"Dr.Gifford-Jones" Ontario Docs frightened to do Gynae. exams.

Canada's top syndicated medical journalist, Toronto Gynaecologist K.F.WALKER MD (HARVARD 1950) FRCS(C) a.k.a "Dr.W.Gifford-Jones" wrote in EPOCH TIMES that Ontario MDs are doing fewer pelvic.& breast exams because of the fear of losing their CPSO licence under the Sex Zero-tolerance Law. The result is delayed diagnosis of Cancer. Dr.Walker stresses the medico-legal  need for a CHAPERONE while examining a female.

Problem is the expense of hiring even a low-level Registered Practical nurse as a chaperone as well as a receptionist for the State-paid, piece-work Ontario GP.

An Ontario MD has to wait at least 5 years before applying to have a licence re-activated.

Many male Ontario docs are now limiting practices to Adult males. Precedence is by OMA having separate meetings for "WOMENS" HEALTH". (More than 50% of Ontario med.students are femaale.) This also avoids the problem of persuading mothers to immunise their children  CPSO now recognises Chiropraxy,Naturopathic and Traditional Chinese medicine. Ont.MDs`can actually now be censured by the CPSO if they do not take seriously patients demands for so-called "Alternative Medicine".

CPSO ELECTION RESULTS Dist 10 TORONTO

11,595 voters
2066 voted
18% response

ELECTED:
North Toronto GP Richard B. MacKenzie (Tor.73)  1138
Central Toronto GP-psychotherapist Marc C.GABEL (NY State U. 62) 1104
Sick Child.Hosp Paed Cardiologist Joel KIRSH (Tor 92) 1020

NOT ELECTED
Tor.Gen Hosp Psychiatrist Gerard CRAIGEN (Queen's 83) 977
East Toronto GP Kumar K.GUPTA (Manitoba 94) 853
Tor Psychiatrist Mark A. VOYSEY (Monash 78) 571
Tor. Nephrologist now GP-psych Derek A. DAVIDSON (Tor.63) 483
NorthyWest Tor. Radiologist Isadore J. CZOSNIAK (McGill 82) 476
North-Tor. Psychiatrist Toghra GHAEMMAGHAMI (nee HRAB) (Tehran 69) 193

Serum Light Chain analysis only paid in Cancer units.

Monitoring patients with monoclonal light chain diseases but no M-spike on protein electrophoresis

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

The monoclonal gammopathies are characterized by a clonal expansion of plasma cells that secrete a monoclonal immunoglobulin (Ig). The monoclonal Ig secreted by these cells serves as a marker of the clonal proliferation, and the quantitation of monoclonal protein can be used to monitor the disease course.

The monoclonal gammopathies include multiple myeloma (MM), light chain multiple myeloma (LCMM), Waldenstrom’s macroglobulinemia (WM), nonsecretory myeloma (NSMM), smoldering multiple myeloma (SMM), monoclonal gammopathy of undetermined significance (MGUS), primary systemic amyloidosis (AL), and light chain deposition disease (LCDD).

Monoclonal proteins are typically detected by serum protein electrophoresis (SPEP) and immunofixation (IF). However, the monoclonal light chain diseases (LCMM, AL, LCDD) and NSMM often do not have serum monoclonal proteins in high enough concentration to be detected and quantitated by SPEP.

A sensitive nephelometric assay specific for kappa free light chain (FLC) that doesn’t recognize light chains bound to Ig heavy chains has recently been described. This automated, nephelometric assay is reported to be more sensitive than IF for detection of monoclonal FLC. In some patients with NSMM, AL, or LCDD the FLC assay provides a positive identification of a monoclonal serum light chain when the serum IF is negative. In addition, the quantitation of FLC has been correlated with disease activity in patients with NSMM and AL.

See Laboratory Approach to the Diagnosis of Amyloidosis and Laboratory Screening Tests for Suspected Multiple Myeloma in Special Instructions.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

KAPPA-FREE LIGHT CHAIN
0.33-1.94 mg/dL

LAMBDA-FREE LIGHT CHAIN
0.57-2.63 mg/dL

KAPPA/LAMBDA FLC RATIO
0.26-1.65

Interpretation Provides information to assist in interpretation of the test results

The specificity of this assay for detection of monoclonal light chains relies on the ratio of free kappa and lambda light chains. Once an abnormal free light chain (FLC) K/L ratio has been demonstrated and a diagnosis has been made, the quantitation of the monoclonal light chain is useful for monitoring disease activity.

