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Canadian Cardiovascular Harmonized National Guideline Endeavour (C-CHANGE) guideline for the prevention and management of cardiovascular disease in primary care: 2022 update



Competing interests: James Stone reports receiving consulting fees and honoraria from Bayer Canada and Sanofi Canada. Dr. Stone is senior medical director, Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services; and member at large, Governing Council, College of Physicians and Surgeons of Alberta. Jason Andrade reports receiving payment or honoraria from Medtronic, Biosense-Webster, Abbott, Bio-tronik, Bayer, Servier and BMS-Pfizer. Simon Bacon reports receiving grants from Moderna, paid through Respiplus for the development of vaccine hesitancy education modules, and consultancy and speaker fees from Respiplus. Dr. Bacon has served on advisory boards for Bayer, Sanofi, Respiplus and Lucilab, none of which are related to the current article. Dr. Bacon also holds a Canadian Institutes of Health Research (CIHR) Strategy for Patient-Oriented Research Mentoring Chair (SMC-151518) and Fonds de recherche du Québec Chair (251618 and 309815). Harpreet Bajaj reports receiving grants from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Gilead, Janssen, Kowa Pharmaceuticals, Merck, Novo Nordisk, Pfizer, Sanofi and Tricida; and honoraria for lectures from Eli Lilly and Novo Nordisk. Mark Gelfer reports receiving consulting fees from Telus Health Care Centres and holding an unpaid role as board chair of GenXys Health Care Systems, in which Dr. Gelfer also holds stock options. Jeffrey Habert reports receiving consulting fees from MDBriefcase, Liv, MedPlan, Master Clinician Alliance, Academy, Bridge, Seacourses, Thrombosis Canada, Meducom, Antibody, the Canadian Heart Research Centre, CTC Communications, STA Healthcare Communications, Canadian Collaborative Research Network, CPD Network, Telus Health, EOCI Pharmacomm and Operatic. Dr. Habert has also received honoraria from Pfizer, Amgen, BMS, Bayer, Boehringer Ingelheim, Eli Lilly, GlaxoSmithKline, Purdue, Bausch, Allergan, AbbVie, AstraZeneca, Novartis, Lundbeck, Canadian Cardiovascular Health Education Program (CHEP+), Novo Nordisk, Janssen, Eisai, HLS, Otsuka, Sunovion and Jazz. Dr. Habert was the previous co-chair of the Thrombosis Canada Clinical Guides (2018–2021). Karim Keshavjee reports receiving consulting fees from McMaster University, Demers Professional Corporation and Normative. Darlene Kitty reports receiving teaching stipends from the University of Ottawa Faculty of Medicine and the McGill University Faculty of Medicine for occasional lectures, and travel support as director for the Indigenous Program of the University of Ottawa Faculty of Medicine. Dr. Kitty is the chair of the Indigenous Health Committee, College of Family Physicians of Canada. David Lau reports receiving grants from Novo Nordisk; consulting fees from Amgen, Bayer, Boehringer Ingelheim, CME at Sea, HLS Therapeutics, Eli Lilly, Novo Nordisk and Viatris; honoraria from Amgen, Bayer, Boehringer Ingelheim, CME at Sea, HLS Therapeutics, Eli Lilly and Novo Nordisk; and payment for expert testimony from the Canadian Medical Protective Association. Dr. Lau has served in leadership roles with Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons. Laurent Macle reports receiving grants and honoraria from BMS-Pfizer, Servier and Bayer. Michael McDonald reports receiving consulting fees from Boehringer Ingelheim, and honoraria from Novartis and Servier. Dr. McDonald also participated in the data safety monitoring board for the IVVE Trial. Kara Nerenberg reports membership with the clinical practice guideline committees for the Heart and Stroke Foundation, Obesity Canada, Hypertension Canada, Diabetes Canada and the Society of Obstetricians and Gynaecologists of Canada. Glen Pearson reports receiving consulting fees from Novartis Canada as an advisory board participant. Alexandre Poppe reports receiving a research grant from Stryker and an honorarium from Pfizer-BMS. Dr. Poppe has also participated on a data safety monitoring board for the FLOW trial of fluoxetine after stroke and the safety committee for the Alteplase Compared to Tenecteplase in Patients With Acute Ischemic Stroke (AcT trial) of tenecteplase for acute stroke. Dr. Poppe has received fellowship program support from