BUPA Worldwide insurance (since 1947) now covers CANADA

British United Provident Association now offers Canadian coverage. Multiple options.(in USA$) For World Hospital treatment (except USA) 29y-$1584 year; 39y- $2595; 49y- $3417. (Private General Hospitals now exist Montreal ROCKLAND MD; Ontario has one:Homewood Psychiatric in Guelph) RocklandMD MEDICAL CLINIC DOWNTOWN MONTREAL 1538 Sherbrooke ouest, Office 500, Montreal (Quebec) H3A 1L5 Guy-Concordia Metro Opening hours Monday to Friday from 8:00 am. to 4:00 pm Phone 514-667-3383 option 1 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com ROCKLANDMD MEDICAL CLINIC VILLE MOUNT-ROYAL 100 Rockland road, suite 110, Ville Mont-Royal (Québec) H3P 2V9 Acadie metro Opening hours Monday to Friday 7:00 am to 6:00 pm Saturday from 8:00 am to 4:00 pm Phone 514-667-3383 option 1 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com ROCKLANDMD SURGERY CENTER VILLE MOUNT-ROYAL 100 Rockland road, 115A, Ville Mount-Royal (Quebec) H3P 2V9 Acadie metro Opening hours Monday to Friday from 7:30 am to 18:00 pm Phone 514-667-3383 option 2 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com

ONTARIO CHAPTER American College Physicians Anglo-Canadian Nephrologist Prof A.R. MORTON.

Meet Our Governor-elect Designee Ontario Chapter Congratulations to the Ontario Chapter Governor-Elect Designee, Alexander Ross Morton, MD, FACP. Our new Governor-elect Designee will do a year of training as a Governor-elect and then will start his four-year term as Governor in the Spring of 2015. As Governor, Dr. Morton will serve as the official representative of the College for the Ontario Chapter, providing a link between members at the local level and leadership at the national level. In the meantime, Dr. Morton will be working closely with Dr. Feldman (the current Governor) and College staff to learn about the College and his duties as Governor. To learn more about Dr. Morton, feel free to read his bio below. Alexander Ross Morton, MD, FACP Dr. Morton EDUCATION: University of Saint Andrews, University of Manchester POST DOCTORAL TRAINING: University of Manchester, University of Toronto; CERTIFICATION: BSc (Saint Andrews) MB ChB (Manchester) MD (Manchester); FRCP (London) FRCPC (Canada) FACP PRESENT POSITION: Professor of Medicine, Queen’s University, Kingston, Ontario, Canada ACP ACTIVITIES: FACP October 2008 CHAPTER INVOLVEMENT/LEADERSHIP ACTIVITIES: Member of the Governor’s Advisory Council. Queen’s University representative. Frequent Speaker at Chapter Annual Meeting HOSPITAL/COMMUNITY SERVICE: Kingston General Hospital OTHER APPOINTMENTS: Chair, Division of Nephrology AREAS OF PROFESSIONAL INTEREST/EXPERTISE: General Internal Medicine, Nephrology, Mineral Metabolism Vision Statement The Ontario Chapter of the American College of Physicians has forged strong links with the Canadian Society of Internal Medicine this year. These links needs to be maintained and strengthened to include other Chapters across the country. With the President of the Canadian Medical Association due to be appointed from Ontario in the summer of 2014, this is an ideal opportunity to increase dialogue between the two major national organizations using Ontario as a base. The link between the Ontario University and Community Physicians is ripe for strengthening as Social Media communications increases. Issues relevant to the membership can be brought to the attention of the Chapter quickly and dealt with in a timely manner, enhancing the relevance of the ACP to the Ontario membership. Furthermore using such rapid communication techniques, Medical Student and Trainee interest can be engaged, and educational opportunities increased.

