http://cjgim.ca/index.php/csim/issue/feed Canadian Journal of General Internal Medicine 2019-02-18T18:46:01+00:00 Scott Bryant sbryant@dougmargroup.com Open Journal Systems <p><strong>The Canadian Journal of General Internal Medicine (CJGIM) ISSN: 2369-1778</strong> is the official publication of the Canadian Society of Internal Medicine (CSIM). The journal has a well respected editorial board and provides a sharp focus on the topics and issues facing the profession of Internal Medicine with a combination of society news, clinical and scientific original articles. CJGIM is published four times a year and is distributed to all members of the Canadian Society of Internal Medicine along with physicians in various subspecialties of medicine.</p> http://cjgim.ca/index.php/csim/article/view/348 Health Promotion Heroes 2019-02-18T18:46:00+00:00 James Douketis jdouket@mcmaster.ca <p>N/A</p> 2019-02-12T00:00:00+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/349 Heros de la promotion de la sante 2019-02-18T18:46:00+00:00 James Douketis jdouket@mcmaster.ca <p>N/A</p> 2019-02-12T00:00:00+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/318 BMJ Rapid Recommendations: A Possible Revolution in Clinical Practice Guidelines 2019-02-18T18:46:00+00:00 Gordon Guyatt guyatt@mcmaster.ca Thomas Agoritsas thomas.agoritsas@gmail.com Lyubov Lytvyn lytvyn.lyubov@gmail.com Reed Siemieniuk reed.siemieniuk@medportal.ca Per Vandvik per.vandvik@gmail.com <p>BMJ rapid recommendations hold the potential to revolutionize clinical practice guidelines, achieving both timeliness, trustworthiness, and usefulness to clinicians and patients to allow well informed decisions in clinical practice.</p> 2019-02-12T00:00:00+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/289 Gender Equity in Academic Medicine: Why Should We Care? 2019-02-18T18:46:01+00:00 Sonia S. Anand anands@mcmaster.ca Anita I. Anand, BA, BA, LLB, LLM anita.anand@utoronto.ca <p>Gender disparity exists generally in academia and specifically in research and education among academic medical specialists. Reasons for this disparity include overt and unconscious biases that result in women getting fewer opportunities to lead, receiving less compensation, being excluded from networking channels in which privileged positions are discussed, and facing bias in research, including in the peer review grant process. The recent spotlight on these disparities in other sectors pushes us to focus attention on the causes and consequences of gender disparity in academic medicine and to advocate for structural changes to ensure gender equity in academic departments of hospitals and universities.&nbsp;</p> 2019-02-12T00:00:00+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/284 Not Every Low Back Pain is a Radiculopathy 2019-02-18T18:46:00+00:00 Pankaj Bansal bansalp@hhsc.ca Laura Grennan laura.anne.g@hotmail.com Karthik Mahadevappa drkarthikm@gmail.com Emilia Semenov esemenov@msn.com Shanker Nesathurai nesathurai@hhsc.ca <p class="p7">A 66 year old man with a history of chronic low back pain and three previous spine surgical procedures presented with new onset, acute, excruciating low back pain with dysesthesias radiating to the left leg, left leg weakness, and difficulty walking.&nbsp;</p> 2019-02-12T18:00:51+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/261 Metastatic Breast Cancer Presenting as Refractory Anemia 2019-02-18T18:46:01+00:00 Julie Beaudoin-Maitre julie.beaudoin-maitre@usherbrooke.ca Chantal Vallée chantal.vallee@usherbrooke.ca <p>We will review the case of a 71-year-old woman with an atypical presentation of stage IV breast cancer. She presented with symptomatic normocytic anemia (Hb 85 to 100 g/L) for the past two years, with a normal extended laboratory evaluation. Due to deterioration of her anemia, a bone marrow biopsy was done and concluded to myelodysplastic syndrome. Treatment with Epoetin alfa and a trial of Lenalidomide didn’t improve her hemoglobin and she was still transfusion dependent. A second bone marrow biopsy revealed breast carcinoma infiltration, which was initially missed on the first biopsy. The patient was started on Letrozole and Palbociclib with good clinical response. Here, we present the clinical evolution, diagnosis and management of bone marrow micrometastasis due to breast cancer.&nbsp;</p> <p>&nbsp;</p> <p><strong>Résumé</strong></p> <p>Nous présentons l’étude de cas d’un cancer du sein de stade IV, chez une femme de 71 ans, ayant eu une présentation atypique. Elle s’est présentée avec une anémie normocytaire (Hb 85 à 100 g/L) symptomatique depuis deux ans, non explicable par un bilan biochimique approfondi. Suite à la dégradation de son anémie, une biopsie de moelle osseuse a été effectuée concluant à un syndrome myélodysplasique. Un traitement à l’epoetin alfa ainsi qu’un essai de lenalidomide ne permirent pas l’amélioration de son hémoglobine et elle est demeurée dépendante aux transfusions. Une seconde biopsie de moelle osseuse démontra une infiltration par un carcinome mammaire qui n’avait pas été constatée lors de la première biopsie. Un traitement avec du letrozole et du palbociclib a alors été débuté avec une réponse clinique satisfaisante. Nous passons en revue la présentation clinique, la démarche diagnostique ainsi que la prise en charge des micro métastases de la moelle osseuse dans le cancer du sein.