Schulich students for emergency childcare: Results of a community initiative during COVID-19

The coronavirus disease (COVID-19) pandemic led to the abrupt suspension of many businesses and services in Ontario including schools and childcare centres. This resulted in many parents struggling to identify options for childcare, including frontline healthcare workers (HCWs). A volunteer initiative composed of medical and dental students was developed to provide emergency childcare support to HCWs in Southwestern Ontario. Experts in areas of public health, law, and bioethics were consulted to minimize the risks associated with participation and develop a clear policy to prioritize the health and safety of all participants. Social media was utilized to recruit volunteers and HCWs who were matched on a first-come, first-served basis. 59 medical and dental students were recruited to provide emergency support for 21 HCWs within the unique safety and ethical conditions posed by COVID-19. By reflecting on the strengths of this initiative and the challenges faced during its completion, key areas of improvement were identified that should be addressed in future initiatives of a similar nature.

Heparin Resistance in ECMO and the Role of Direct Thrombin Inhibitors: A Case Report

Extracorporeal membrane oxygenation (ECMO) is a potentially life-saving technology that can provide timely support to those failing to oxygenate their blood, either due to cardiac or respiratory related illnesses. However, ECMO also requires a careful hemostatic balance due to the thrombotic nature of the external circuit and the potential for bleeding events while anticoagulated. Current standard procedure for anticoagulating patients on ECMO is the use of unfractionated heparin. Despite its widespread use, many patients still face bleeding and/or clotting complications during their admission, some resulting in disastrous consequences. One possible etiology for this ineffectiveness is due to the mechanism by which heparin works via antithrombin (AT) and the AT deficiency of a critically ill patients. In this case study, we discuss the use of an alternative anticoagulant, a direct-thrombin inhibitor (DTI) in a patient cannulated to ECMO, which is independent of AT. The case study follows their course while on ECMO, focusing on relevant hemostatic measures. We further demonstrate the therapeutic potential for DTIs in place of UFH in ECMO patients, and the need for further research into anticoagulation strategies in critically ill patients.

The Impact of Animal Agriculture on Human Health

Animal agriculture contributes to many health problems that exist today, such as the spread of infectious diseases, antibiotic resistance, and chronic human diseases like heart disease and cancer. With regards to infectious diseases, most modern day infections were unknown before the domestication of animals. Industrial agriculture forces a large number of genetically similar animals into unsanitary situations, providing the perfect conditions for viruses to emerge and spread to different species. With regards to antibiotic resistance, the US FDA estimates that each year, 80% of microbial drugs are sold to the meat industry. Countries that have the most microbial resistance also have the highest use of antimicrobials, such as penicillins, tetracyclines, and sulfonamides in animal agriculture. With regards to chronic human diseases, there is extensive evidence that the excessive consumption of animal-based products can lead to chronic diseases such as cardiovascular disease and some types of cancer. The purpose of this article is to further discuss how animal agriculture may be a cause of these current health problems and how adopting a plant-based diet can be a potential solution.

Ethical considerations of age-based allocation of intensive care treatments amid the COVID-19 outbreak

With the COVID-19 outbreak severely overwhelming healthcare systems worldwide, countries must decide on allocation criteria for scarce intensive care resources such as ventilators, leaving some without life-saving treatment. Groups such as the Italian College of Anesthesia, Analgesia, Resuscitation and Intensive Care (SIAARTI) have suggested using age as allocation criteria, prioritizing the young over the elderly. In judging the morality of such criteria, different ethical frameworks must be applied. From a utilitarian perspective, age-based allocation ensures “the greatest good” – that those with greater “therapeutic success” or “quality-of-life” get access to intensive treatment. However, age poorly predicts prognostic outcomes, and quality-of-life measures are inherently value-laden. From a contractarian view, a morally justifiable action is one made in ignorance of one’s own stake in the outcome. In this lens, age-based allocation is justified since it maximizes the most life-years for the most people. However, it relies on the same flawed assumptions as utilitarianism. From a prioritarian view, age-based allocation ensures that the rights of the young to live out a “normal life span” are respected. However, such judgements ignore the positive experiences of later life and cannot be made on a patient’s behalf. Through a deontological lens, age-based allocation is discriminatory as it views elderly people as means to an end rather than individual agents. Ultimately, the rationing criteria a society uses reflects its values, with age limitations implicitly devaluating the elderly. Therefore, allocation guidelines should deemphasize age in favor of more predictive and less discriminatory measures like multimorbidity or frailty.