ProMed:ZIKA VIRUS- FIRST in EUROPE A SEXUALLY TRANSMITTED DISEASE

PRO/EDR> Zika virus - Germany ex Thailand Inbox x promed@promedmail.org 20:24 (12 hours ago) to promed-post, promed-edr-post ZIKA VIRUS - GERMANY ex THAILAND ******************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Fri 27 Dec 2013 From: Jonas Schmidt-Chanasit [edited] A previously healthy 53-year-old man consulted at the Saarland University Medical Center on 22 Nov 2013 after returning from travel to Thailand. During his 3-week round trip (31 Oct-20 Nov 2013), including visits to Phuket, Krabi, Ko Jum, and Ko Lanta, he developed joint pain and swelling on his left ankle and foot on 12 Nov 2013 after several mosquito bites, followed by a maculopapular rash on his rear and front trunk that spread to the face and the upper as well as lower extremities over the next 4 days before fading. Accompanying symptoms were malaise, fever, and shivering, of which the latter 2 appeared only for one day. He and his travel partner, who never had any comparable symptoms, were using insect repellent during travel. Upon presenting in Germany, which was intended as a check for tropical diseases and included taking blood samples, no clinical signs could be found, and the only subjective complaint was continuing tiredness. Initially, the 1st serum sample collected 10 days after disease onset gave a positive result in the dengue IgM antibody tests (IFA and rapid test), although tests for dengue IgG antibody (IFA and rapid test) and dengue NS 1 antigen (ELISA and rapid test) were negative. However, the isolated positive result for dengue IgM antibodies prompted us to investigate a probable flavivirus etiology through a serological approach. Serological tests for Japanese encephalitis virus, West Nile virus, yellow fever virus, tick-borne encephalitis virus, and Zika virus were performed by the WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research (WHOCC), Hamburg, Germany. IFAs gave positive results for Zika virus IgG and IgM antibodies, demonstrating an acute or recent Zika virus [ZIKV] infection of the patient. In contrast, IFAs gave negative results for the other flaviviruses tested as well as for chikungunya virus. Real-Time RT-PCR for ZIKV RNA (in-house) was negative. The presence of ZIKV-specific neutralizing antibodies was confirmed by a virus neutralization assay, and an IgM titer decrease in IFA was demonstrated in the 2nd serum sample collected 31 days after disease onset. This is the 1st laboratory confirmed case of ZIKV reported in Germany and Europe and the 2nd case reported from Thailand. Thus, differential diagnosis in febrile returning travelers from the south of Thailand (Phuket, Krabi, Ko Jum, and Ko Lanta) should include Zika virus infection. -- Jonas Schmidt-Chanasit, Petra Emmerich, Dennis Tappe, Martin Gabriel, Stephan Gunther: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany. Jorgen Rissland, Gerhard Held, Sigrun Smola: Saarland University Medical Center, Homburg/Saar, Germany [ProMED thanks Jonas Schmidt-Chanasit and colleagues for sending in this interesting, firsthand report. This is the 2nd ProMED-mail report of a Zika virus infection originating in Thailand. The virus was 1st isolated in 1947 from sentinel rhesus monkey serum in Uganda. Fortunately, the probability of ongoing transmission from this case in Germany is nil. This is another example of long-distance international travel involving an individual who acquired a tropical arbovirus disease who was seen in a temperate zone clinic halfway around the world. The above case is an excellent example of a thorough laboratory approach to establishing a diagnosis of a disease exotic to Germany. It also underscores the importance of taking a good travel history for these types of cases. It also indicates that Zika virus transmission is active in Thailand and could be confused easily with a dengue virus infection without comprehensive laboratory testing. This report along with the earlier one this year [2013] make one wonder how many Zika virus infections in Thailand and other Southeast Asian countries are mistakenly diagnosed as dengue virus infections.

CME: Can.Soc.CLINICAL HYPNOSIS

CANADIAN SOCIETY OF CLINICAL HYPNOSIS (ONTARIO DIVISION) announces registration opening for: The Fundamentals of Hypnosis a two-day Introductory workshop - March 28th and 29th $575 until Feb 17th, then $625 Non-members can pay online to reserve their spot, but you still need to mail your registration form to establish eligibility. www.HypnosisOntario.com Book soon, attendance may be limited. Full details are in the attached brochure in Adobe PDF format

GILEAD: SOVALDI (Sofosbuvir) for Chr.HEP.C.

