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Esmonde-White C. Let food be thy knowledge gap: the lack of nutrition education in medical curricula. Can Med Educ J 2023; 14:142-143. [PMID: 37719403 PMCID: PMC10500411 DOI: 10.36834/cmej.76390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
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Preti BTB, Sanatani MS, Breadner D, Lakkunarajah S, Scott C, Esmonde-White C, McArthur E, Rodrigues G, Chaudhary M, Mutsaers A, Sachdeva R, Vincent MD. Real-World Analysis of Durvalumab after Chemoradiation in Stage III Non-Small-Cell Lung Cancer. Curr Oncol 2023; 30:7713-7721. [PMID: 37623040 PMCID: PMC10453685 DOI: 10.3390/curroncol30080559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
The 2017 PACIFIC trial heralded the incorporation of routine adjuvant durvalumab following curative-intent chemoradiation for stage III non-small-cell lung cancer (NSCLC). However, carefully selected clinical trial populations can differ significantly from real-world populations, which can have implications on treatment toxicities and outcomes, making it difficult to accurately counsel patients. Consequently, we performed a real-world, retrospective analysis of outcomes and toxicities in 118 patients with stage III NSCLC treated with durvalumab after platinum-based chemoradiotherapy. The data were collected from patients who underwent treatment at a single, tertiary-level Canadian cancer centre from May 2018 to October 2020. The variables collected included patient demographics, treatment specifics, progression-free survival, overall survival, and immune-related adverse events (IRAE) from durvalumab. Descriptive statistics were used for toxicity analysis, and progression-free survival and overall survival estimates were calculated using the Kaplan-Meier method. The statistical analyses indicated a 64.4% (n = 76) toxicity rate, with a 21% (n = 25) toxicity rate of grade 3+ IRAEs. The most common documented IRAEs were pneumonitis (n = 44; 40%), followed by rash (n = 20; 18%) and thyroid dysfunction (n = 17; 15%). FEV1 and DLCO were not found to be associated predictors of pneumonitis toxicity. The median PFS and OS were estimated to be >1.7 years and >2.7 years, respectively.
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Affiliation(s)
- Beatrice T. B. Preti
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Michael S. Sanatani
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Daniel Breadner
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Suganija Lakkunarajah
- Department of Medical Oncology, University of British Columbia, Victoria, ON V8R 6V5, Canada
| | - Carolyn Scott
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
| | - Caroline Esmonde-White
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
| | - Eric McArthur
- London Health Sciences Centre, London, ON M5S 1A8, Canada
| | - George Rodrigues
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Mitali Chaudhary
- Temerty School of Medicine, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Adam Mutsaers
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Radiation Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
| | - Robin Sachdeva
- Department of Medical Oncology, University of British Columbia, Victoria, ON V8R 6V5, Canada
| | - Mark D. Vincent
- Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada; (B.T.B.P.)
- Division of Medical Oncology, Schulich School of Medicine & Dentistry, Western University, London, ON N6A 3K7, Canada
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Esmonde-White C, McLachlan RS, Burneo J, Arts J, Redhead C, Suller Marti A. Nationwide Study of Postlegalization Marijuana Use Among Patients With Epilepsy in Canada. Neurol Clin Pract 2023; 13:e200174. [PMID: 37251367 PMCID: PMC10219131 DOI: 10.1212/cpj.0000000000200174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/03/2023] [Indexed: 05/31/2023]
Abstract
Background and Objectives Patients with epilepsy have long sought alternatives to conventional antiseizure medications (ASMs) for the treatment of their epilepsy and to improve the significant side effect burden of ASMs and comorbidities. It was established before the legalization of marijuana in Canada in 2018 that many patients with epilepsy use marijuana to treat their seizures or for recreational purposes. However, there exists no current data on the prevalence and habits of marijuana use in the Canadian epilepsy population since legalization. Methods We conducted a nationwide cross-sectional survey of patients recruited through health care providers or epilepsy organizations to investigate marijuana usage habits and perceptions. Results From 395 responses obtained through the survey, 221 responses stated that they used marijuana within the past year. A history of seizures for more than 10 years was noted in 50.7% (n = 148) patients with generalized seizures being the most common type (n = 169; 57.1%). Most of them (n = 154; 52.0%) had tried 3 or more ASMs, and 37.2% (n = 110) used various other treatments (ketogenic diet, vagus nerve stimulation, or resective surgery) indicating a proportion with drug-resistant epilepsy. This subgroup was more likely to have started using marijuana for drug-resistant epilepsy (p < 0.001). Current marijuana use for epilepsy management was endorsed by 47.5% (n = 116). Marijuana was "somewhat" to "very" effective at reducing seizure frequency for 60.1% (n = 123). The main side effects of marijuana were impaired thinking (n = 40; 17.17%), anxiety (n = 37; 15.74%), and altered hunger (n = 36; 15.32%). Marijuana was used at least once daily by 70.3% (n = 168) with the median amount per week being 5.0 g (IQR = 1-10), and the preferred method of consumption was smoking (n = 83; 34.7%). The participants expressed concerns regarding financial strain (n = 108; 36.5%), lack of recommendation from a doctor (n = 89; 30.1%), and lack of information (n = 56; 18.9%) surrounding marijuana use. Discussion This study reveals a high prevalence of marijuana use among patients with epilepsy living in Canada particularly when seizures are drug resistant. A significant proportion of patients reported improvement of seizures with marijuana use, consistent with previous studies. With the increased accessibility of marijuana, it is imperative that physicians are aware of marijuana usage habits among patients with epilepsy.
