• Two Lesions on the Leg
• Asymptomatic Dark Papule
• A Mass on the Palate
• Minute, Red Papules
• White Spots on the Nails
• Sudden Inability to Speak

Eating Disorders: Management in General and Family Practice
Heather Derry, MD; and Blake Woodside, MD, FRCPC

Eating disorders are illnesses of eating behaviour that stem predominantly from an overvaluation of the desirability of weight loss resulting in functional, medical, psychological and social impairment. The two major categories of eating disorders are anorexia nervosa and bulimia nervosa. Dr. Derry and Dr. Woodside explain early identification of the two disorders, assessment and treatment strategies, pharmacotherapy and specific interventions.

Managing Major Depression: A Review for the Busy Physician
Marcelo T. Berlim, MD, MSc; and Gustavo Turecki, MD, PhD

Major depressive disorder (MDD), which is characterized by the presence of at least one major depressive episode, is highly prevalent in the general population. A worldwide survey carried out by the World Health Organization suggests that the one-year prevalence of a depressive episode in the general population is 3.2%, while in primary care patients it increases to 5% to 10%. Dr. Berlim and Dr. Turecki give an overview of the symptoms, diagnosis and management of MDD.

2009 CHEP Recommendations: An Annual Update
On behalf of the Canadian Hypertension Education Program (CHEP)

The year 2009 marks the 10th consecutive year that the CHEP has updated recommendations for the management of hypertension. This year CHEP focuses on reducing death and CVD in people with diabetes by encouraging healthcare professionals to ensure their parents' BP is maintained < 130/80mmHg.

July 2009, Volume 26, Number 7

Dalhousie Emergency Medicine Department
Case of the Month
“Why does my left knee hurt?”

Case in Point
"Expanding, Red Plaque"

Experts on Call
Answers to your questions from our medical experts

• Pros and Cons of Probiotics
• Increased Risk of Pneumonia with Long-Term PPI Use
• Cardioversion in New Onset Rapid AF
• Glucosamine for Osteoarthritis
• Brittle, Cracking Fingernails
• Seasonal Affective Disorder
• Obstructive Sleep Apnea
• Relationship Between Acne and Food
• Risk of QT Interval with Methadone Therapy
• Bochdalek Hernia
• Cardiomyopathy in Pregnancy
• Antiviral Cream for Herpes Zoster

What's Your Diagnosis?
A Pigmented Lesion

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Erythematous Blisters
• Hyperpigmented Lesions
• Plaques on the Elbows
• Pain and Numbness of the Face
• Slowly Enlarging White Area
• A Small Mass on the Nipple
• Asymptomatic Swelling

Heart Failure: A Common Clinical Problem
Andrea MacDougall, BSc, MD, FRCPC; and Erik Paus-Jenssen, MD, FRCPC

Heart failure (HF) is a clinical syndrome that manifests with signs and symptoms of low cardiac output and/or pulmonary/systemic congestion. HF is common and its incidence is expected to increase as the population ages. The condition carries an annual mortality rate of 5% to 50% and is associated with significant morbidity and cost to the healthcare system. Dr. MacDougall and Dr. Paus-Jenssen describe the signs, symptoms and causes associated with HF, how to make the diagnosis, management options and pharmacologic therapies.

Fibromyalgia: A Light at the End of the Tunnel
Mary-Ann Fitzcharles, MB, ChB, FRCPC

After more than two decades of debate, fibromyalgia (FM) can now be definitively categorized as a valid condition that may affect up to 2% of the population. FM remains a clinical challenge because symptoms are subjective and there is still no objective abnormality on physical examination or laboratory testing to validate the diagnosis. Dr. Fitzcharles gives an overview of what causes FM, the clinical presentation, treatment approaches and stresses that it should be positively diagnosed and must no longer be a diagnosis of exclusion at the end of a long line of excessive and unnecessary invesigations.

June 2009, Volume 26, Number 6

Dalhousie Emergency Medicine Department
Case of the Month
“It was only a little scratch!”

