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The Canadian Medical Association Journal Get weekly issues straight to your inbox: http://cmaj.ca/getCMAJ

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CMAJ @cmaj.ca · 3d ago

A medical student reflects on moving through clinical environments as a wheelchair user, and on the quiet labour required to navigate spaces that were not designed with every body in mind. ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260779

Hands land on the back of your chair before you can answer. The frame jolts forward. Your balance shifts. For a brief, sharp second, your body is no longer yours.

CMAJ @cmaj.ca · 4d ago

Left circumflex myocardial infarction, a subtype of acute coronary syndrome, is under-recognized and undertreated. Here are 5 things to know ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260030

Of left circumflex myocardial infarctions, 33% lack ST-segment elevation and are misclassified as non–ST segment elevation myocardial infarction.

CMAJ @cmaj.ca · 5d ago

What causes severe dyslipidemia in children, and what further investigations are needed? What therapeutic lifestyle modifications should be recommended? When should pharmacologic therapy be considered? What follow-up actions are needed? Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260584

Many monogenic processes cause primary dyslipidemia, the most common of which is familial hypercholesterolemia, an autosomal codominant condition.

CMAJ @cmaj.ca · 6d ago

The clearest benefit of British Columbia’s decriminalization policy is reduced arrests for drug possession, which represents a meaningful change in how people who use drugs experience and interact with the justice system. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.261198

The lesson from BC is not that decriminalization is irrelevant, but that such policies must be supported within prepared, trusted, and adequately resourced systems.

CMAJ @cmaj.ca · 6d ago

Drug decriminalization and health outcomes: The research findings suggest that decriminalization effectively reduced criminalization of drug possession but did not, in isolation, produce direct impacts on outcomes related to drug toxicity. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260038

Drug decriminalization and recriminalization in BC were associated with substantial changes in police-reported drug possession incidents but no corresponding changes in drug toxicity deaths or hospitalizations when compared to other regions in Canada.

CMAJ @cmaj.ca · 6d ago

Drug decriminalization: what are the impacts on crime and health outcomes? CMAJ Volume 198, Issue 31, features new articles on drug decriminalization and health outcomes; familial hypercholesterolemia; left circumflex myocardial infarction, and more. ➡️ https://www.cmaj.ca/content/198/31

2 police officers leading a woman away with handcuffs

CMAJ @cmaj.ca · last wk.

Recombinant herpes zoster vaccination: Herpes zoster (shingles) is associated with major neuro- and cardiovascular events, and recombinant zoster vaccine is associated with lower risk of acute myocardial infarction and stroke. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252032

Recombinant zoster vaccine is the only authorized shingles vaccine in Canada. A 2-dose series yields 85% to 90% efficacy over 11 years. The vaccine is recommended for all adults aged 50 years and older (regardless of previous
chickenpox, shingles, or receipt of the discontinued live-attenuated vaccine) and 18 years and older if immunocompromised or due to be.

Recombinant herpes zoster vaccination
DOI: 10.1503/cmaj.252032

CMAJ @cmaj.ca · last wk.

We don't talk about our dead: A neurosurgeon reflects on unwritten rules of his profession ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260727

“No one teaches physicians how to carry a child’s death. Everyone improvises privately and calls it coping.”
— Mirko Micovic MD PhD

We don't talk about our dead
DOI: 10.1503/cmaj.260727

CMAJ @cmaj.ca · last wk.

Patients with epidemiologic risk factors for TB infection and a high risk to reactivate, or patients with epidemiologic, clinical, and radiologic features of TB disease, should be promptly assessed and treated for TB infection or disease as appropriate. ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260343

New or worsening hemoptysis during antituberculous treatment warrants urgent re-evaluation to assess for vascular complications like Rasmussen aneurysm.

Cavitary pulmonary tuberculosis
DOI: 10.1503/cmaj.260343

CMAJ @cmaj.ca · 2w ago

Outpatient hyperkalemia and risk of death: Research findings support urgent emergency department referrals and underscore the need for standardized reporting and management guidelines. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252008

Presentation to the emergency department within 24 hours of a severe outpatient hyperkalemia result is associated with lower rates of immediate and short-term death.