Health Canada Issues Notice of Compliance for Sovaldi™ (Sofosbuvir) for the Treatment of Chronic Hepatitis C – Sovaldi Receives Marketing Authorization for Patients with Genotypes 1, 2, 3 or 4 HCV – – High Cure Rates (SVR 12) and Therapy Shortened to Just 12 Weeks for Many Patients – FOSTER CITY, Calif.--(BUSINESS WIRE)--Dec. 16, 2013-- Gilead Sciences, Inc. (Nasdaq: GILD) today announced that Health Canada has issued a Notice of Compliance for Sovaldi™ (sofosbuvir) 400 mg tablets, a once-daily oral nucleotide analog polymerase inhibitor for the treatment of chronic hepatitis C (CHC) infection. Sovaldi is indicated for use in adult patients with compensated liver disease, including cirrhosis, for the treatment of genotype 1 or 4 CHC in combination with pegylated interferon and ribavirin, and for the treatment of genotype 2 or 3 CHC in combination with ribavirin. The recommended dose and treatment duration for Sovaldi combination therapy is as follows: Treatment Duration Treatment-naïve patients with genotype 1 or 4 CHC Sovaldi + peginterferon alfa + ribavirin 12 weeks Patients with genotype 2 CHC Sovaldi + ribavirin 12 weeks Patients with genotype 3 CHC Sovaldi + ribavirin 16 weeks* * Consideration should be given to extending the duration of therapy beyond 16 weeks and up to 24 weeks guided by an assessment of the potential benefits and risks for the individual patient (these factors may include cirrhosis status and treatment history). Treatment regimen, duration and response to Sovaldi are dependent on viral genotype and patient population, and associated baseline factors. Sovaldi must not be administered as monotherapy. The Canadian Product Monograph is available at www.Gilead.ca. Gilead submitted the marketing application for Sovaldi in Canada on May 17, 2013 and was granted Priority Review by Health Canada. Gilead is awaiting federal and provincial reimbursement review for Sovaldi under the Canadian Common Drug Review process. Gilead anticipates that Sovaldi will be available to patients in Canada early next year. Sovaldi was approved in the United States on December 6, 2013 and applications are pending in the European Union, Australia and New Zealand, Switzerland and Turkey. “I believe sofosbuvir has the potential to transform HCV treatment in Canada as it addresses many unmet patient needs,” said Jordan Feld, MD, MPH, Staff Hepatologist, Toronto Western Hospital, Department of Medicine, Division of Gastroenterology. “The high cure rates, shortened treatment duration, and potential to eliminate or reduce interferon injections give us our best opportunity to successfully treat Canadians with hepatitis C.” An estimated 250,000 Canadians are living with chronic hepatitis C virus (HCV), but because the disease can progress for many years without causing noticeable symptoms, about 35 percent of these individuals do not know they are infected. HCV disproportionately impacts “baby boomers,” individuals born between 1945 and 1965, and the Canadian Liver Foundation now recommends that all Canadian baby boomers be tested for the virus. The current standard of care for HCV in Canada involves up to 48 weeks of therapy with a pegylated interferon (peg-IFN)/ribavirin (RBV)-containing regimen, which may not be suitable for certain types of patients. The marketing authorization is supported primarily by data from four Phase 3 studies, NEUTRINO, FISSION, POSITRON and FUSION, which evaluated 12 or 16 weeks of treatment with Sovaldi combined with either RBV or RBV plus peg-IFN. Three of these studies evaluated Sovaldi plus RBV in genotype 2 or 3 patients who were either treatment-naïve (FISSION), treatment-experienced (FUSION) or peg-IFN intolerant, ineligible or unwilling (POSITRON). NEUTRINO evaluated Sovaldi in combination with peg-IFN/RBV in treatment naïve patients with genotypes 1, 4, 5 or 6. Patients who achieve SVR12 are considered cured of HCV. Trial participants taking Sovaldi-based therapy achieved SVR12 rates of 50-90 percent. For full study details, see the Clinical Studies section of the Product Monograph. Sovaldi combination therapy was well tolerated in clinical studies. Adverse events were generally mild and there were few treatment discontinuations due to adverse events. The most common adverse reaction occurring in at least 5 percent of patients receiving Sovaldi in combination with ribavirin was fatigue. Among patients receiving Sovaldi in combination with RBV and peg-IFN, the most common adverse reactions occurring in at least 5 percent of patients were fatigue, anemia, neutropenia, insomnia, headache and nausea. See below for Important Safety Information regarding contraindications, warnings and precautions, adverse reactions and drug interactions. Patient Assistance Program in Canada As part of its commitment to ensuring that people with hepatitis C can access Sovaldi, Gilead Sciences Canada has developed the Momentum Support Program™, which will launch on January 6, 2014. The program is designed to provide an integrated offering of support services for patients and healthcare providers, including: Access to dedicated case managers to help patients and their providers with insurance-related needs, including identifying alternative coverage options such as federal and provincially-insured programs. The Sovaldi Co-pay assistance program, which will provide financial assistance for eligible patients who need help paying for out-of-pocket medication costs. For more information regarding Sovaldi or the Momentum Program in Canada, please call the Gilead Sciences Canada medical information line at 1-866-207-4267. About Sovaldi Sovaldi is an oral nucleotide analog inhibitor of the HCV NS5B polymerase enzyme, which plays an essential role in HCV replication. Sovaldi is a direct-acting agent, meaning that it interferes directly with the HCV life cycle by suppressing viral replication. Treatment regimen and duration for Sovaldi are dependent on both viral genotype and patient population. Treatment response varies based on baseline host and viral factors. Sovaldi must not be administered as monotherapy. - See more at: http://www.gilead.com/news/press-releases/2013/12/health-canada-issues-notice-of-compliance-for-sovaldi-sofosbuvir-for-the-treatment-of-chronic-hepatitis-c#sthash.wY1SdSIb.dpuf