Case in Point
"Red Growth on the Finger"

Experts on Call
Answers to your questions from our medical experts

• Garlic and Cardiac Health
• Effective Medication for Fibromyalgia
• Treadmill Testing
• Celiac Disease
• Tardive Dyskinesia
• Recurrent Aphthous Stomatitis
• Managing Acute Thyroiditis in Pregnancy
• Symptoms of Pancoast Tumours
• Measuring Alcohol Intake with GGT
• Severe Otitis Externa
• Latex Allergy
• Optimal TSH
• New-Onset Dandruff
• Pharmacy BP Readings

What's New in Clinical Research
Update on Formulary Use of Clopidogrel in Ontario: Revised ODB for Limited Use
Sol Stern, BSc, MSc, MD, MCFP

Endocrine Update
Hyperparathyroidism

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Red, Scaly Plaques
• A Dark Lesion
• Inspiratory Stridor
• An Erythematous Patch
• Two Different Lesions

What's New in Clinical Research
The Importance of Lowering Blood Pressure Quickly and Effectively in Hypertensive Patients
Anil Gupta, MD, FRCPC

May 2009, Volume 26, Number 6

Dalhousie Emergency Medicine Department
Case of the Month
“Don't I need an IV?”

Case in Point
"Brown Bump on the Back"

Experts on Call
Answers to your questions from our medical experts

• Managing Prominauris
• Microalbuminuria as a Risk Factor for CVD
• Update on the Management of Gout
• Chronic and Aggressive Hiccups
• Oral Lichen Planus Involving the Buccal Mucosa
• Treating a Diabetic Patient with a Large Amount of Microalbuminuria
• Health Risks of Black Mould
• Fetal Fibronectin Testing
• Tea Tree Oil and Psoriasis
• Isolated Low HDL-C Levels
• Dealing with Adult Nightmares and Sleepwalking
• Stopping Risedronate or Aledronate Therapy
• Asthma in Preschool Children
• Ultrasound Showing Fatty Liver
• Onychomycosis
• Length of PPI Therapy
• Clark's Nevus
• Medications for Dementia Patients with Chronic Pain
• Post-Concussion Syndrome
• When to Restart ASA Therapy After a Gastric Ulcer
• An Rh Negative Female with Bleeding
• b-Blocker Therapy in Heart Failure Patients

What's Your Diagnosis?
"A Pruritic Eruption"

Endocrine Update
Primary Hyperparathyroidism

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Thickening of the Joint
• Mobile Mass
• Numbness of the Left Side
• Blisters on the Fingertips
• Red, Scaly Plaque
• White-Yellow Tosillar Spot
• Weakness of the Legs
• Palpable Cord-Like Structure
•A Pimple on the Lip

Cardiovascular Congress Reporter

Dual Antiplatelet Option to Reduce Events in Atrial Fibrillation
Evaluating Interaction between Clopidogrel and PPIs: Results from Two Studies

An Overview of Back Pain and Sciatica
Mohammad Maleki, MD, FRCSc

Back Pain affects millions of people and is among the most common conditions for which patients seek medical attention. It is a huge health problem with associated enormous socio-economic impact on society. Dr. Maleki gives an overview of back pain and sciatica, discussing disc degeneration and herniation, spinal stenosis and when to operate.

Diabetes Review: What's New?
Andrew Farquhar, MB, ChB, BSc, DA

The epidemic of Type 2 diabetes continues to explode, with an especially worrying trend affecting younger people. Dr. Farquhar discusses the importance of FPs, as they are the gatekeepers to diabetic care. The primary care physician is responsible for initial diagnosis and ongoing management. He also stresses the importance of patients being involved in their own diabetes care. He discusses new trials/evidence of diabetes, new drugs and new approaches to diabetes management.

Prostate Cancer:
From Screening to Treatment
Andrew Farquhar, MB, ChB, BSc, DA

The lifetime risk of developing clinically apparent prostate cancer (PCa) is approximately one in seven. Though not all PCa is lethal, it remains the third highest cause of cancer related to death among men. PCa is usually asymptomatic especially in the early stages. Therefore, if one does not look for PCa, it may remain undiagnosed until late stages that are more difficult to treat. Dr. Kassouf and Dr. Violette discuss the diagnosis of PCa, screening recommendations, indications for biopsy and management options for the patient with PCa.

April 2009: Volume 26, Number 4

Dalhousie Department of Emergency Medicine
Case of the Month
"Remeber The Man You Sent Home Last Night..."