Servier. Diana Sherifali reports receiving personal funding through her Heather M. Arthur Population Health Institute/Hamilton Health Sciences Chair in Interprofessional Health Research. Peter Selby reports receiving grants from the Ontario Ministry of Health and Pfizer (Global Research Awards for Nicotine Dependence). Dr. Selby has also participated on the C-CHANGE guideline panel since 2010. Eric Smith reports receiving consulting fees from Bayer, Biogen, Alnylam and Cyclerion. Sol Stern reports receiving consulting fees and honoraria from and Sea Courses Inc. George Thanassoulis reports receiving grants, consulting fees and honoraria from Amgen, Sanofi, Novartis and Silence. Dr. Thanassoulis has also been a member of the CCS Dyslipidemia Guideline committee. Kristin Terenzi reports receiving consulting fees for advisory boards of, honoraria for speaking events for, and support for attending meetings from AstraZeneca, Boehringer Ingelheim, Astellas, Allergan, Amgen, Aspen, Bayer, Lilly, Lundbeck, AbbVie, Aralez, GSK, Merck, Novo Nordisk, Pfizer and Novartis. Karen Tu reports receiving grants (payments to institution) from CIHR, St. Michael’s Hospital Foundation, The College of Family Physicians of Canada, Foundation for Advancing Family Medicine, Canadian Medical Association Foundation, North York General Hospital Exploration Fund, Heart and Stroke Foundation of Canada, Heart and Stroke Foundation of Ontario, United States Department of Defense, University of Toronto — Department of Family and Community Medicine, MaRS Innovation Fund, Canadian Dermatology Foundation, Canadian Rheumatology Association (Canadian Initiative for Outcomes in Rheumatology Care), PSI Foundation, Cancer Care Ontario, Toronto Rehab Institute Chair Fund, UTOPIAN, Arthritis Society, MS Society of Canada, The Canadian Vascular Network, Ontario SPOR Support Unit Targeted IMPACT Award and Rathlyn Foundation. Dr. Tu holds a Research Scholar Award from the Department of Family and Community Medicine at the University of Toronto. Jacob Udell reports receiving grants from Boehringer Ingelheim, Janssen, Sanofi and Novartis; and honoraria from AstraZeneca, GlaxoSmithKline and Sanofi. Dr. Udell has also participated on advisory boards for Boehringer Ingelheim, Sanofi and Novartis. Sean Virani reports receiving grants from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, Servier, Otsuka and Medtronic; consulting fees from Abbott, Amgen, AstraZeneca, Boehringer Ingelheim, Bayer, Novartis, Seriver and Otsuka; and honoraria from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bayer, Novartis, Servier, Otsuka and Medtronic. Dr. Virani has also participated in data safety monitoring boards or advisory boards for Abott and Medtronic. Richard Ward reports receiving consulting fees from Eisai and Lilly-Boehringer Ingelheim, and payment or honoraria from Boehringer Ingelheim, AstraZeneca, Janssen, Amgen, Lilly, Pfizer and Takeda. Dr. Ward also serves as director of the Alberta Medical Association. Sean Wharton reports receiving grants and honoraria from Novo Nordisk, Eli Lilly, Bausch Health Canada and Boehringer Ingelheim; has participated in data safety monitoring boards for Novo Nordisk, Eli Lilly, Bausch Health Canada and Boehringer Ingelheim; and has received equipment, medical writing or other services from Novo Nordisk, Eli Lilly and Bausch Health Canada. Dr. Wharton has also played a leadership role in The Obesity Society and Obesity Canada. Jennifer Zymantas reports receiving an honorarium from Pfizer for a moderator role during speaking engagements related to anticoagulation. Diane Hua-Stewart holds the role of director of CHEP+. Peter Liu reports receiving grants from Genome Canada, the Heart and Stroke Foundation and CIHR. Dr. Liu holds a patent for IGFBP7 as a biomarker for heart failure and is chief scientific officer with the University of Ottawa Heart Institute. Sheldon Tobe reports receiving a KMH clinic unrestricted grant and in-kind support for the Zero to Five study, paid to Sunnybrook Research Institute; consulting fees from AstraZeneca; and payment for the CHEP+ education program from Amgen, Astra-Zeneca, BMS, Bayer, Boehringer Ingelheim, Janssen, Lilly, Novartis, Novo Nordisk, Pfizer and Sanofi Genzyme. Dr. Tobe also holds a volunteer role with the American Hypertension Specialists Certification Program. No other competing interests were declared.