Changes in FLC quantitation reflect changes in the size of the monoclonal plasma cell population. Our experience to date is limited, but changes of >25% or trending of multiple specimens are needed to conclude biological significance.

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Elevated kappa and lambda free light chain (FLC) may occur due to polyclonal hypergammaglobulinemia or impaired renal clearance. A specific increase in FLC (eg, FLC K/L ratio) must be demonstrated for diagnostic purposes.

Moderate to marked lipemia may interfere with the ability to perform testing.

Supportive Data

Studies at Mayo Clinic have shown that in some patients with urine monoclonal light chains and negative serum immunofixation (IF), the free light chain (FLC) assay can identify monoclonal FLC in the serum. These studies support the increased sensitivity of the nephelometric FLC assay. In a series of patients with primary systemic amyloid treated by stem cell transplantation, the quantitation and monitoring of FLC predicted organ response (eg, disease course).

Clinical Reference Provides recommendations for further in-depth reading of a clinical nature

Drayson M, Tang LX, Drew R, et al: Serum free light chain measurements for identifying and monitoring patients with nonsecretory multiple myeloma. Blood 2001;97(9):2900-2902

UK DAILY MAIL: COST of AIDS

MOUNTING COSTS OF HIV TREATMENT

The cost of treating someone with HIV in the UK is estimated to be around £18,000 per year when they are not showing any symptoms.

This is based on the price of care as well as triple-drug antiretroviral therapy.

However, it costs £21,500 to treat patients who are showing symptoms and £41,000 for those with full-blown AIDS.

Patients who have four drugs cost the NHS between £22,775 and £48,000 per year.

The annual cost of providing HIV treatment and care in the UK could be as high as £758 million by 2013, according to a study in PLoS One. 

Read more: http://www.dailymail.co.uk/health/article-2067496/Number-people-HIV-UK-poised-hit-100-000-infections-rise-6-year.html#ixzz1f6DXIu6F

CSCH-(OD) WORKSHOPS JAN & MARCH 2012

CANADIAN SOCIETY OF CLINICAL HYPNOSIS
(ONTARIO DIVISION)

The Fundamentals of Hypnosis
a three-day Introductory workshop - January 20-21 and March 15
Medical accreditation info: 19.5 CFPC Mainpro-M1 or RCPS Section 1 credits
$675 - only $225 per day
three workshops on the Evolution of Ego State Therapy
with Claire Frederick M.D.
Part 1: History and Applications
a two day Intermediate workshop on Friday March 16 and Saturday March 17 $695
Part 2: Healing the Divided Self
a two day Advanced workshop on Friday June 8  and Saturday June 9 $695
Part 3 will be presented as part of the SCEH conference which will be held in Toronto in October 2012, co-sponsored by CSCH-OD
All workshops will be held in downtown Toronto. Student discount and CSCH / ASCH / SCEH members discounts may be available. These are non-member "early bird" rates shown above. There are eligibility requirements for each workshop. Brochures will be distributed through this mailing list as they are finalised. Registration for the Introductory workshop will open in early December.
http://www.hypnosisontario.com/

Ontario College of Family Physicians new Pres. David TANNENBAUM MD( McGill 77) FCFP

At Richmond St. HILTON HOTEL Toronto Mt. Sinai Granovsky Glusken  GP Centre David TANNENBAUM MD FCFP was acclaimed President.

Many GPs now leaving General GP and Focusing on a Specialty recognised by the Royal Colleges of Physicians & Surgeons. Mainly Acupuncture, Anaesthesia, Cosmetic medicine, Geriatrics (Nursing Homes) Hair Transplants, Musculoskeletal medicine(including joint injections & manipulation), Palliative medicine, Psychotherapy, Refraction, Rehabilitation (car accidents & WSIB), Sports Medicine, Surgical assisting.Weight loss.

Reasons:
Many specialties have lower overhead: especially psychotherapy.
Higher status: not "just a GP" Similar to UK GPwSI (GP with Special Interest).
Higher income as many services not covered by Provincial insurance with higher PRIVATE RATES.
Less medico-legal risk as TREATMENT stressed not Diagnosis.

With increase of clinical responsibility of Nurse Practitioners, the rise in Canada of Physician Assistants, and of Pharmacists in PAID Counselling, the role of GP in Ontario is declining. A worry to the College of FPs.