Case in Point
“Thickened Ankle Skin”


Experts on Call
Answers to your questions from our medical experts

• Mortality and Morbidity of Renal Dialysis
• Resistant Head Lice
• Bipolar Disorder Medications During Pregnancy
• Treating Osteopenia with Bone Resorption Medications
• Significance of Asymptomatic Bigeminy
• Pediatric GERD
• Ankylosing Spondylitis
• Investigating Frequent Watery Stools
• Therapy Options for Smoking Cessation
• Pseudoseizures
• Ruptured Tympanic Membrane
• Testosterone Testing
• Combining Yasmin and Spironolactone to Treat Acne
• A Pregnant Woman Suffering From Pruritus
• Cross-Reactivity Between Fruits and Nuts
• How to Treat Relapsing C. Difficile
• Levothyroxine and Iron Supplements
• Adult Onset of ADHD
• C-Reactive Protein in Patients with Acute Coronary Syndrome
• Teenage Male Pattern Baldness
• Screening for Bone Loss
• Reliability of Cervical Length Assessment
• Wegener's Granulomatosis
• Vascular Depression
• Multiple Seborrheic Keratoses
• Contracting H.Pylori
• Guidelines for Routine Cardiac Testing
• Quetiapine in Thyroid Disease
• Treatment for Scabies


What's Your Diagnosis?
"Doctor! Help I Can't Walk!"

Endocrine Update
Approach to the Patient with Hypercalcemia: Diagnostic Principles

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Fissuring Fingers
• Bilateral Deformities
• Loss of Vision
• Hair Loss
• Back Pain
• History of Falling
• Multiple, Crusted Lesions
• A Pruritic on the Eyelid

Clinical Approach to Migraine
Alan E. Goodridge, MD, FRCPC

After tension type headache, migraine is the most common form of headache affecting about 15% of females and 10% of males. Diagnostic criteria are well-established but a myriad of issues present diagnostic challenges. There is some overlap of the symptoms of migraine and tension type headache and migraine may exist even if the full criteria are not met. Dr. Goodridge discusses the different types of symptoms associated with migraines and the different treatment options for patents suff

Prostate Specific Antigen Assessment
Theresa J. McCallum, MD, FRCSC

Prostate specific antigen (PSA) is a glycoprotein produced by the prostate. It is secured into the semen and is usually detected at low levels in the blood. It is found in bound (usual) and free forms. PSA has a half-life of two to three days. Several weeks must pass after an event to allow for accurate re-assessment. Dr. McCallum discusses the influencing factors of PSA, its velocity and density and free PSA.

Diagnosing Chronic Kidney Disease
Fadaw Al- Ali, MD; and Ayub Akbari, MD

Kidney damage has been defined as pathologic abnormalities or markers of kidney damage (such as proteinuria) including abnormalities in blood and urine tests or imaging studies. Dr. Al-Ali and Dr. Akbari discuss how the primary care physician can diagnose chronic kidney disease (CKD) and why it is imperative to identify CKD patients early so that interventions that improve CV mortality and morbidity and delay progression of the disease can be implemented in a timely manner.

Clinical Viewpoint:
Sorting Through the Challenges of Chronic Pain
Brian Goldman, MD, FACEP, FCFP; and Alan Kaplan, MD, CCFP (EM), FCFP

March 2009: Volume 26, Number 3

Dalhousie Department of Emergency Medicine
Case of the Month
“Chloe's Complications”

Case in Point
“A Yellow, Crusty Face Plaque”

Experts on Call
Answers to your questions from our medical experts

• Metformin Use in Pregnancy
• Migraine Therapy for Those with Increased Cardic Risk
• At What Age Can Isotretinoinbe Started?
• Elevation of Creatine Kinase While on a Statin
• The Difference Between IBS and IBD
• Practical Work-Up for Chronic Cough or Sore Throats
• Mindfulness Therapy
• Annual Limit of Prostatic Biopsies
• How to Approach Significant LDL-C Levels
• Best Treatment for Hypercholesterolemia
• Urticarial Rash with Arthritis
• Are Drug Allergies Permanent?
• The Relationship Between NSE and Stroke Outcome
• Management of Chronic IBS
• Important Findings in COPD
• BP Level When Treating Hypertension
• Prescribing Statins in the Elderly
• The Role of Melatonin for Insomnia
• Work-Up for a Patient with Dizziness
• Treatment Options for Oral Aphthosis
• Acne Rosacea
• Managing a Low Potassium Level
• Combining Warfarin and ASA Therapy

