Highlights

Inequalities in access to bariatric surgery

Fewer than 6 out of 1000 Canadians living with class II or class III obesity receive a bariatric surgery procedure each year, with an estimated yearly shortfall of 5129 surgeries. Substantial disparities in access exist across the country. However, bariatric surgery should be integrated into a comprehensive national obesity management strategy. See Commentary, page 317

Remote ischemic preconditioning

More than 25% of patients undergoing cardiac surgery experience acute myocardial infarction. This randomized controlled trial and update of a meta-analysis of remote ischemic preconditioning on one leg just before surgery show that this procedure does very little to mitigate common types of ischemia–reperfusion damage in cardiac surgery patients. See Research, page 329

Planned home birth for low-risk pregnancies

Planned home birth attended by midwives in a jurisdiction where home birth is well-integrated into the health care system was not associated with a difference in serious and common adverse neonatal outcomes compared with planned hospital birth. It was associated with fewer intrapartum interventions. See Research, page E80

Colorectal cancer screening guideline

Who should be screened for colorectal cancer? How often? What screening method should be used? The Canadian Task Force on Preventive Health Care tackles these questions in its updated guideline on screening for colorectal cancer in primary care. See Guidelines, page 340

Does bronchiolitis really exist?

Recently published guidelines for the diagnosis and management of viral bronchiolitis in infants agree that bronchiolitis is a very common illness with no treatment options other than supportive care and, perhaps, inhaled hypertonic saline for inpatients only. Have we understood its pathologic mechanisms incorrectly? Perhaps bronchiolitis is part of the spectrum of early-onset asthma, ventures Kuzik. See Analysis, page 351

Bridging anticoagulation during surgery

A 78-year-old man taking warfarin for chronic nonvalvular atrial fibrillation is scheduled for prostate surgery. Should his warfarin be stopped? If so, should bridging anticoagulation be used? This Choosing Wisely Canada article looks at the management of anticoagulation in the perioperative period. See Decisions, page 361

Rubella in a returned traveller

Both vaccine- and non–vaccine-preventable illnesses can cause fever and rash in returned travellers. The case of a 42-year-old man with fever and rash upon returning from a trip to the Philippines reinforces the importance of ensuring that the immunization status of all new immigrants to Canada is assessed and that vaccination is offered accordingly, say Chan and colleagues. See Cases, page 363

Zika virus infection

Since its identification in Brazil in May 2015, the Zika virus has spread rapidly throughout South and Central America, the Caribbean and Mexico via bites from infected Aedes aegypti mosquitoes. Although the infection appears to be self-limited and mild or asymptomatic in most people, it has been linked with neurologic illnesses and congenital microcephaly. Pregnant women and those planning pregnancy should consider postponing travel to affected areas. See Five things to know about …, page 367

Alcohol, tacrolimus and periorbital erythema

A 32-year-old man ingested alcohol during treatment with topical tacrolimus and developed transient periorbital erythema. Although extensively reported in the literature, this reaction may not be widely recognized in clinical practice, say Woolner and Sauder. See Clinical images, page 368