BMJ: COITUS PORTALIS

Like a virgin (mother): analysis of data from a longitudinal, US population representative sample survey BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f7102 (Published 17 December 2013) Cite this as: BMJ 2013;347:f7102 Amy H Herring, professor12, Samantha M Attard, PhD candidate23, Penny Gordon-Larsen, professor23, William H Joyner, the reverend4, Carolyn T Halpern, professor25 Author Affiliations Correspondence to: A H Herring amy_herring@unc.edu Abstract Objective To estimate the incidence of self report of pregnancy without sexual intercourse (virgin pregnancy) and factors related to such reporting, in a population representative group of US adolescents and young adults. Design Longitudinal, population representative sample survey. Setting Nationally representative, multiethnic National Longitudinal Study of Adolescent Health, United States. Participants 7870 women enrolled at wave I (1995) and completing the most recent wave of data collection (wave IV; 2008-09). Main outcome measures Self reports of pregnancy and birth without sexual intercourse. Results 45 women (0.5%) reported at least one virgin pregnancy unrelated to the use of assisted reproductive technology. Although it was rare for dates of sexual initiation and pregnancy consistent with virgin pregnancy to be reported, it was more common among women who signed chastity pledges or whose parents indicated lower levels of communication with their children about sex and birth control. Conclusions Around 0.5% of women consistently affirmed their status as virgins and did not use assisted reproductive technology, yet reported virgin births. Even with numerous enhancements and safeguards to optimize reporting accuracy, researchers may still face challenges in the collection and analysis of self reported data on potentially sensitive topics.

OMA PRESIDENT Stoney Creek (Hamilton) GP Scott Douglas WOODER

Dr.S.D.WOODER MD (U.Toronto 1985) High School:Scarborough CEDERBRAE COLLEGIATE INSTITUTE. Married: McMaster U.Professor Lori WHITEHEAD MD(Tor.1985) FRCPC(Internal Medicine & Respirology) Daughter:Hamilton Realtor Jess WOODER BA (McMaster U.,Sociology) STONEY CREEK HEALTH SCIENCE BUILDING Dr. C. Ambis Family Physician Dr. B. Babic Pediatrician Dr. M. C. De Benedetti Family Physician Dr. F.D. Fraser Family Physician Dr. K. Hallett Pediatrician Dr. J. Jones Family Physician Dr. T. Kwok Family Physician Dr. A. Lozinski Dermatology & Cosmetic Surgery Dr. J. Profetto Family Physician Dr. S. Wooder Family Physician

Mycobacteriun leprae incidence in INDIA

LEPROSY - INDIA (05): (ANDHRA PRADESH) INCREASED INCIDENCE ********************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sat 21 Dec 2013 Source: The Times of India Times News Network (TNN) [edited] Leprosy is increasing alarmingly in Andhra Pradesh with the government doing little to check the bacterial infection from spreading, experts said as a staggering 8285 cases were reported in the state during 2012-13. As many as 239 new cases were detected in Hyderabad in the same period. Health department officials said Andhra Pradesh now figures among the top 12 states with the highest caseloads of leprosy in the country. The proportion of new paediatric cases in the state was also among the highest in the country, experts said. Data from the National Leprosy Eradication Programme shows that out of the total new cases, a substantial 911 cases (11.34 per cent) are of children, officials said. Experts said the numbers have gone up particularly in the last 2 years. During 2011-12, 7820 cases were detected, they pointed out and attributed the situation to the state government's apathy towards the health issue, so much so that it is now regaining ground. "We could not identify these cases well in time," said Dr Michael Sukumar, a WHO consultant who is working with the state leprosy cell [in Hyderabad], underscoring a situation when agencies are sometimes helpless when local governments fail to read health warnings.