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Affiliation(s)
- Caroline Esmonde-White
- Schulich School of Medicine and Dentistry (CE-W, RSM); Clinical Neurological Sciences Department (JB, ASM); Neuroepidemiology Unit (JB), Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre (JA, CR); and Paediatrics Department (ASM), Western University, London, Ontario, Canada
| | - Richard S McLachlan
- Schulich School of Medicine and Dentistry (CE-W, RSM); Clinical Neurological Sciences Department (JB, ASM); Neuroepidemiology Unit (JB), Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre (JA, CR); and Paediatrics Department (ASM), Western University, London, Ontario, Canada
| | - Jorge Burneo
- Schulich School of Medicine and Dentistry (CE-W, RSM); Clinical Neurological Sciences Department (JB, ASM); Neuroepidemiology Unit (JB), Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre (JA, CR); and Paediatrics Department (ASM), Western University, London, Ontario, Canada
| | - Jayme Arts
- Schulich School of Medicine and Dentistry (CE-W, RSM); Clinical Neurological Sciences Department (JB, ASM); Neuroepidemiology Unit (JB), Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre (JA, CR); and Paediatrics Department (ASM), Western University, London, Ontario, Canada
| | - Carmela Redhead
- Schulich School of Medicine and Dentistry (CE-W, RSM); Clinical Neurological Sciences Department (JB, ASM); Neuroepidemiology Unit (JB), Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre (JA, CR); and Paediatrics Department (ASM), Western University, London, Ontario, Canada
| | - Ana Suller Marti
- Schulich School of Medicine and Dentistry (CE-W, RSM); Clinical Neurological Sciences Department (JB, ASM); Neuroepidemiology Unit (JB), Schulich School of Medicine and Dentistry, Western University; London Health Sciences Centre (JA, CR); and Paediatrics Department (ASM), Western University, London, Ontario, Canada
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Esmonde-White C, Palma D, Mutsaers A. Mistaken Metastasis: Radiation-Induced Rib Fracture Mimicking Malignancy on Computerized Tomography Case Report. Case Rep Oncol 2023; 16:243-248. [PMID: 37092118 PMCID: PMC10114023 DOI: 10.1159/000528613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/02/2022] [Indexed: 04/25/2023] Open
Abstract
A 62-year-old woman with a 40-pack-year smoking history and severe chronic obstructive pulmonary disease with early-stage right upper lobe non-small cell lung cancer (NSCLC) was treated with stereotactic ablative radiotherapy (SABR). Two years after treatment, a surveillance computerized tomography scan showed lesions of the posterior 4th and 5th ribs including expansion of the medulla that was unusual and of concern for possible malignant infiltration. A follow-up magnetic resonance imaging (MRI) scan revealed these lesions to be healing fractures post-radiotherapy. Although generally well tolerated, SABR is known to produce inflammatory and fibrotic changes both in-field and in organs at risk, and rib fractures are a well-established adverse event. MRI has high diagnostic accuracy and sensitivity for rib fractures and was able to rule out malignant spread. This case demonstrates the need for regular follow-up following SABR for early-stage NSCLC, as well as the challenge of interpreting indeterminate post-SABR radiography findings.
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Affiliation(s)
| | - David Palma
- Radiation Oncology, London Health Sciences Center, London, ON, Canada
| | - Adam Mutsaers
- Radiation Oncology, London Health Sciences Center, London, ON, Canada
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Cheng H, Esmonde-White C, Kassay AD, Wunder ML, Martin C. Developing a Hybrid Four-Prong Approach to Anatomical Education During the COVID-19 Pandemic. Med Sci Educ 2021; 31:1529-1535. [PMID: 34026305 PMCID: PMC8131080 DOI: 10.1007/s40670-021-01322-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 05/30/2023]
Abstract
During COVID-19, the anatomy faculty and students at Schulich School of Medicine and Dentistry observed strengths and weaknesses in their transition to online learning. A "four-prong" approach to teaching anatomy was developed. Asynchronous content modules were tailored to specific learning objectives, virtual labs were implemented to work through case-based applications, "live from the lab" review sessions provided the opportunity for interaction and integration, and finally, limited face-to-face laboratory sessions provided an opportunity for supervised consolidation with cadaveric specimens. Our approach may be used by other institutions to enhance anatomical education and student engagement.
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Affiliation(s)
- Henry Cheng
- Schulich School of Medicine & Dentistry, Medical Sciences Building, Western University, London, N6A 3K7 Canada
| | - Caroline Esmonde-White
- Schulich School of Medicine & Dentistry, Medical Sciences Building, Western University, London, N6A 3K7 Canada
| | - Andrea D. Kassay
- Schulich School of Medicine & Dentistry, Medical Sciences Building, Western University, London, N6A 3K7 Canada
| | - Meaghan L. Wunder
- Schulich School of Medicine & Dentistry, Medical Sciences Building, Western University, London, N6A 3K7 Canada
| | - Charys Martin
- Department of Anatomy & Cell Biology, Schulich School of Medicine & Dentistry, Medical Sciences Building, Western University, London, N6A 3K7 Canada
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Esmonde-White C, Yaqubi M, Bilodeau PA, Cui QL, Pernin F, Larochelle C, Ghadiri M, Xu YKT, Kennedy TE, Hall J, Healy LM, Antel JP. Distinct Function-Related Molecular Profile of Adult Human A2B5-Positive Pre-Oligodendrocytes Versus Mature Oligodendrocytes. J Neuropathol Exp Neurol 2019; 78:468-479. [DOI: 10.1093/jnen/nlz026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Moein Yaqubi
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
| | | | - Qiao Ling Cui
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
| | - Florian Pernin
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
| | | | - Mahtab Ghadiri
- Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Yu Kang T Xu
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
| | - Timothy E Kennedy
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
| | - Jeffery Hall
- Department of Neurosurgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - Luke M Healy
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
| | - Jack P Antel
- Neuroimmunology Unit, Montreal Neurological Institute, McGill University
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