Cryptococcal meningitis is a common and devastating complication of advanced HIV, and is most prevalent in low resource settings in sub Saharan Africa. Raised intracranial pressure is one of the hallmarks of the disease, which can lead to visual and hearing loss and ultimately death. We present the case of a patient with visual and hearing impairment secondary to Cryptococcal meningitis successfully managed by serial cerebrospinal fluid drainage. This case highlights some of the challenges of managing this severe opportunistic infection in a low resource setting.

Before 2015, few people outside the infectious disease community had heard of Zika virus. However, this virus is now the centre of global conscience. Pictures of newborns with microcephaly have been widely circulated and misinformation abounded. This piece explores and examines the evolution of infectious disease outbreaks, in addition to the historical public health responses. This investigation serves to garner lessons which can be applied to the current Zika outbreak. The virus’ role as a pathogen is introduced, and current public health responses and their impacts are also examined. Finally, we posit what Canada’s role should be in the midst of this outbreak.

Introduction: Health promotion and disease prevention have been increasingly recognized as activities within the scope of emergency medicine. Exercise prescription by physicians has been shown to improve outcomes in obesity, cardiovascular disease, and many other diseases. An estimated 600,000 Canadians receive the majority of their care from emergency departments (ED), representing a substantial opportunity for health promotion. Our study examined the frequency of exercise prescription by emergency physicians (EPs) and determined factors that influence decisions to prescribe exercise. Methods: A national, confidential 22-item survey was distributed to Canadian EPs via email by the CAEP survey distribution protocol in November/December 2015. Demographics, exercise prescription rates and self-reported exercise habits were collected. Results: A total of 332 EPs responded. 92.4% of EPs reported being at least moderately active. 62.7% of EPs often or always council their patients about preventative medicine (smoking cessation, drug and alcohol use, diet and safe sex). However, only 23.8% often or always ask about their exercise habits. Even fewer (12.7%) often or always prescribe exercise. Training background significantly predicted level of comfort prescribing exercise. CCFP trained EPs were 5.1 (p = 0.001) times more likely than trained EPs to respond 'yes' they feel comfortable prescribing exercise, and 3.7 (p = .009) times more likely to respond 'sometimes'. CCFP (EM) trained EPs were 3.5 (p < 0.001) times more likely than trained EPs to respond 'yes' they feel comfortable prescribing exercise, and 2.0 (p = .031) times more likely to respond 'sometimes'. 76.1% of respondents believe that other EPs rarely or never prescribe exercise. Of respondents, only 36% feel comfortable prescribing exercise. The majority of EPs (73.4%) believe that the ED environment did not allow adequate time for exercise prescription. Conclusion: The majority of EPs council their patients regarding other forms of preventative medicine but few prescribe exercise to their patients. Available time in the ED was cited as a significant barrier to exercise prescription. CCFP trained EPs are more comfortable prescribing exercise, suggesting that their training may better educate and prepare them to council patients on exercise compared to trained EPs. Further education may be required to standardize an approach to prescribing exercise in the ED.

Antibiotics are a powerful tool in fighting bacterial infections but with overuse and misuse, resistance is emerging at an alarming rate. To better understand the root causes of resistance, studying the perceptions of both physicians and the general populace may prove beneficial from a health promotion standpoint. Research reveals that diverging views of these 2 groups remain significant, which proves concerning especially in the face of increasingly resistant bacteria and associated mortality. The issue at large, therefore, requires a better understandifrom both parties with regard to antibiotic guidelines, prescription habits and public awareness campaigns.

Study/Objective: The primary objective is to determine the clinical presentation of emergency department patients with Tuberculosis (TB) in southwestern Ontario, and to evaluate their pre-diagnosis emergency department utilization. Patterns and clinical findings will be used to develop a center-specific TB educational resource for ED physicians, to aid in the recognition and diagnosis of high risk patients which could be used at other large Canadian, urban tertiary care hospitals. Broadly, this study aims to increase awareness of TB in local EDs. Background: The Middlesex-London Health Unit (MLHU) reports on average 10 cases of active tuberculosis (TB) per year, with 99 cases between January 2005 and December 2015. Most patients with TB heavily utilize the emergency department (ED) prior to diagnosis. Patients with TB seeking care in the ED are often unrecognized as having TB, as risk factors and symptoms are frequently missed. Delays in diagnosis of TB worsen morbidity/mortality and increases disease transmission. The emergency department may present an opportunity for earlier diagnosis and intervention. To date, no studies have been undertaken to examine TB diagnosis and burden of care in Ontario EDs. Methods: A hospital-based retrospective review of adult and paediatric patients (n = 99) identified by Middlesex-London Health Unit as having active TB between January 1st 2005 and December 31st 2015 will be performed. Health records will be reviewed 1 year prior to and 6 months after the formal TB diagnosis to determine the clinical presentation of ED patients with TB. Results: This is a proposed study. Conclusion: This is a proposed study.