UK DAILY MAIL:: ERROR in "NIL BY MOUTH" at ROYAL BOURNEMOUTH HOSPITAL

Elderly patient starved because a 'nil by mouth' sign meant for the previous occupant of her bed had not been removed Royal Bournemouth Hospital in Dorset under attack from hospital inspector Care Quality Commission inspection found alarming care of elderly patients One was left naked on top of a soiled sheet and other forced to wet the bed Another left on the verge of malnutrition because they couldn't reach food By Anna Hodgekiss PUBLISHED: 11:49 GMT, 19 December 2013 | UPDATED: 11:53 GMT, 19 December 2013 An elderly patient starved because a ‘nil by mouth’ sign meant for the previous occupant of her bed had not been removed. A damning report into care at the Royal Bournemouth Hospital also found that another elderly patient was left completely naked on top of a soiled sheet, while others were forced to wet the bed after their repeated calls for assistance went unanswered. A dementia patient was also left on the verge of malnutition because they were unable to reach food or drink left for them. The Royal Bournemouth Hospital in Dorset has received a damning hospital inspection report. Patients were found to have had fluids and food restricted by mistake while others were left lying in soiled or wet beds The Royal Bournemouth Hospital in Dorset has received a damning hospital inspection report. Patients were found to have had fluids and food restricted by mistake while others were left lying in soiled or wet beds The terrible treatment came to light after the Care Quality Commission, which inspects hospitals, visited in October. The two-day inspection singled out wards three and 26 for being particularly bad and understaffed. The report states the family of an elderly woman were surprised to find the ‘nil by mouth’ sign on her bed and were shocked when it was realised it wasn’t meant for her. Yet it took another five hours for the patient to be given water, such was the lack of staff on the ward. The report states: 'One person on ward 3 told us they had come to visit their relative and had been surprised to find they had a sign above their bed saying "nil by mouth", which told staff not to offer this patient food or fluids orally. More... How was NHS surgeon allowed to carry out controversial breast cancer surgery even AFTER colleagues raised concerns? Report published today as victims sue 'Bully' chief of cancer scandal hospital quits: £165,000-a-year executive accused of fiddling cancer waiting times 'The relative had questioned this with a nurse, who told them that their relative was due to undergo an investigation, which meant that they couldn’t eat or drink. 'They then asked the nurse to find out what this investigation was. When the nurse returned they said that the patient was not in fact meant to be ‘nil by mouth’ but that the sign had been left on the bed from a previous patient. 'This meant that the patient had missed breakfast and lunch, and had not received fluids since their admission to the ward. 'The concerned relative went on to say that although this mistake was discovered at 2pm, when they returned to the ward at 7pm their relative had still not been given water to drink.' The report also highlights the case of a dementia patient who lost a significant amount of weight because they were unable to reach their food just inches away. Professor Sir Mike Richards, the Chief Inspector of Hospitals Royal Bournemouth Chief Executive Tony Spotswood Despite the scathing report from the chief inspector of hospitals, Professor Sir Mike Richards (left), Bournemouth chief executive Tony Spotswood (right) said there was no reason for him to resign It reads: 'Despite them being able to eat independently, food and drinks had been left out of their reach and left to go cold. 'As a result, their relative had lost a significant amount of weight on the ward. 'When they asked about the weight loss they were told that staff had weighed their relative that morning and they had weighed 90 kilograms. 'As they felt that this did not seem correct, they asked staff to weigh them again. On that occasion they weighed 69 kilograms. 'They said that the ward had given their relative a Malnutrition Universal Screening Tool (MUST) score of zero after the first weight was recorded, which needed to be changed to a three after the second weight was recorded. Dorothy Simpson, 84, telephoned her family from the hospital because she could not breathe, and died 20 minutes later Dorothy Simpson, 84, telephoned her family from the hospital because she could not breathe, and died 20 minutes later 'This score of three showed that their relative was at risk of malnutrition.' The Royal Bournemouth was one of the first to be inspected by the CQC in the wake of the Mid Stafforshire scandal, following complaints about the level of care there. The inspection found that nurses on ward three accepted staffing levels were ‘horrendous’. The chief inspector, Sir Mike Richards, concluded: 'The trust did not employ enough staff, even though it was fully aware that nearly all its beds were occupied all the time. Professor Sir Mike Richards, the Chief Inspector of Hospitals, said: 'Whenever we inspect we will always ask the following five questions of every service: Is it safe? Is it effective? Is it caring? Is it responsive to people's needs? Is it well-led? 'At Royal Bournemouth Hospital, we were told about basic nursing care which was not being given to patients on two medical care wards. We heard from five patients who told us they had been left to wet or soil their beds. 'The hospital had a high occupancy rate and there had been ongoing use of escalation beds when a ward or unit was full - even though these beds could not meet patients' needs properly. The 64-page document also said that stroke victims were 'not always given the urgent care they needed'. Surgical services and outpatient departments also came under the microscope at the hospital managed by The Royal Bournemouth and Christchurch Hospitals NHS Trust, which serves 550,000 people. 'A number of services were not always safe, effective, responsive, caring or well-led,' stated the CQC report. 'In particular we found that medical care (including care older people's care) was inadequate. 'There were widespread and significant negative views from patients and staff.' The outpatients' department was found to have infection control risks. The main outpatient reception, the floor sinks and the waste bins in the female toilets were not clean. The sluice room - a specially designed cleaning room - was cluttered with 'obsolete equipment' and stacked with used clinical dressing packs. The Royal Bournemouth was one of the first to be inspected by the CQC in the wake of the Mid Stafforshire (pictured) scandal, following complaints about the level of care there The Royal Bournemouth was one of the first to be inspected by the CQC in the wake of the Mid Stafforshire (pictured) scandal, following complaints about the level of care there The report said: 'Staff entered the sluice with dirty packs, adding to the pile, and left without washing their hands.' Despite the report beign scathing of the leadership of the hospital, chief executive Tony Spotswood said there was no reason for him to resign. He added: 'We accept the broad findings of the report and would like to apologise to those patients who received poor care. 'Clearly it is unacceptable but many of these issues have now been set right. 'We have put in place a number of changes in relation to staffing and care of the elderly and we have already seen a number of improvements within the last six weeks. Paula Shobbrook, director of nursing at the Royal Bournemouth, added: 'I don’t want patients to be frightened about coming to hospital. 'We have recruited more nurses; 57 newly qualified nurses are now working on our wards and we have new ward sisters who are committed to raising standards.' Read more: http://www.dailymail.co.uk/health/article-2526334/Patients-left-soiled-sheets-locums-poor-nursing-Hospital-chief-inspector-slams-two-leading-hospitals-unsafe.html#ixzz2nvdpTWcw Follow us: @MailOnline on Twitter | DailyMail on Facebook