COFP Exec.Director & CEO is a Registered Nurse Ms Jan KASPERSKI

COCKROACH SENSITIVITY in Allergic rhinitis

Tahira Batool

*, Rozita Borici-Mazi

From

Victoria, Canada. 3-6 November 2010

Canadian Society of Allergy and Clinical Immunology Annual Scientific Meeting 2010

Background

Role of cockroach allergy in asthma has been widely studied

and the effect of environmental control on asthma

symptoms has been established. However, the role of

cockroach sensitivity remains unknown. We have

designed this study to establish role of cockroach sensitization

on allergic rhinitis.

Hypothesis

Cockroach allergy has significant role in allergic rhinitis.

Population

Allergic rhinitis patients attending allergy and clinical

immunology clinic under Dr Rozita Borici-Mazi in Kingston

General Hospital, Kingston ON.

Method

Retrospective chart review of patients evaluated for

allergic rhinitis and underwent skin prick testing.

A cohort of 250 patients was randomly selected with

inclusion criteria being symptomatic allergic rhinitis and

positive allergy skin prick testing to usual panel of allergens.

Data collection included demographics, smoking

exposure, symptom pattern, presence or absence of

non-nasal symptoms, positive skin prick testing for

cockroach and other environmental allergens such as

dust mite, cat, dog, and seasonal pollens.

Results

Allergy to seasonal allergens was found to be the most

common (n=191, 76.4%) followed by house dust mite

(n=149, 59.6%) and cat allergen (n=118, 47.2%). Cockroach

sensitization was found in 62 (25%). Among the

cockroach sensitivity group, 8 patients had monosensitization

to cockroach. All of them had perennial symptoms.

75%of these people were residents of urban areas.

Two patients who had symptoms for more than 8 years

had developed asthma.

Conclusion

Cockroach allergy is found to be one of the significant

indoor allergens in allergic rhinitis in Kingston area.

Given the relationship of Allergic Rhinitis and Asthma

development, there is need to recognize this important

allergen earlier and treat it through allergen avoidance

and/or Immunotherapy, not only to treat allergic rhinitis

symptoms but also to prevent development of allergic

asthma. Further studies to establish the correlation

between allergic rhinitis and cockroach sensitization are

needed.

Published: 4 November 2010

doi:10.1186/1710-1492-6-S2-P11

Cite this article as:

allergic rhinitis patients; is it significant? To see prevalence of cockroach

sensitivity in allergic rhinitis patients in Kingston area.

Clinical Immunology

* Correspondence: 7TB11@queensu.ca

Department of Internal Medicine, Queen

Ann Allergy. 1978 Dec;41(6):333-6.

A comparative study of prevalence of skin hypersensitivity to cockroach and house dust antigens.

Kang B, Sulit N.

Abstract

Allergy skin tests with cockroach antigen along with various common inhalant allergens were performed on 222 atopic and on 63 non-atopic subjects. The most prevalent allergen producing a positive skin test was house dust antigen with a positive response of 72%, 78% and 57% in atopic adults, atopic children and non-atopic children, respectively. The next prevalent positive skin test was to cockroach antigen with 50%, 60% and 27%, respectively, of the three groups tested. The differences between positive cockroach hypersensitivity and house dust hypersensitivity in all three groups tested were statistically significant. Next in order of prevalence of positive skin test to common inhalants were western weeds, ragweeds and cats. Incidence of cockroach hypersensitivity was 58% among asthmatic adults and 69% among asthmatic children. The results indicate that cockroach hypersensitivity is highly prevalent and that cockroach antigen is an independent agent from house dust as a cause of immediate hypersensitivity reaction.

PMID:

569451

[PubMed - indexed for MEDLINE]

Batool and Borici-Mazi: Cockroach sensitivity inAllergy, Asthma &2010 6(Suppl 2):P11.’s University, Kingston, Ontario,

POSTER PRESENTATION Open Access

WISEMAN RD, WOODIN WG, MILLER HC, MYERS MA. Insect allergy as a possible cause of inhalant sensitivity. J Allergy. 1959 May–Jun;30(3):191–197. [PubMed]

Cockroach sensitivity in allergic rhinitis patients;

is it significant? To see prevalence of cockroach

sensitivity in allergic rhinitis patients in

Kingston area