Endocrine Update
Lipid Targets for Diabetic and Pre-diabetes

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Brown Thick Papules
• A Canal-Like Lesion
• A Slow-Growing Lesion
• Pruritic Eyelids
• Rash With Low Grade Fever
• A Changing Mole
• An Asymptomatic Growth

Depression in the Elderly
Jenny Rogers, MD; and Kiran Rabheru, MD, CCFP, FRCP, ABPN

Late-life depression is common and frequently under-diagnosed. In a community sample of adults
> 65-years-of-age, 6% to 9% suffer major depression and mild depressive symptoms affect an additional 17% to 37%. Dr. Rabheru and Dr. Rogers discuss how the diagnosis of depression in the elderly can be missed because of atypical presentation, multiple comorbidities with overlapping symptoms, reluctance to disclose depressive symptoms and lack of adequate screening.

What's New in Clinical Research
Intensive LDL-C Lowering in Type 2 Diabetes: How Can We Achieve It?
Lawrence A. Leiter, MD, FRCPC, FACP

Compression Therapy for Venous Leg Ulcers
Brian T. Kunimoto, MD, FRCPC

Venous leg ulcers represent a major public health problem, especially for the elderly. If one looks at only active venous ulcers, the point prevelance rates are in the range of 1%. Not to be dismissed are the social and psychological costs of this chronic disease. The management of venous leg ulcers requires a few important steps that involve taking into account the different aspects of general wound care and specific venous ulcer treatment, outlined by Dr. Kunimoto in this article.

What's New in Clinical Research
Treating Hypertension: The Importance of Achieving and Sustaining Target Blood Pressure
George Honos, MD, FRCPC, FACC

February 2009: Volume 26, Number 2

Dalhousie Department of Emergency Medicine
Case of the Month
“To V/Q or To Spiral CT”

Case in Point
A Swelling Finger Nodule

Experts on Call
Answers to your questions from our medical experts

• Potential Complications of Maternal Shingles
• Treating CIPD
• Sleep Apnea and Congestive Heart Failure
• Terbinafine and Hair Changes
• When Not to Use Antidepressants
• Differing BP Readings
• Treating Skin Atrophy due to Steroids
• Pregabalin for Fibromyalgia
• Cross-Reactivity of Coconut and Peanuts
• Treating a Borderline LDL-C Level
• Confirming Adrenal Insufficiency
• The Treatment of Choice for Bipolar Disorder
• Treating Recurring Tinea Corpora in Children
• How to Remove a Wax Plug
• Headaches Post Anesthetic
• Modafinil for Sleep Apnea
• The Best Treatment for Poison Ivy
• Advantages of Long-Term Varenicline Use
• Working-Up an Abnormal eGFR
• Atrial Hypertrophy in Patients with Atrial Fibrillation
• Benign Positional Vertigo
• The Different Types of Serum Calcium
• Preventing Osteoporosis in Early Menopause
• Recent Guidelines for Treating Hypertension
• Digital Myxoid Cysts
• A Varying PR Interval
• Narrowband vs. Broadband UVB
• Follow-Up for Eosinophilic Esophagitis
• New Prescription Options for Morbid Obesity
• Diastolic Dysfunction
• The Role of Spirometry in COPD
• Using Calcipotriol on the Face

What's Your Diagnosis?
"Fiona's Fiery Tale"

Endocrine Update
The New WHO for Osteoporosis: Absolute Fracture Risk Assessment

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Peter's Patch
• Sam's Skin Rash
• Norman's Nose
• Richard's Red Eye
• Eric's Eruption
• Diego's Digits
• Barry's Breasts
• Clark's Circular Marks
• Luka's Line
• Nicholas' Neck

Smoking Cessation: How Can We Do Better?
Anees Sindi, MBChB, ABIM; and Andrew McIvor, MD, MSc, FRCP

It is estimated that 100 million people will die during the 20th century as a result of tobacco related disease and this number could increase to 1 billion in the current century. Dr. Sindi and Dr. McIvor describe how adopting a systematic approach in your practice to nicotine addiction is a medically-effective and cost-effective intervention.