Switzerland: PRESERVATIVE-FREE EYE DROPS.

Consider using preservative-free topical medication in patients with ocular surface disease Publishing date: December 2013 The Science behind the Tip Many glaucoma drops contain a preservative agent to minimise the risk of microbial contamination. Benzalconium chloride, a cationic surfactant, is the most widely used preservative, but even in doses of 0.002% to 0.004% can result in toxic effects on the surface of the eye and ocular inflammation. (1) Symptoms and signs of ocular surface disease (OSD) are found in 48-60% of patients on topical glaucoma medication (2) (3). This is a multifactorial condition which leads to adverse local reactions, reduced visual acuity, reduced quality of life and reduced compliance with prescribed therapy. (1). Risk factors associated with OSD include the number of preserved drops used and duration of therapy. (4) An improvement of symptoms is found if these patients are switched to preservative-free topical medication. (1) Contributor: Frances Meier-Gibbons, Switzerland References 1. Baudouin C, Labbé A, Liang H et al Preservatives in eyedrops: the good, the bad and the ugly. Prog Retin Eye Res 2010; 29 (4) 312-334. 2. Leung EW, Medeiros FA, Weinreb RN. Prevalance of ocular surface disease in glaucoma patients. J Glaucoma 2008; 17 (5) 350-355. 3. Fechtner RD, Godfrey DG, Budenz D et al. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure lowering medications. Cornea 2010;? 29: 618-621. 4. Rossi GC, Pasinetti GM, Scudeller L et al. Risk factors to develop ocular surface disease in treated glaucoma or ocular hypertension patients. Eur J Ophthalmol 2013; 23 (3) 296-302. Tip Editors: John Salmon and John Thygesen Reviewers: Roger Hitchings and Anders Heijl

OMA TORONTO STREET ADS

ASTRAL TTC STOP ADS. $3787 (inc 13% tax) per face for 4 weeks (central core area).

UK PRIVATE MED.SCHOOL: University of BUCKINGHAM

Accredited by UK Gen Med.Council www.buckingham.ac.uk/medicine Tuition:$70,000/year for 4.5 years (short vacations) NO SCHOLARSHIPS Living expenses: circa $30,000/yr Entry: Int.Baccalaureate(36+)for Canadian students.

Dr.GERHARD MANN PHARMA, Berlin ( a Bausch & Lomb company ) CARBOMER, MYRITOL 318 "LIPOSIC" eye drops.

OMA had an EYE CME @ WESTIN PRINCE HOTEL. BAUSCH & LOMB presented LIPOSIC combination of Ophthalmic drops & night use Liposic gel for xerophthalmia.

