Shannon Humphrey, MD, FRCPC, FAAD, Clinical Assistant Professor, Director of Continuing Medical Education, Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

Abstract
The pathogenesis of acne is tied to Propionibacterium acnes (P. acnes), an anaerobic bacteria. There has been a dramatic rise in resistance to antibiotics that are usually prescribed to treat acne. Given resistance to antibiotic therapy can occur in more pathogenic bacteria than P. acnes, and the fact that a rise in pathogenic P. acnes has been reported, the development of antibiotic resistance in acne is a public health matter globally. Clinical practice guidelines are aiming to curb the further development of antibiotic resistance without detracting from effective management of both inflammatory and non-inflammatory acne.
Key Words: acne vulgaris, antibiotic resistance, benzoyl peroxide, anti-inflammatory, sub-antimicrobial dosing.

P.K. Shenoy, MD, FRCS, DLO, FACS, ENT Service Chief, Campbellton Regional Hospital, Campbellton, NB, Canada.

Dr. Lyew Warren, MD, FRCSC, Consultant Pathologist, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.

Abstract
Nasal vestibular mass are not commonly seen in ENT practice. We are presenting a patient with a large right nasal vestibular mass, who complained of nasal obstruction and epistaxis. Differential diagnosis of the similar growths in the nasal vestibule with their pathology and the treatment options, have been reviewed from the literature.
Key Words: Nasal vestibular mass, papilloma, 0 and 30 degree endoscopes, lateral rhinotomy.

Michael Gordon, MD, MSc, FRCPC, Medical Program Director, Palliative Care, Baycrest Geriatric Health Care System, Professor of Medicine, University of Toronto, Toronto, ON.

Abstract
With the rapidly increasing numbers of elders in North American Society, the prevalence of those living with dementia is clearly on the increase. According to the most recent document provided by the Alzheimer Society of Canada, The Rising Tide the growth in the numbers of those living with dementia will increase from 480,600 in 2008 (1.5% of Canada's population) to in the year 2038—1,125,200 people with dementia (2.8% of Canada's population).¹ All the challenges that Canadian society faces with this growing population merely mirror the enormous complexities that those living with dementia, their families and health care professional providers must increasingly contend with. Government policy makers must find ways to address this increasing population in which Dementia plays a prominent role. The result of the Supreme Court ruling on the Rasouli case has major potential implication for those facing the later stages of dementia and those under whose care members of this population will be entrusted.
Key Words: dementia, aging population, substitute decision makers.

Francesca Cheung, MD CCFP, is a family physician with a special interest in dermatology. She received the Diploma in Practical Dermatology from the Department of Dermatology at Cardiff University in Wales, UK. She is practising at the Lynde Centre for Dermatology in Markham, Ontario and works closely with Dr. Charles Lynde, MD FRCPC, an experienced dermatologist. In addition to providing direct patient care, she acts as a sub-investigator in multiple clinical studies involving psoriasis, onychomycosis, and acne.

Abstract
Hairy tongue, or known as lingua villosa, is a result of hypertrophy, elongation, and defective desquamation of the filiform papillae of the tongue. This condition may present in a variety of colors depending on the specific etiology. Etiologies of hairy tongue include poor oral hygiene, lack of mechanical stimulation and debridement of the tongue, the use of medications (especially broad-spectrum antibiotics), and therapeutic radiation of the head and the neck. This condition is also commonly seen in people having high consumption in coffee and tea, heavy use of tobacco, individuals addicted to drugs, patients who are HIV positive, and intravenous drug users. In most cases, non-pharmacologic interventions are used for the management of hairy tongue. Treatment involves brushing the tongue with a toothbrush or using a commercially available tongue scraper to retard the growth or to remove elongated filiform papillae. If Candida albicans is present, topical antifungal medications are used for patients who are symptomatic.
Key Words: Hairy tongue, Lingua villosa, Glossopyrosis, Halitosis.

Ian PUN, MD, Family Physician, Scarborough, Ontario with help from Anthony Vu, 4th Year student, University of Toronto undergraduate life science, Rob Myers, MD, Associate Professor of Medicine, Hepatologist, and Director of the Viral Hepatitis Clinic at the University of Calgary, Calgary, AB.

Abstract
It is estimated that there are 350 million world wide carriers of the hepatitis B virus, mostly coming from Asia (Lai et al., 2005). With immigration of Chinese into Western countries, hepatitis B is now becoming established in countries where it was previously uncommon. Chronic hepatitis B infection is a prevalent disease especially in the Toronto and Vancouver areas where most Asians live. Fortunately, over the past decade effective anti-viral treatments have become available. Chronic hepatitis B is mostly an asymptomatic disease, therefore, serological and imaging tests should be used to identify, follow and treat those considered high risk.
Key Words: HBV DNA (hepatitis B DNA), cirrhosis, anti-viral tenofovir, FibroScan.