Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized controlled trial.

BACKGROUND: Less than two-thirds of children with abdominal pain in the emergency department receive analgesia. We sought to determine whether hyoscine butylbromide was superior to acetaminophen for children with nonspecific colicky abdominal pain. METHODS: We randomly allocated children aged 8-17 years with nonspecific colicky abdominal pain who presented to the pediatric emergency department of London Health Sciences Centre, London, Ontario to receive hyoscine butylbromide, 10 mg given orally, or acetaminophen, 15 mg/kg given orally (maximum 975 mg). We considered the minimal clinically important difference for the primary outcome (self-reported pain at 80 min) to be 13 mm on a 100 mm visual analogue scale. Secondary outcomes included administration of rescue analgesia, adverse effects and pain score less than 30 mm at 80 minutes. RESULTS: A total of 236 participants (120 in the hyoscine butylbromide group and 116 in the acetaminophen group) were included in the trial. The mean visual analogue scale scores at 80 minutes were 29 mm (standard deviation [SD] 26 mm) and 30 mm (SD 29 mm) with hyoscine butylbromide and acetaminophen, respectively (adjusted difference 1, 95% confidence interval -7 to 7). Rescue analgesia was administered to 4 participants (3.3%) in the hyoscine butylbromide group and 1 participant (0.9%) in the acetaminophen groups ( INTERPRETATION: Hyoscine butylbromide was not superior to acetaminophen in this setting. Both agents were associated with clinically important pain reduction, and either can be considered for children presenting to the emergency department with nonspecific colicky abdominal pain

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Multisystem inflammatory syndrome in children (MIS-C) and COVID-19: a review of the literature

Multisystem Inflammatory Syndrome in Children (MIS-C) is a novel pediatric hyperinflammatory syndrome that has recently emerged globally as a potential complication of COVID-19 infection and has features similar to Kawasaki Disease (KD).  In this article, a review of existing literature on MIS-C was conducted to identify trends in patient characteristics, clinical and biological features, treatment, and outcomes. MIS-C affects previously healthy school-age children, with over-representation of those of Black and Afro-Caribbean descent. It presents with fever, gastrointestinal complaints, and KD-type features including rash and conjunctivitis. Laboratory and imaging studies demonstrate evidence of systemic inflammation and myocarditis. Accordingly, children are often critically ill and require intensive care admission and organ support. However, prompt anti-inflammatory treatment with intravenous immunoglobulin, steroids, and aspirin appears to lead to favourable outcomes. Though evidence of current coronavirus infection by RT-PCR is variable, most children have positive serology results indicating prior infection, which supports theories of MIS-C as a dysfunctional post-infectious immune process. Though similar to KD in some ways, MIS-C has important differences in its patient characteristics, clinical features, and cardiac involvement. Large-scale case registries and analysis of resulting data will be crucial to refining our understanding of MIS-C to ensure optimal outcomes for children worldwide

Psychiatry and mental health in the medical community: An interview with Dr Sreelatha Varapravan

Dr. Varapravan completed medical school in Bangalore, India, then continued her medical training in Canada and finished her residency at Western University in psychiatry. Originally interested in otolaryngology, her exposure to psychiatry in Canada caused her to change tracks and to pursue psychiatry. She is currently a part of the Assessment Unit at Parkwood Institute Mental Health Care, has previously worked as Undergraduate Education Psychiatry Clerkship Coordinator, and is heavily involved in exposing the students of Schulich to psychiatry. We had the opportunity to talk to Dr. Varapravan about psychiatry as a field, the psychiatry clerkship program, and about burnout in the medical community

CSTAR, Robotics, and Minimally Invasive Surgery: An Interview with Dr. Christopher Schlachta

Dr. Schlachta received his undergraduate and medical degrees from McGill University. With a keen interest in various types of surgery, he then completed a surgery internship at Toronto General Hospital before choosing to pursue residency in general surgery here at Western. Subsequently, he returned to Toronto for a fellowship in advanced minimally invasive surgery and subsequently worked as a staff surgeon at the Wellesley Hospital and St. Michael’s Hospital, where he was the head of the division. Finally, Dr. Schlachta was recruited back to London to serve as the medical director of Canadian Surgical Technologies & Advanced Robotics (CSTAR) in 2005. He presently holds this position, as well as cross-appointment as a Professor in the Departments of Surgery and Oncology. He has been involved in numerous Canadian and world firsts in robotic gastrointestinal surgery. We had the opportunity to speak with Dr. Schlachta to discuss his surgical practice, current research, and the technology at CSTAR

Mental health, system barriers, and implicit bias in the treatment of refugees and newcomers: An interview with Dr. Javeed Sukhera

For psychiatrist Dr. Javeed Sukhera, quality mental health care for newcomer and refugee youth is extremely important. In particular, he advocates for trauma-informed care and awareness of implicit bias in medicine. Though frustrated with the currently inadequte funding of mental health treatment in Canada, Dr. Sukhera suggests that health professionals can take steps to provide care that serves the unique needs of refugee and newcomer populations. Fundamentally, he believes that this simply involves recognition of one’s own humanity and the common human experiences shared by refugees, newcomers, and healthcare providers alike

The Schulich Pain Medicine residency: An interview with Dr Geoff Bellingham

Dr Bellingham completed his medical school and anesthesiology residency at Western University. He followed this with a fellowship in Chronic Pain Management at the University of Toronto, with a focus on interventional pain management using fluoroscopy and ultrasound guided techniques. Dr Bellingham returned to Western University to work in the Department of Anesthesia and Perioperative Medicine in his capacity as an anesthetist and as a chronic pain specialist. Here at Western, he directs the Pain Clinic at St. Joseph’s Health Care and also played a key role in the development of Canada’s first Pain Medicine residency program. We had an opportunity to chat with Dr Bellingham and discuss a wide range of topics including his choice of career path, the Pain Medicine residency program, and other pain medicine topics in the context of the current opioid epidemic