TORONTO: MEDICAL ADVICE FOR VISITORS

FROM PHYSICIAN CONTRIBUTOR. AVOID LOCAL ER. WAITING TIME 4-6 hrs. ADVISE LIMO RIDE ($400) 1.5 - 2 hr. to Mount St.Mary Hospital,Lewiston, NY. Quick access to Specialists, MRI etc. For general medical advice CLEVELAND CLINIC CANADA, (30,000 sq.ft.)@ BROOKFIELD PLACE, 181 BAY ST. (also entrance YONGE ST.) 416-507-6600 Same building as Hockey Hall of Fame & MARCHE Swiss Restaurant. Connected to USA Cleveland clinics. (Near Fairmont ROYAL YORK Hotel.) MEDCAN Private clinic 150 YORK St.(@ Adelaide)416-350-5900 (Mid-Town location)Near to HILTON & SHERATON Hotels.) No Private Hospitals in Ontario (Quebec has Private Medicine)

50y. anniversary of development of Measles vaccine by Duke Univ. Emeritus Prof S.L. KATZ

Press Release Embargoed until: Thursday, December 5, 2013 at 12:00 noon ET Contact: Media Relations (404) 639-3286 Measles Still Threatens Health Security On 50th Anniversary of Measles Vaccine, Spike in Imported Measles Cases Fifty years after the approval of an extremely effective vaccine against measles, one of the world’s most contagious diseases, the virus still poses a threat to domestic and global health security. On an average day, 430 children – 18 every hour – die of measles worldwide. In 2011, there were an estimated 158,000 measles deaths. In an article published on December 5 by JAMA Pediatrics, CDC’s Mark J. Papania, M.D., M.P.H., and colleagues report that United States measles elimination, announced in 2000, has been sustained through 2011. Elimination is defined as absence of continuous disease transmission for greater than 12 months. Dr. Papania and colleagues warn, however, that international importation continues, and that American doctors should suspect measles in children with high fever and rash, “especially when associated with international travel or international visitors,” and should report suspected cases to the local health department. Before the U.S. vaccination program started in 1963, measles was a year-round threat in this country. Nearly every child became infected; each year 450 to 500 people died each year, 48,000 were hospitalized, 7,000 had seizures, and about 1,000 suffered permanent brain damage or deafness. People infected abroad continue to spark outbreaks among pockets of unvaccinated people, including infants and young children. It is still a serious illness: 1 in 5 children with measles is hospitalized. Usually there are about 60 cases per year, but 2013 saw a spike in American communities – some 175 cases and counting – virtually all linked to people who brought the infection home after foreign travel. “A measles outbreak anywhere is a risk everywhere,” said CDC Director Tom Frieden, M.D., M.P.H. “The steady arrival of measles in the United States is a constant reminder that deadly diseases are testing our health security every day. Someday, it won’t be only measles at the international arrival gate; so, detecting diseases before they arrive is a wise investment in U.S. health security. Eliminating measles worldwide has benefits beyond the lives saved each year. Actions taken to stop measles can also help us stop other diseases in their tracks. CDC and its partners are building a global health security infrastructure that can be scaled up to deal with multiple emerging health threats. Currently, only 1 in 5 countries can rapidly detect, respond to, or prevent global health threats caused by emerging infections. Improvements overseas, such as strengthening surveillance and lab systems, training disease detectives, and building facilities to investigate disease outbreaks make the world -- and the United States -- more secure. “There may be a misconception that infectious diseases are over in the industrialized world. But in fact, infectious diseases continue to be, and will always be, with us. Global health and protecting our country go hand in hand,” Dr. Frieden said. Today’s health security threats come from at least five sources: The emergence and spread of new microbes The globalization of travel and food supply The rise of drug-resistant pathogens The acceleration of biological science capabilities and the risk that these capabilities may cause the inadvertent or intentional release of pathogens Continued concerns about terrorist acquisition, development, and use of biological agents. “With patterns of global travel and trade, disease can spread nearly anywhere within 24 hours,” Dr. Frieden said. “That’s why the ability to detect, fight, and prevent these diseases must be developed and strengthened overseas, and not just here in the United States.” The threat from measles would be far greater were it not for the vaccine and the man who played a major role in creating it, Samuel L. Katz, M.D., emeritus professor of medicine at Duke University. Today, CDC is honoring Dr. Katz 50 years after his historic achievement. During the ceremony, global leaders in public health are highlighting the domestic importance of global health security, how far we have come in reducing the burden of measles, and the prospects for eliminating the disease worldwide. Measles, like smallpox, can be eliminated. However, measles is so contagious that the vast majority of a population must be vaccinated to prevent sustained outbreaks. Major strides already have been made. Since 2001, a global partnership that includes the CDC has vaccinated 1.1 billion children. Over the last decade, these vaccinations averted 10 million deaths – one fifth of all deaths prevented by modern medicine. “The challenge is not whether we shall see a world without measles, but when,” Dr. Katz said. “No vaccine is the work of a single person, but no single person had more to do with the creation of the measles vaccine than Dr. Katz,” said Alan Hinman, M.D., M.P.H., Director for Programs, Center for Vaccine Equity, Task Force for Global Health. “Although the measles virus had been isolated by others, it was Dr. Katz’s painstaking work passing the virus from one culture to another that finally resulted in a safe form of the virus that could be used as a vaccine.”

