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The Canadian Journal of Medicine is the official journal of the Society.  CJM encourages submission of articles aimed at improving patient care, education, and research in primary care and general medicine in all settings as well as the journal covers all aspects of the medicine. Submissions must be original and not currently under consideration for publication in another peer- reviewed medium (paper or electronic). CJM is committed to making the review process as timely and useful as possible for authors.   Open Access Policy  All articles published by CJM are made freely and...
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Re-evaluating the Effectiveness of Hydroxychloroquine on Urticaria: A Systematic Review

Immanuel Sani; Muambo Eko; Youssef Chedid; Yaser Hamza; Jubilent Amalendran

Canadian Journal of Medicine, 2020, Volume 2, Issue 2, Pages 1-12
DOI: 10.33844/cjm.2020.60496

Urticaria is a common disease characterised by transient erythematous, oedematous, pruritic
wheals in the dermis due to the release of various inflammatory mediators from mast cells.
There was previously limited evidence on the effectiveness of hydroxychloroquine (HCQ) in
the literature but there is now emerging evidence that warrants further investigation. This
review aims to appraise the current literature and propose contemporary evidence
recommendations for hydroxychloroquine treatment of patients with urticaria by performing
a systematic review. The MEDLINE, Embase and Cochrane databases were searched from
inception to 12 June 2020 in accordance with the PRISMA guidelines. We also examined the
reference lists of the retrieved studies. Texts were reviewed independently by two authors.
The risk of bias and quality of the studies was assessed using the Critical Appraisal Skills
Programme for systematic reviews. A total of 7 studies were included, involving 211 pooled
trial participants. There was moderate-quality evidence from two RCTs that revealed the
effectiveness of HCQ in the subjective improvement of urticarial symptoms. Two case reports
and one case series also demonstrated the therapeutic benefit of HCQ for urticaria. There was
considerable heterogeneity of outcome variables and trial designs which did not permit a meta
analysis of the results. The limited available evidence reveals that HCQ is effective for the
resolution of urticaria. Further multi-centred, placebo-controlled, RCTs are required in order
to reveal the relative effectiveness of HCQ in comparison to current second-line treatment
modalities








Coronavirus [COVID-19] and IgA Deficiency:Mini Review Article

Hossein Pakzad; Zahra Sadeghi; Massoud Houshmand; Farzaneh Rahvar

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 13-16
DOI: 10.33844/cjm.2020.60494

Spread of COVID-19 in all of the world caused the warning alert from WHO. It began from China and was the reason of many death through the world since 2019 December. Elders and people with previous diseases such as IgA deficiency [IgAD] are more susceptible to get COVID family. Also, higher level of IgA can combat with infectious disease.

Re-evaluating the Effectiveness of Hydroxychloroquine on Urticaria: A Systematic Review

Immanuel Sani; Muambo Eko; Youssef Chedid; Yaser Hamza; Jubilent Amalendran

Canadian Journal of Medicine, 2020, Volume 2, Issue 2, Pages 1-12
DOI: 10.33844/cjm.2020.60496

Urticaria is a common disease characterised by transient erythematous, oedematous, pruritic
wheals in the dermis due to the release of various inflammatory mediators from mast cells.
There was previously limited evidence on the effectiveness of hydroxychloroquine (HCQ) in
the literature but there is now emerging evidence that warrants further investigation. This
review aims to appraise the current literature and propose contemporary evidence
recommendations for hydroxychloroquine treatment of patients with urticaria by performing
a systematic review. The MEDLINE, Embase and Cochrane databases were searched from
inception to 12 June 2020 in accordance with the PRISMA guidelines. We also examined the
reference lists of the retrieved studies. Texts were reviewed independently by two authors.
The risk of bias and quality of the studies was assessed using the Critical Appraisal Skills
Programme for systematic reviews. A total of 7 studies were included, involving 211 pooled
trial participants. There was moderate-quality evidence from two RCTs that revealed the
effectiveness of HCQ in the subjective improvement of urticarial symptoms. Two case reports
and one case series also demonstrated the therapeutic benefit of HCQ for urticaria. There was
considerable heterogeneity of outcome variables and trial designs which did not permit a meta
analysis of the results. The limited available evidence reveals that HCQ is effective for the
resolution of urticaria. Further multi-centred, placebo-controlled, RCTs are required in order
to reveal the relative effectiveness of HCQ in comparison to current second-line treatment
modalities








Meta-Analysis of Prevalence of CFTR Mutations in Middle East Populations

Kazhaleh Mohammadi; Sahar Hassannejad; Arthur Saniotis; Massoud Houshmand

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 1-6
DOI: 10.33844/cjm.2020.60491

Cystic fibrosis (CF) is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In this study, we performed a systematic review and meta-analysis of middle east CFTR gene mutations in CF patients to find out the most common mutations in this area. Tree mutations are common in all middle-east populations: Del 508, W1282X and N1303K which can have detection rate as high as 60.9 %.