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Rates of infectious sexual diseases on the decline in region – CambridgeToday



Unprotected sex with more than one partner in a six month period is the biggest risk factor behind a recent rise in syphilis cases in Waterloo region, according to a report on infectious disease trends from Region of Waterloo Public Health.

The annual infectious diseases surveillance report gathers and analyzes information on the infectious diseases that physicians, laboratories and hospitals are required to report to the region’s public health unit in line with Ontario Public Health Standards.

Infectious diseases are illnesses caused by microorganisms such as bacteria, viruses, and parasites that have the potential to cause serious illness and outbreaks.


There were 116 reports of infectious syphilis in the region last year, a rate of 17.8 per 100,000 population compared to 23.1 across the province. The number is down from a high of 143 reported cases in 2021, and a rate of 22.2 per 100,000 that was higher than the provincial average of 20.6.

The report says rates of syphilis, while lower than the province, have increased substantially in recent years, especially among females. This trend has also been observed in the province, which suggests a shift in epidemiology and sexual health practices.

The most common sexually transmitted infections in Waterloo Region continue to be chlamydia and gonorrhea.

There were 1,388 cases of chlamydia reported across the region last year, a rate of 192.8 per 100,000 population compared to 255.9 provincially. That’s down slightly from the age-standardized rate of 196.9 per 100,000 reported in 2021.

Gonorrhea case counts continued to spike across the province in 2022, while experiencing a slight decline in the rate of infection in Waterloo region.

Waterloo region reported 266 cases last year, a rate of 38.2 per 100,000. That’s compared to 77.5 per 100,000 province-wide.

Across the board, the demographic with the highest number of cases of sexually transmitted infections locally and across the province is the 20 to 29 age group.

Mpox, previously known as monkeypox, was declared a disease of global public health concern and became a newly reportable disease in Ontario in 2022.

There were only four local cases of mpox last year. Public Health says it has been monitoring the situation, working with health care providers to provide up-todate treatment guidance, and providing mpox vaccines to high-risk individuals.

The mpox virus is most commonly spread to people through close, physical contact with an infected person.

Campylobacter enteritis and salmonellosis were the most common enteric diseases in Waterloo Region in 2022. The local rates for enteric diseases were similar to or lower than those of the province.

Risk factors for enteric illnesses such as Campylobacter enteritis and salmonellosis include consuming undercooked meats and unpasteurized dairy products, ingesting contaminated food or water, and contact with infected persons.

Rates of vaccine preventable diseases in Waterloo Region were similar to those of the province. The most common vaccine preventable diseases in Waterloo Region were pneumococcal disease and pertussis (whooping cough).

In 2022, as we returned to normal activities, we saw a return of circulating respiratory viruses including pertussis with rates higher than had been seen during the first two years of the pandemic.

Public Health says immunization is the best way to prevent whooping cough. Pneumococcal vaccine is also recommended for infants, older adults 65 years and older, and those at high risk from the infection.

Region of Waterloo Public Health undertakes a number of activities to prevent or reduce the burden of infectious diseases in the community.