PHILADELPHIA:WILLS EYE INSTITUTE FREE CMEs

Wills Eye Knowledge Portal www.willseyeonline.org Wills Eye Knowledge Portal Free Registration. Free CME. Sign Up Here! Experience Wills Eye education online at www.willseyeonline.org Learn from top doctors at Wills Eye Institute. Experience web-based medical education. Earn CME credits from world-renowned experts. ---------------------------------- CME Courses Strabismus Disorders 0.5 AMA PRA Credit Strabismus is a common condition in children, occurring in about 4% of children in the United States. If untreated, strabismus can lead to untreatable visual compromise once the child is grown. The treatments for strabismus have evolved with scientific studies. Given the potential to minimize a lifetime of sub-optimal vision, physicians should be aware and up-to-date on this topic as significant practice gaps exist in awareness of strabismus disorders. ------------------------------------ ALL CME COURSES ON THE WILLS EYE KNOWLEDGE PORTAL ARE FREE! ------------------------------------ Wills Eye 39th Annual Ophthalmology Review Course March 1-5, 2014 A comprehensive review of the basic principles and recent advances in ophthalmology for Residents and Fellows. Information: (215) 440-3169 Wills Eye 65th Annual Conference March 6-8, 2014 Philadelphia, PA willsconference.org This is a three day conference designed for comprehensive ophthalmologists, specialists, and allied health personnel. The conference will review clinical, diagnostic and therapeutic approaches to eye problems related to all ophthalmic sub-specialties. Follow us on Twitter Like us on Facebook View our videos on YouTube December 2013 Corneal Trauma, Abrasions, Chemical Burns, Perforating Trauma Presenter: Kristin Hammersmith, MD Dr. Hammersmith is an assistant surgeon on the Cornea Service and Director of the Cornea Fellowship Program at Wills Eye Hospital. She is also an instructor at the Jefferson Medical College of Thomas Jefferson University. Dr. Hammersmith interests include severe ocular surface diseases such as dry eye, blepharitis, ocular cicatricial pemphigoid, chemical burns, and the potential of limbal cell transplantation to help patients with these conditions. Central Retinal Venous Obstruction Presenter: Joseph I. Maguire, MD Dr. Maguire is an attending surgeon on the Retina Service at Wills Eye Hospital and an associate professor of ophthalmology at Thomas Jefferson University. He is a past Retina Service President and Scientific Director of the Eye Reseach Institute (ERI). He is currently a principal investigator in the VEGF-trap clinical trial and the National Institutes of Health sponsored AREDS 2, and has been clinical co-investigator in several completed and ongoing clinical trials evaluating novel treatments for diabetic retinopathy and AMD. Low Vision 101: Custom Refractions, Prisms, and Optics; and Low Vision 201: Rehabilitation Presenter: Scott Edmonds, OD Dr. Edmonds is Co-Director of the Low Vision and Contact Lens Service at Wills Eye Hospital. He has written and lectured extensively on clinical topics of post operative care, low vision, contact lenses, and ocular diseases as well as management topics of managed care and medicare. Dr. Edmonds has been recognized as Optometrist of the year by the Philadelphia Optometric Society, the Chester-Delaware Optometric Society, and Pennsylvania Optometric Association. IOP Variation: Should It Affect Our Management of Glaucoma? Presenter: L. Jay Katz, MD, FACS Dr. Katz is the director of the glaucoma service at the Wills Eye Hospital and professor of ophthalmology at Thomas Jefferson University. He has published more than 160 articles in peer reviewed journals and has authored, coauthored, or edited more than 30 books and book chapters. He has received numerous awards including the Physicians Recognition Award from the American Medical Association and an Honor award from the American Academy of Ophthalmology. Dr. Katz has been an investigator in several landmark multicenter trials. Additional Highlights: Importance of Adherence and Quality of Life in People Under Glaucoma Treatment George L. Spaeth, MD Introduction to Ocular Pathology Ralph C. Eagle, MD Biopsy Techniques Edward H. Bedrossian, MD Contemporary Management of Retinal Detachment Repair Gaurav K. Shah, MD Herpetic Disease of the Anterior Segment Brad Feldman, MD Visiting Professor Lectures and Cases Joshua R. Ehrlich, MD; Timothy V. Johnson, MD; Jared D. Peterson, MD Chiefs' Rounds Anthony W. Farah, MD; Nina Ni, MD; Michael S. Ehrlich, MD; Kristin M. DiDomenico, MD; Blair K. Armstrong, MD