Metastatic Poorly Differentiated Carcinoma of Unknown Primary Site

Zahra Sadeghi; Hossein Pakzad; Hamide Rahmani seraji

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 17-22
DOI: 10.33844/cjm.2020.60495

Cancer of Unknown Primary (CUP) is a malignant widespread metastatic disease, which primary lesion cannot be identified by exact clinical Inspection. We reported a case of metastases from cancer of unknown primary here. A 58-year-old male presented with abdominal pain, backache, weakness and weight loss. Abdominopelvic sonography of the patient revealed two heterogeneous mass lesions in the right and left of the adrenal region. The primary site of the tumor was not identified According to our evaluation. We performed brain magnetic resonance imaging (CT) for the patient that showed a very large mainly peripheral enhancing mass lesion measuring 48×37 mm in the cerebellum as Glioblastoma multiforme (GBM). We did chemotherapy with platinum-based regimens including paclitaxel and carboplatin. In this case, the clinical situation of the patient swiftly deteriorated and unfortunately before doing local treatment for the brain mass we lost our case.

Two-Phase Immune Responses of COVID-19 and Therapeutic Approaches

Seyed Hassan Saadat

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 0-0
DOI: 10.33844/cjm.2020.60492

The novel coronavirus disease 2019 spread rapidly worldwide and disease was announced a pandemic by the WHO. Standard therapeutic strategy against COVID-19 is lacking. Regarding to the two-phase pathogenesis of the COVID-19 (immune defense-based protective and postinitial inflammation-driven damaging phases, different therapeutic regimens including antiviral agents (e.g., lopinavir/ritonavir, remdesivir, ribavirin, oseltamivir, and sofosbuvir, etc.), some antibiotics and immunomodulatory (chloroquine/hydroxychloroquine) and anti inflammatory agents (corticosteroids) have been considered in hospitals for COVID-19 patients, but balancing their
benefits and potential risk is of great importance [1-7].
Immune-boosting strategies (e.g., anti-sera or pegylated IFNα) and antiviral therapy may be of great importance in the initial phase or non-severe stages, while immunosuppressive or immunomodulatory approaches can be used for halting tissue damage and managing the symptoms in the inflammatory phase. There are conflicting results in prescribing corticosteroids or immunomodulation for COVID-19 patients due to paradoxical negative effects (risk of death, secondary bacterial infections and longer hospitalization) [8-9]. Activation of coagulation pathways
is also associated with increased proinflammatory cytokines, resulting in multiorgan injury. Severe COVID‐19 had disseminated intravascular coagulation, leading to the risk of venous thromboembolism [10], where naproxen (for antiplatelet and anti-inflammatory and anticoagulative effects) and low molecular weight heparin (LMWH; anti-inflammatory properties) may be considered for patients. It has been suggested that LMWH is contemplated because of concerns because of the presence of thrombi in the pulmonary circulation for those in patients with
raised d-dimer.
However, effective therapeutic approach requires balancing harmful and beneficial effects of regimens, to be prescribed by precision. Also, two-phase pathophysiology and immune responses of COVID-19 should not be underemphasized for treatment of patients.

Coronavirus [COVID-19] and IgA Deficiency:Mini Review Article

Hossein Pakzad; Zahra Sadeghi; Massoud Houshmand; Farzaneh Rahvar

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 13-16
DOI: 10.33844/cjm.2020.60494

Spread of COVID-19 in all of the world caused the warning alert from WHO. It began from China and was the reason of many death through the world since 2019 December. Elders and people with previous diseases such as IgA deficiency [IgAD] are more susceptible to get COVID family. Also, higher level of IgA can combat with infectious disease.

Metastatic Poorly Differentiated Carcinoma of Unknown Primary Site

Zahra Sadeghi; Hossein Pakzad; Hamide Rahmani seraji

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 17-22
DOI: 10.33844/cjm.2020.60495

Cancer of Unknown Primary (CUP) is a malignant widespread metastatic disease, which primary lesion cannot be identified by exact clinical Inspection. We reported a case of metastases from cancer of unknown primary here. A 58-year-old male presented with abdominal pain, backache, weakness and weight loss. Abdominopelvic sonography of the patient revealed two heterogeneous mass lesions in the right and left of the adrenal region. The primary site of the tumor was not identified According to our evaluation. We performed brain magnetic resonance imaging (CT) for the patient that showed a very large mainly peripheral enhancing mass lesion measuring 48×37 mm in the cerebellum as Glioblastoma multiforme (GBM). We did chemotherapy with platinum-based regimens including paclitaxel and carboplatin. In this case, the clinical situation of the patient swiftly deteriorated and unfortunately before doing local treatment for the brain mass we lost our case.