Outpatient hyperkalemia and risk of death
DOI: 10.1503/cmaj.252008

CMAJ @cmaj.ca · 2w ago

Regulatory oversight of ice arena air quality: At least 12 poisoning incidents from carbon monoxide (CO) and nitrogen dioxide (NO2) at Canadian ice arenas have been reported in the media in the past 10 years. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.261120

Health Canada has indicated best practices regarding air quality in ice arenas, but these are not enforced in most provinces and territories. Implementation and enforcement of air quality regulations in
ice arenas have been effective in preventing CO and NO2 poisonings in Minnesota; such enforcement is needed in Canada.

Regulatory oversight of ice arena air quality
DOI: 10.1503/cmaj.261120

CMAJ @cmaj.ca · 3w ago

Serotonin toxicity: The condition results from acute, excessive serotonergic activity at serotonin receptors following initiation or dose escalation of a serotonergic agent, overdose, or through drug–drug interactions. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260159

Serotonin toxicity is a potentially life-threatening adverse reaction to serotonergic agents.

Serotonin toxicity
DOI: 10.1503/cmaj.260159

CMAJ @cmaj.ca · 3w ago

Tinea incognito: Topical corticosteroid application over dermatophytosis (fungal infections) can lead to tinea incognito. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260512

(A) Multiple erythematous plaques with interspersed pustules over the malar region and forehead of a 38-year-old woman. (B) Resolution of tthe erythematous plaques following 7 days of oral and topical antifungal therapy.

Tinea incognito
DOI: 10.1503/cmaj.260512

CMAJ @cmaj.ca · 4w ago

What features differentiate a new stroke from post-stroke recrudescence? What causes post-stroke recrudescence? What investigations are recommended? What should patients and families be told about management and prognosis? Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251837

Post-stroke recrudescence is the transient recurrence of stroke deficits after initial improvement.

Post-stroke recrudescence
DOI: 10.1503/cmaj.251837

CMAJ @cmaj.ca · 4w ago

Hypertriglyceridemia-induced pancreatitis: Diabetic ketoacidosis with severe hypertriglyceridemia-induced acute pancreatitis as the initial presentation of type 2 diabetes is a rare, severe metabolic emergency. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260244

Hypertriglyceridemia should be considered in all patients presenting with acute pancreatitis.

Hypertriglyceridemia-induced pancreatitis
DOI: 10.1503/cmaj.260244

CMAJ @cmaj.ca · 4w ago

Dependent on the immunity of others: A father reflects on his medical student son’s death from measles Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260060

“I want people to understand what declining immunization rates mean for individuals who cannot receive all vaccines.”
— Pascal Muijtjens

Dependent on the immunity of others
DOI: 10.1503/cmaj.260060

CMAJ @cmaj.ca · 4w ago

This qualitative research study describes restrictive policies that challenge blood donation among Black people in Canada and underscore deep mistrust in the health care and blood donation systems owing to historical and current racial discrimination ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.250123

Blood donation supports critical treatments; however, Black people in Canada face multiple barriers to donating blood, including restrictive blood donation policies, institutional and systemic racism in health systems, historic anti-Black racism, and lack of confidence in blood donation systems.

Systemic racial barriers to blood donation
DOI: 10.1503/cmaj.250123

CMAJ @cmaj.ca · 4w ago

Updated HIV prophylaxis guidelines: what clinicians need to know This week on #CMAJPodcasts, we discuss HIV prophylaxis guidelines with Dr. Darrell Tan and Natasha Lawrence ➡️ www.cmaj.ca/transcript-250511

CMAJ @cmaj.ca · 4w ago

Serotonin syndrome: what is the latest on management? CMAJ Volume 198, Issue 29, features new articles on serotonin toxicity; tinea incognito; systemic racial barriers to blood donation, and more. ➡️ https://www.cmaj.ca/content/198/29

CMAJ @cmaj.ca · last mo.

Metacarpophalangeal joint dislocation: Metacarpophalangeal joint dislocations may be missed if they are subtle or if the appropriate 3-view radiographs are not obtained. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251814

"Figure 1
(A) Anterior–posterior and (B) lateral radiographic images of the left index finger of a 15-year-old boy showing dorsal dislocation at the metacarpophalangeal joint. The proximal phalanx (white arrow) is not articulating with the metacarpal head (asterisk)."