Chloroquine and Hydroxychloroquine for COVID-19: Demonstrating the Importance of the Scientific Process

Although chloroquine and hydroxychloroquine have been touted in the media as “miracle drugs” in the fight against COVID-19, the research backing this claim is controversial. Some studies have shown impressive results – like one study that reported a 100% cure rate – while numerous other studies have reported inefficacy. However, the evidence presented in many of these studies has been laden with glaring flaws – from low sample sizes to a lack of control group – and many had been pre-printed without peer review. No matter how contentious the evidence for efficacy may be, studies have shown an undeniable association with serious adverse events, most notably heart arrythmias. In this article, we will discuss where the hype originated, the current state of evidence, and where the future of these in drugs is headed in the current climate of COVID-19.

An infusion of history: transfusion medicine from the 17th century to current emergency practices

Blood transfusions represent a key life-saving practice for the management of hemorrhage in emergency medicine and a commonly performed procedure in hospital settings. The ability to store and utilize the various components of blood, while avoiding adverse reactions and ensuring public health, is due to many historical research advances and refinements in our understanding of the circulatory and immune systems. This article will review the historical development of blood transfusion practices including the initial descriptions of animal-human transfusion, the first implementations in patient care and the translation into a widely used emergency procedure.

Building the fourth pillar

The past decade saw great excitement over cancer immunotherapy, reaching a fever pitch, with the discovery being heralded as a “game changer”.1 In 2013 Science magazine dubbed immunotherapy the “breakthrough of the year”,2 and in 2018 the Nobel prize in physiology and medicine was awarded for contributions to the field.3 Throughout the 2010s unprecedented clinical results were seen with chimeric antigen receptor (CAR) T-cell therapy,4–6 and the first FDA approvals were obtained for CAR T-cell products,7 oncolytic viruses,8 and checkpoint blockade.9 Despite rapid advances, cancer immunotherapy progress has not been without its hurdles. New toxicities and high costs continue to challenge the field, alongside uncertainties regarding the durability of responses and widespread applicability of these therapies across different tumour types.10,11 Now, at the close of the decade we provide herein a brief overview of the history and current state of immunotherapy, reflecting on whether this treatment modality has truly “changed the game”.

A Delayed Presentation of Diffuse Axonal Injury

Diffuse axonal injury is one of the most common and debilitating pathologies resulting from mechanical deformation of the brain. The current case involves a 19-year-old female involved in a high velocity ski crash. The accident resulted in a right lower leg fracture, with no loss of consciousness or evidence of head trauma. Approximately 6.5 hours after her admission, the neurological status of the patient deteriorated markedly, and magnetic resonance imaging findings were consistent with diffuse axonal injury. This presentation illustrates a case of delayed diffuse axonal injury, a phenomenon not commonly described. Diffuse axonal injury involves rapid inertial forces causing strain to brain tissue. This strain results in various stages of diffuse axonal damage and inflammation. This article highlights a case of delayed onset diffuse axonal injury, describes the progression of neural sequelae post-injury resulting in axonal damage and explores proposed therapeutic targets.

A Rare Case of Myocarditis Induced by Cannabis Use

Cannabis is one of the most commonly abused drugs in the world and there is a widespread misconception that cannabis is a safe drug without adverse effects. Tetrahydrocannabinol (THC) is one of the main chemicals of cannabis and considerable research suggests that cannabis and THC may have severe consequences on mental as well as physical health. However, the cardiovascular effects of cannabis are not well known. This article outlines the first reported case of pediatric death due to myocarditis induced by cannabis exposure. The subject is an 11-month-old male without any previous medical history that presented to the emergency department with central nervous system depression. The patient then went into cardiac arrest and died. Autopsy revealed myocarditis as the cause of death. Post-mortem blood analysis further revealed high concentrations of Δ-9-THC which is a metabolite of THC that can be detected for 24 hours after exposure. Considering that no other alternate causes of myocarditis have been confirmed, this raises cannabis exposure as the most likely cause. Although this is the first case of death from cannabis-induced myocarditis, there have been other cases wherein which cannabis exposure lead to myocarditis in young males. Altogether, these cases highlight the need for further investigation into the cardiovascular effects of cannabis and to consider cannabis in the diagnosis of myocarditis.