Programs and services include case management, contacts and exposures for diseases of public health significance; inspections, investigations and outbreak management, including community outbreaks and those in institutions; health promotion activities and services for primary care providers, emergency service workers, childcare providers, and other community groups; and clinic-based services for sexual health, immunization, and tuberculosis screening and management.

Region of Waterloo Public Health says it will provide highlights of respiratory disease trends, including influenza, in a report to council this fall.

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Canadians diagnosed with IBD expected to reach 470K by 2035 – CTV News



The number of people in Canada with inflammatory bowel disease (IBD) is increasing rapidly and is expected to grow to 470,000 by 2035, according to a new report from Crohn’s and Colitis Canada. 

On Thursday, the national health charity unveiled its 2023 report on the impact of IBD in Canada, calling for action to be taken in order to enhance the well-being of individuals affected by the condition.

According to the report, 322,600 people, or 0.8 per cent of Canada’s population, are expected to be diagnosed with IBD this year. The percentage is projected to reach 1.1 per cent by 2035.


“The number of people in Canada living with IBD is growing rapidly. Healthcare needs to evolve to include multidisciplinary care, including access to specialist physicians and nurses, mental health professionals, dietitians and others to improve quality of.” report co-chair Dr. Gilaad Kaplan, a professor of medicine and gastroenterologist at the University of Calgary, said in a news release on Thursday. 

The report says in 2023, a new case of IBD will be diagnosed every 48 minutes, totaling 11,000 individuals. By 2035, this number is expected to rise to 14,000, with a new case being identified every 38 minutes.

The report adds that the incidence of IBD among children under the age of six years old is increasing at a particularly rapid rate. However, the group experiencing the fastest growth in diagnosed cases of IBD is older Canadians.

People with low socioeconomic status, residents of rural, remote, and Northern communities as well as Indigenous people encounter additional barriers to care, the report says.

“We see there is a significant impact on mental health – psychiatric disorders are 1.5 to two times more common in people with IBD. Youth with IBD have nearly double the risk of psychiatric diagnosis. This underlines the importance of making mental health services available, especially in children, adolescents, and young adults.” Dr. Eric Benchimol, report co-chair and professor of pediatrics and clinical epidemiology at the University of Toronto said in the news release.


Crohn’s and Colitis Canada says IBD describes a group of conditions the two main forms of which are Crohn’s disease and ulcerative colitis. These autoimmune diseases cause inflammation, ulcers, and bleeding in the bowel that can extend to the rest of the body. IBD is a completely different disease from irritable bowel syndrome (IBS), which does not result in visible inflammation or ulcers in the bowel, according to the report.

“The report highlights the need to use our financial and health care resources as effectively as possible. That’s why, since 2016, our PACE network project has brought together leading Canadian hospital centres to develop best practices to help patients. We’re hoping that within the next two years, we start seeing these pilot innovations being rolled out across Canada and leading to better care.” Lori Radke, CEO of Crohn’s and Colitis Canada, said in a news release.

Reporting for this story was paid for through The Afghan Journalists in Residence Project funded by Meta.

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Canadian researchers find brain inflammation in patients with long COVID – Winnipeg Free Press – Winnipeg Free Press



Leslie Ann Coles knew “almost immediately” something was wrong after her COVID-19 infection in January 2021.

The filmmaker from Woodbridge, Ont., had never had writer’s block in her life — but she couldn’t find the words to make revisions to a screenplay she’d been working on.

“It was really, really frightening,” Coles said.


Leslie Ann Coles poses for a photograph in Toronto on Wednesday, May 31, 2023. Coles knew “almost immediately” something was wrong after her COVID-19 infection in January 2021. THE CANADIAN PRESS/Nathan Denette

Her emotional state changed too.

“I’ve never in my life suffered from depression,” Coles said. “My friends refer to me as the eternal optimist.”

But her usual passion for life and work had waned, leaving her feeling “apathetic, for lack of a better word,” she said.

