Robot-assisted surgical treatment in a case of superior mesenteric artery syndrome

We present a case of superior mesenteric artery syndrome in a 14-year-old female. The patient was initially managed using dietary changes and postprandial assumption of the left lateral decubitus position, however, after two months with no improvement, the patient was treated using a robot-assisted Strong’s procedure.  The patient fully recovered within one year.  We further discuss superior mesenteric artery syndrome and its current treatment practices, and give a general overview of the current state of robot-assisted surgery

A case of opioid-induced hyperalgesia: An overview of current evidence and recommendations

This article presents a previously reported case of a 44-year-old woman receiving opioids for malignancy-related pain who presented with increasing pain symptoms. After a detailed examination of the patient’s medical history, the pain was determined to be unrelated to her cancer and opioid-induced hyperalgesia (OIH) was diagnosed. The patient was eventually treated through a gradual tapering of opioids, in addition to complementary therapy and counseling. Following the case description, a concise review of the pertinent literature on OIH is conducted, emphasizing distinguishing factors between OIH and other similar syndromes as well as potential molecular targets. Finally, a brief summary of current recommendations is provided, although further research into this area is required to better evaluate the significance and treatment of OIH

Chikungunya virus in Canada: A case report highlighting the need for increased global health education

This article presents a previously reported case involving the first Canadian patient to acquire Chikungunya virus (CHIKV) infection after travelling to a newly endemic region in the Americas. The specific history and clinical presentation of this patient is examined, including the treatment and complete resolution of the patient’s symptoms. A brief overview of the general disease course and diagnosis of CHIKV is provided. This case emphasizes the importance of global health education in Canadian medical curricula. The current standards of global health education in Canadian medical schools are briefly reviewed and recommendations based on expert opinions are provided. Although such programs exist, their implementation was found to be variable between schools and increased attention and standardization is currently required

Emergency lateral canthotomy and cantholysis to relieve intraocular pressure following severe motor vehicle collision

A young woman displayed a dilated and fixed pupil following a motor vehicle collision with blunt force trauma to face. This was associated with drastically elevated intraocular pressure and proptosis. It was believed that a retrobulbar bleed was causing ocular compartment syndrome, an ischemic condition whereby elevated pressure within the orbit occludes blood flow to the retina and ocular nerves. This is a rare ocular emergency, and must be promptly treated to prevent permanent damage. Ophthalmology was consulted by telephone to confirm the diagnosis and direct treatment. A lateral canthotomy and cantholysis was performed under guidance from Ophthalmology and free open access medical education resources. The trauma team managed to save the eye, with visual acuity remaining near normal. In this report, the mechanism of orbital compartment syndrome is explained, and the lateral canthotomy and cantholysis procedure is outlined. This case highlights the importance of telephone consultation and easily accessible medical education resources in the acute care of rare conditions that may arise following trauma

Patient and caregiver engagement in research: factors that influence co-enrollment in research

Abstract Background Recruitment of pediatric participants in studies is difficult due to the vulnerability of this population and the scarcity of certain conditions. Co-enrolling in multiple studies is a strategy that may help overcome this problem. Although anecdotal evidence suggests that co-enrollment may increase patient and caregiver burden, few studies have been conducted from the patient perspective. The objective of this quality improvement project was to elicit patient and caregiver opinions on co-enrolling in multiple research studies. Methods Patients and caregivers attending the rheumatology clinic at The Hospital for Sick Children were invited to participate in a semi-structured interview or focus group session. Participants were asked to respond to ten prompts, organized into five categories: experience in clinical research, multiple studies, study selection, study timing and other comments. Sessions were recorded, transcribed and analyzed using NVivo 10 to identify common themes. Results Overall, eighteen caregivers and two patients were included in the study. Participants felt that the level of study involvement, rather than the number of studies, was the biggest factor affecting their decision to participate. Another factor commonly identified was the competing demands of participants’ work and family life. Participants indicated that they generally preferred to be informed about all study opportunities and liked to receive this information prior to their appointments. Once informed, they preferred to be approached by the research team while they were waiting for their appointment. Conclusion Patients and caregivers are open to the concept of co-enrolling in multiple research studies. There are multiple factors which influence decisions to co-enroll in studies including the demands of the study and personal limitations. These findings will help guide the design and practices of future research