Highlights

Testosterone deficiency guideline

The diagnosis and management of testosterone deficiency syndrome remains highly controversial, and in many instances, the evidence continues to be of doubtful quality. This guideline addresses clinical questions surrounding the diagnosis of testosterone deficiency and the appropriate use of testosterone replacement therapy in men. See Guidelines, page 1369

Despite the large volume of research on testosterone deficiency syndrome, many unanswered questions remain. To help Canadian physicians, a new guideline from the Canadian Men’s Health Foundation provides recommendations on diagnosing and managing this complex syndrome. See Commentary, page 1342

Holiday reading

Medical journals and social media

The number of Twitter followers that a medical journal has is strongly correlated with its impact factor and total citations, but many leading journals have disproportionately large followings relative to traditional impact measures. This bibliometric study compared impact factor and citation data for 2014 from the 43 of 153 general and internal medicine journals that had their own Twitter accounts with Twitter activity data captured over a three-day period in July 2015. To assess proportionality of Twitter popularity to scientific merit, the existing Kardashian Index and a novel (Fifty Shades of) Grey Scale were calculated. These results provide validation that higher impact science is reaching more of the general public than lower impact science, says the author. See Research, page 1353

Doctors and dark personality traits

Are health care professionals more narcissistic than most? Actually, physicians and their colleagues scored significantly lower on the dark triad personality traits of narcissism, Machiavellianism and psychopathy than the general population according to a cross-sectional study conducted in a large UK hospital. See Research, page 1359

Pareidolia and clinical reasoning: the pattern awakens

Aortic ultrasound of a 20-year-old woman after a cliff-jumping incident gone awry showed the “DarthVader sign.” Was there anything wrong with this patient, or was it the physicians who had the problem? Baylis and King tell us about pareidolia. See Clinical images, page 1364

On the road from Bethany

Our holiday poem sees an unusual patient arrive during the Christmas Eve graveyard shift: a big guy, leather clad, who had taken a bad spill on his motorcycle. See Poetry, page 1365

Crack cocaine use

A 38-year-old man who uses crack cocaine is worried about his risks of acquiring tuberculosis and other infections. Sur and Loh cover the key components of the history, physical examination, investigations and immediate interventions for this patient, including a look at the evidence supporting harm-reduction programs. See Decisions, page 1383

Cardiac platypnea-orthodeoxia syndrome

Platypnea-orthodeoxia syndrome usually presents with platypnea (dyspnea in an upright posture that is relieved by recumbency) and orthodeoxia (hypoxemia in an upright position). Both anatomic and functional components must be present to cause the syndrome. The syndrome had developed in this patient because of a patent foramen ovale and abnormal orientation of the heart from kyphoscoliosis and dilation of the ascending aorta, leading to intracardiac shunting in the upright position. See Cases, page 1385

Strongyloidiasis in immigrants

Screening for strongyloidiasis is recommended in Canada for refugees from Southeast Asia and Africa. If undetected, the infection can be lifelong and may lead to complications with high mortality rates. See Five things to know ..., page 1389