Researchers have been trying to understand what causes the many symptoms of long COVID, including neurological issues suffered by an estimated hundreds of thousands of Canadians like Coles.

Now, a team led by the Centre for Addiction and Mental Health (CAMH) has found physiological evidence of brain inflammation in people with cognitive and depressive symptoms months after their COVID-19 infections.

Autopsies of people who died in the midst of severe COVID-19 infection have previously shown they had brain inflammation, said Dr. Jeffrey Meyer, head of the neuroimaging program in mood and anxiety at CAMH and senior author of the study published Thursday in JAMA Psychiatry.

The current study shows brain inflammation inpeople who have recovered from acute COVID-19 but go on to have lasting neurological problems — even though their initial infection wasn’t severe, he said.

“These are people who’ve got long COVID and have actually not been hospitalized. They have mild to moderate severity acute COVID, but then have considerable symptoms thereafter,” Meyer said.

“Our study shows that there’s inflammation months to over a year later in people who’ve got long COVID.”

The researchers did positron emission tomography (PET) scans on the brains of 20 participantswho had started suffering from depression within three months of testing positive for COVID-19.

Most of them had additional cognitive issues associated with long COVID, including problems with memory and concentration, also known as “brain fog.”

The researchers compared those scans to 20 brain scans from “healthy” people that had been done prior to the pandemic.

They found that people who had long COVID had higher levels of translocator protein, or TPSO, in their brains. TSPO appears on glial cells, which increase with inflammation.

The most pronounced increase in inflammation was in two areas of the brain — the ventral striatum and dorsal putamen, the study said.

Those are parts of the brain associated with the ability to experience enjoyment, energy and motivation levels, cognitive processing and speed of movement.

“We know that when there’s injury to these brain regions you get some of the symptoms that we’re seeing in the people with long COVID,” Meyer said.

Long COVID sufferers have been eagerly awaiting these findings “for validation that brain fog is real and caused by functional changes from COVID-19,” said Susie Goulding, founder of the COVID Long-Haulers Canada online support group, which helped recruit study participants.

“This concrete evidence will hopefully bring understanding and guidance” to family doctors who encounter patients describing neurological symptoms after COVID infection, Goulding said in a text message to The Canadian Press.

Dr. Angela Cheung, co-lead of a national long COVID research network and senior physician-scientist at the University Health Network in Toronto, said the study confirms what long COVID researchers have suspected for some time.

“We have always thought that inflammation plays a part,” said Cheung, who was not involved in the CAMH study.

“It’s been difficult to measure inflammation in patients.” she said. “This study shows that in people with persistent depressive and cognitive issues, that there is neural inflammation in the brain.”

But Dr. Lakshmi Yatham, a psychiatrist at the University of British Columbia who researches mental health issues related to COVID-19, said that although the study is valuable, there are important limitations to consider.

“It’s a good first attempt to look at the inflammation. But you cannot at this stage attribute that the inflammation is what’s responsible for depressive symptoms,” Yatham said.

One limitation, he said, is that some of the participants had previous experiences with depression.

However, Meyer said those people made up fewer than half of the participants, and any past depressive symptoms had resolved before they got COVID-19.

Yatham said further study is needed using a control group of people who have recovered from COVID-19 and didn’t have long COVID to compare the levels of brain inflammation. That wasn’t possible in the CAMH study because the brain scans of the control group had been done prior to the pandemic.

One of the next steps for the CAMH team is to “test out whether some kinds of anti-inflammatory or inflammatory-altering medications might be helpful for long COVID,” said Meyer.

Cheung said other researchers are also planning anti-inflammatory medication studies.

Leslie Ann Coles has learned tactics to work around memory problems that persist to this day, including constantly writing things down and taking photos on her phone.

For her, like so many other long COVID sufferers, the next steps in research can’t come soon enough.

“I hope they find ways in which this study helps people with long COVID recover,” she said.

This report by The Canadian Press was first published June 1, 2023.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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