CMAJ @cmaj.ca · last mo.

Children with medical complexity: Early conversations about what a safe discharge requires, including caregiver readiness and home care realities, can shape clinical decisions. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260404

Families describe feeling most supported when discharge planning begins early and is framed as a shared goal, not a sudden event.

CMAJ @cmaj.ca · last mo.

Telemetry monitoring: Telemetry (continuous remote cardiac rhythm monitoring) can detect arrhythmias, abnormal QT intervals, and electrocardiographic changes suggestive of myocardial ischemia. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.252113

Between 30% and 90% of noncritical care telemetry use is inappropriate or is continued longer than recommended.

CMAJ @cmaj.ca · last mo.

Vancomycin infusion reaction is an idiopathic, non immunoglobulin E-mediated anaphylactoid reaction that results in endogenous histamine release from mast cells. Never use the term “red man syndrome” to describe it. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251714

Vancomycin infusion reaction was once named “red man syndrome” because manifestations include flushing that shows red in those who are White, but this term has long been used as a racial slur toward people of Indigenous decent in North America and is not acceptable.

CMAJ @cmaj.ca · last mo.

Emergency departments across Canada are seeing record patient volumes, bed shortages and overcrowding. This week on #CMAJPodcasts, we discuss emergency physician burnout and attrition with Drs. Kerstin de Wit and Jillian Horton ➡️ www.cmaj.ca/transcript-251863

CMAJ @cmaj.ca · last mo.

Hemoperitoneum pregnancy: Uterine fibroids in pregnancy are mostly asymptomatic, but as many as 20% will develop complications such as degeneration, torsion of a pedunculated fibroid, or spontaneous rupture. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251938

Ultrasound of a 36-year-old primigravida woman with an exophytic fibroid (arrow) at point of maximal tenderness. Approximate myometrial thickness and distance from fibroid to gestational sac (arrowhead) ranged from 5 mm to 12 mm (double arrow).

Hemoperitoneum pregnancy
DOI: 10.1503/cmaj.251938

CMAJ @cmaj.ca · last mo.

Deaf community experiences in health care: Deaf community experiences highlight how the privileging of spoken language and hearing norms operates both structurally and interpersonally to shape and constrain health care access and navigation. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.251945

In Canada, approximately 357 000 people identify as culturally Deaf, which is a distinct cultural and linguistic identity rather than a deficit requiring correction.

Deaf community experiences in health care
DOI: 10.1503/cmaj.251945

CMAJ @cmaj.ca · last mo.

Health care access and navigation: what are the experiences of culturally Deaf people? CMAJ Volume 198, Issue 28, features new articles on Deaf community experiences in health care; children with medical complexity; telemetry monitoring, and more. ➡️ https://www.cmaj.ca/content/198/28

Cover of CMAJ featuring a healthcare professional interacting with a patient and a caregiver in a clinical setting.

CMAJ @cmaj.ca · 2mo ago

Every wrinkle holds a thousand tales: A physician reflects on caring for an Inuk man in his final illness ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260356

As clinicians, we often think in terms of what we can fix. The North taught me to also think in terms of what we can receive. It taught me that listening itself — careful, reverent listening — is a form of care, a form of honouring.

CMAJ @cmaj.ca · 2mo ago

Pacemaker lead failure: Pacemaker lead failure is broadly categorized into 2 types: conductor fracture and insulation failure. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260045

(A) Chest radiograph of an 89-year-old woman showing an abnormal configuration of the atrial pacing lead near the sternoclavicular region (B, black arrow), consistent with suspected insulation damage.

CMAJ @cmaj.ca · 2mo ago

Pyoderma gangrenosum: Pyoderma gangrenosum is a rare but serious neutrophilic dermatosis that often presents as a rapidly expanding ulcer. Images provided in article. Learn more ➡️ www.cmaj.ca/lookup/doi/10.1503/cmaj.260050

Pyoderma gangrenosum often mimics infectious or vascular disease, which can contribute to its diagnostic difficulty and delay in management.