The Management of Chronic Prostatitis
Alan So, MD, FRCSC

Chronic bacterial prostatitis is a diagnosis made after identification of pathogenic bacteria in prostatic fluids (urine, semen, expressed prstatic fluid) and is often associated with symptoms such as pain in the pelvic, suprapubic, low back, or perineal regions. In this article, Dr. So details how although "chronic prostatitis" is the most commonly diagnosed urologic diagnosis under the age of 50 and up to 10 % of men in North America have these symptoms, <5% truly have a bacterial cause of their symptoms.

Cannabinoids in Clinical Practice
J. H. Ennis, MSW, MD, FRCP

Marijuana has been used to treat nausea, illness-induced anorexia, symptoms of MS, spinal cord injuries, Tourette's syndrome, epilepsy, glaucoma, Parkinson's disease (PD), dystonia and pain. Here, Dr. Ennis provides a brief review of the evidence which can assist the clinician in making treatment decisions involving the use of cannabinoids.

January 2009, Volume 26, Number 1

Dalhousie Emergency Medicine Department
Case of the Month
“Doc! My back hurts...”

Case in Point
"My nails are turning green!"

Experts on Call
Answers to your questions from our medical experts

• Informing Patients About Borderline
Personality Disorder
• Left Anterior Fascicular Block
• Hair Loss After Pregnancy
• The Best Treatment for Facial Psoriasis
• Inhaled Corticosteroids and Respiratory Infections
• Rashes Related to Lamotrigine Use
• Tongue-Tie in a Newborn
• Early Signs of Celiac Disease
• Thrombolysing Elderly Patients
• Low Dose OC and Pregnancy Risk
• Treating Intra-Abdominal Infections
• Deep Brain Stimulation
• The Predictive Value of Sputum
• The Role of Incretins
• Grapefruit and Statins
• Psychotropic Medications for Depression and Tinnitus
• Treating Esophageal Spasms
• Risks of Oral Allergy Syndrome
• Contraindications to Lithium Use Post-MI
• Lack of Pneumonia Symptoms
• Topical Antifungal Agents
• Screening for Cerebral Aneurysm
• Asymptomatic Pauses on Holter Monitor
• Treating Opioid-Induced Constipation
• The Best OC Pills for Acne
• When to Treat an Elderly Patient
• Sensorineural Hearing Loss
• Treating Pretibial Myxedema

What's Your Diagnosis?
"What is going on with my skin?"

Endocrine Update
Prevention of Type 2 Diabetes and
Treatment of Pre-Diabetes

Photo Diagnosis
Illustrated cases with questions to test your diagnostic skills

• Nick’s Knee Pain
• Carla’s Cheek
• Gina’s Joints
• Samantha’s Scalp
• Harold’s Heel
• Harriet’s Heart

GHB in Your Patients:
Recognizing the Characteristics
Constance LeBlanc, MD, CCFP(EM), FCFP, MAEd; and Nancy Murphy, MD, CCFP(EM), ABFM, ABMT

GHB is a potent central nervous system depressant which can result in serious sequelae. The rapid onset of effect and narrow therapeutic window increase the likelihood of ingesting more than intended. It is frequently co-ingested with ethanol, stimulants or ketamine, further increasing the potential for miscalculation. Although GHB use is declining, recognizing the characteristics of toxicity is important for the clinician.

External Manifestations
of Internal Disease
Isaiah Day, Bsc; and Jaggi Rao, MD, FRCPC

Certain disorders of the skin are more frequently associated with diabetes. Necrobiosis lipoidica (NL) is a general term that refers to lesions that occur mostly in insulin dependent diabetic patients. Astute physicians who spot NL can play an important role in evaluating patients for the early development of diabetes and reassure them of the benign nature of these lesions.

Cardiovascular Congress Reporter

Global Cardiovascular Risk Reduction:
Focus on Inhibiting the Renin Angiotensin System

Hypertension Canada:
News and Opinion from the Canadian Hypertension Society

Global Cardiovascular Risk Reduction:
Focus on Inhibiting the Renin Angiotensin System