</p> 2019-02-12T00:00:00+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/279 Liver Abscess Metastatic Syndrome Caused by Hypermucoviscous Klebsiella Pneumoniae in a Canadian Patient of Vietnamese Origin 2019-02-18T18:45:59+00:00 Sandra Patricia Criales Doria sandra-patricia.criales-doria.1@ulaval.ca Alexandre Lafleur alexandre.lafleur@fmed.ulaval.ca Philippe Gervais philippe.gervais@criucpq.ulaval.ca <p><span style="font-size: medium;"><span style="font-family: Times New Roman;"><em>Klebsiella pneumoniae</em> liver abscess syndrome (KLAS) is an emerging infection caused by hypermucoviscous strains (K1, rmpA, mgA) with a particular virulence at risk of metastatic dissemination. We describe a case of metastatic KLAS in a Canadian immunocompetent patient of Vietnamese origin who presented with fever and abnormal liver function tests. Imaging studies revealed unique liver and pulmonary abscesses. Blood and liver abscess cultures showed colonies of <em>K.pneumoniae</em> with hypermucoviscous phenotype, a K1 serotype and the presence of a rmpA gene confirming biomolecular features of the invasive syndrome. Mostly reported in patients of Asian origin, KLAS has been reported in Canada since 2007. Prompt identification and treatment prevents severe complications such as endophthalmitis, meningitis, lung abscess and spondylodiscitis. </span></span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><strong><span style="font-family: Times New Roman; font-size: medium;">Résumé:</span></strong></p><p><span style="font-family: Times New Roman; font-size: medium;">Le syndrome d’abcès hépatique à <em>Klebsiella pneumoniae</em> (KLAS en anglais) est une infection en émergence résultant d’une souche hypermuqueuse (K1, rmpA, mgA) d’une virulence accrue, à risque de dissémination. Nous décrivons un cas de KLAS métastatique chez un patient canadien d’origine vietnamienne, immunocompétent, qui présentait de la fièvre et des anomalies du bilan hépatique. Les imageries ont révélé des abcès hépatiques et pulmonaires uniques.  Les hémocultures et les cultures du drainage de l’abcès hépatique ont confirmé la présence d’une souche hypermuqueuse de <em>Klebsiella pneumoniae</em>, sérotype K1, génotype rmpA, caractéristiques biomoléculaires associées aux infections invasives. Principalement décrits chez des patients d’origine asiatique, des cas de KLAS sont rapportés au Canada depuis 2007. L’identification et le traitement rapide préviendront des complications sévères, dont l’endophtalmite, la méningite, l’abcès pulmonaire et la spondylodiscite.</span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><p><span style="font-family: Times New Roman; font-size: medium;"> </span></p><strong><br clear="all" /> </strong> 2019-02-12T18:08:10+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/278 A Challenging Case of Non-resolving Pneumonia: Keeping Antisynthetase Syndrome In the Differential Diagnosis 2019-02-18T18:46:01+00:00 Stephanie Lapinsky, MD info@dougmargroup.com Jessica Leen, MD info@dougmargroup.com Jessica Mak, BSc. Pharm (Hons), RPh. MD Candidate  jessica.mak@utoronto.ca Mohammed A. Shafiee, MD info@dougmargroup.com <p>A 62-year-old Caucasian female ex-smoker presented to the emergency department with progressive shortness of breath with associated pleuritic chest pain, new arthralgias, and muscle weakness for two months.&nbsp;She had already been&nbsp;treated with two courses of antibiotics for suspected community acquired pneumonia (CAP) with no improvement in her respiratory symptoms. This is a case that illustrates the eventual diagnosis of antisynthetase syndrome, a subtype of the&nbsp;<span lang="EN-CA">idiopathic inflammatory myopathies. Current standard of diagnostic criteria and treatment for this autoimmune condition will also be discussed.&nbsp;</span></p> 2019-02-12T00:00:00+00:00 ##submission.copyrightStatement## http://cjgim.ca/index.php/csim/article/view/281 Renal Limited Lupus-Like Nephritis 2019-02-18T18:45:59+00:00 Jumana Amir jumana.amir@mail.mcgill.ca Salwa Sheikh salwa.sheikh@jhah.com Abdulrazack Amir abdulrazack.amir@jhah.com <p>Biopsy diagnosis of lupus nephritis with no extra-renal features of SLE, normal complement levels, negative or weekly positive ANA and negative other serology is a rare entity known as “Renal Limited Lupus Like Nephritis”. So far, only 10 cases of RLLLN in adults have been reported in literature. The prognosis of these patients varied depending on their clinical presentation. Herein, we report a case of an elderly female with RLLLN who presented with massive proteinuria and acute kidney injury with crescents, however had a good outcome contrary to reported cases with similar presentations. We also reviewed all reported cases thus far.</p> 2019-02-12T18:22:10+00:00 ##submission.copyrightStatement##