Meta-Analysis of Prevalence of CFTR Mutations in Middle East Populations

Kazhaleh Mohammadi; Sahar Hassannejad; Arthur Saniotis; Massoud Houshmand

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 1-6
DOI: 10.33844/cjm.2020.60491

Cystic fibrosis (CF) is a progressive, genetic disease that causes persistent lung infections and limits the ability to breathe over time. In this study, we performed a systematic review and meta-analysis of middle east CFTR gene mutations in CF patients to find out the most common mutations in this area. Tree mutations are common in all middle-east populations: Del 508, W1282X and N1303K which can have detection rate as high as 60.9 %.

Two-Phase Immune Responses of COVID-19 and Therapeutic Approaches

Seyed Hassan Saadat

Canadian Journal of Medicine, 2020, Volume 2, Issue 1, Pages 0-0
DOI: 10.33844/cjm.2020.60492

The novel coronavirus disease 2019 spread rapidly worldwide and disease was announced a pandemic by the WHO. Standard therapeutic strategy against COVID-19 is lacking. Regarding to the two-phase pathogenesis of the COVID-19 (immune defense-based protective and postinitial inflammation-driven damaging phases, different therapeutic regimens including antiviral agents (e.g., lopinavir/ritonavir, remdesivir, ribavirin, oseltamivir, and sofosbuvir, etc.), some antibiotics and immunomodulatory (chloroquine/hydroxychloroquine) and anti inflammatory agents (corticosteroids) have been considered in hospitals for COVID-19 patients, but balancing their
benefits and potential risk is of great importance [1-7].
Immune-boosting strategies (e.g., anti-sera or pegylated IFNα) and antiviral therapy may be of great importance in the initial phase or non-severe stages, while immunosuppressive or immunomodulatory approaches can be used for halting tissue damage and managing the symptoms in the inflammatory phase. There are conflicting results in prescribing corticosteroids or immunomodulation for COVID-19 patients due to paradoxical negative effects (risk of death, secondary bacterial infections and longer hospitalization) [8-9]. Activation of coagulation pathways
is also associated with increased proinflammatory cytokines, resulting in multiorgan injury. Severe COVID‐19 had disseminated intravascular coagulation, leading to the risk of venous thromboembolism [10], where naproxen (for antiplatelet and anti-inflammatory and anticoagulative effects) and low molecular weight heparin (LMWH; anti-inflammatory properties) may be considered for patients. It has been suggested that LMWH is contemplated because of concerns because of the presence of thrombi in the pulmonary circulation for those in patients with
raised d-dimer.
However, effective therapeutic approach requires balancing harmful and beneficial effects of regimens, to be prescribed by precision. Also, two-phase pathophysiology and immune responses of COVID-19 should not be underemphasized for treatment of patients.

Re-evaluating the Effectiveness of Hydroxychloroquine on Urticaria: A Systematic Review

Immanuel Sani; Muambo Eko; Youssef Chedid; Yaser Hamza; Jubilent Amalendran

Canadian Journal of Medicine, 2020, Volume 2, Issue 2, Pages 1-12
DOI: 10.33844/cjm.2020.60496

Urticaria is a common disease characterised by transient erythematous, oedematous, pruritic
wheals in the dermis due to the release of various inflammatory mediators from mast cells.
There was previously limited evidence on the effectiveness of hydroxychloroquine (HCQ) in
the literature but there is now emerging evidence that warrants further investigation. This
review aims to appraise the current literature and propose contemporary evidence
recommendations for hydroxychloroquine treatment of patients with urticaria by performing
a systematic review. The MEDLINE, Embase and Cochrane databases were searched from
inception to 12 June 2020 in accordance with the PRISMA guidelines. We also examined the
reference lists of the retrieved studies. Texts were reviewed independently by two authors.
The risk of bias and quality of the studies was assessed using the Critical Appraisal Skills
Programme for systematic reviews. A total of 7 studies were included, involving 211 pooled
trial participants. There was moderate-quality evidence from two RCTs that revealed the
effectiveness of HCQ in the subjective improvement of urticarial symptoms. Two case reports
and one case series also demonstrated the therapeutic benefit of HCQ for urticaria. There was
considerable heterogeneity of outcome variables and trial designs which did not permit a meta
analysis of the results. The limited available evidence reveals that HCQ is effective for the
resolution of urticaria. Further multi-centred, placebo-controlled, RCTs are required in order
to reveal the relative effectiveness of HCQ in comparison to current second-line treatment
modalities








Publisher: Canadian Institute For Knowledge Development

Email:  hsaadat@cikd.ca

Editor-in-chief: Seyed Hassan Saadat

Latest News

Canadian Journal of Medicine
As of January 1, 2018, I have the honor to serve as Editor-in-Chief of the Canadian Journal of Medicine. CJM has evolved from the Canadian Institute for Knowledge Development, which was founded in 2018. ...

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