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.

Dr. Pradeep Shenoy, MD, DLO, FRCS, FACS, is the ENT service chief, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.
Dr. Lyew Warren, MD, FRCSC, Consultant Pathologist, Campbellton Regional Hospital, Campbellton, New Brunswick, Canada.

Abstract
A case of a fleshy, granular, pedunculated growth from the oral cavity will be presented. A differential diagnosis of similar growths from the oral cavity and the treatment options will be discussed.
Key Words: congenital epulis, epulis fissuratum, granular cell tumour, immunohistochemistry S-100, vimentin, neurone specific enolase, CO2 laser excision.

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

The last decade has seen an enormous growth in the interest in the recognition of and intervention in those diagnosed and living with the whole range of cognitive impairment and frank dementia. In the western world, the recognition of the impact on patients, families, health care systems, and societies that dementia poses has led to great efforts to help define the indicators for current and future dementia with the intention to treat those already afflicted even with the primarily symptomatic medications that exist and to recognize those at future risk with the hope of providing counselling to forestall its future development. The idea of "early diagnosis" appears at first glance to be attractive for the purposes of future planning and research studies, but it is not clear what the benefits and risks might be if screening processes define people at risk when beneficial interventions might not yet be determined. The ethical as well as financial implications must be explored and defined before implementation of such screening becomes a normal standard of practice.practice.
Key Words: cognitive impairment, dementia, screening, biomarkers, cognitive testing.

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

The prevalence of dementia appears to be increasing in most western countries. That when coupled with the increased average age of the older population has leads to an expectation that projections of financial costs to individuals, families and to society will grow over the next few decades. The current study, out of the United States, based on a number of robust data bases coupled with in-depth interviews has resulted in projections of the current true costs of caring for elderly people living with dementia. It also allowed for the projection of future costs over the next three decades. The results are quite mind-boggling: "We found that dementia leads to total annual societal costs of $41,000 to $56,000 per case, with a total cost of $159 billion to $215 billion nationwide in 2010. Our calculations suggest that the aging of the U.S. population will result in an increase of nearly 80% in total societal costs per adult by 2040."

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
Erythema ab igne (EAI) is a localized hypermelanosis with erythema in a reticulated pattern. It is triggered from repeated exposure to heat and infrared radiation. Actinic keratosis, squamous cell carcinoma, and Merkel cell carcinoma have been reported in patients after chronic exposure to infrared radiation. EAI is diagnosed based on clinical symptoms. If the diagnosis is uncertain, a skin biopsy may be performed. Early in the disease process, elimination of the heat source may lead to complete resolution of the symptoms.

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

Dr.K.B.Bali, MBBS, MS, FACS, Senior ENT Specialist,
Al Ain Hospital, Al Ain, UAE.

Abstract
A 7-week-old child presented with left periorbital swelling. Clinical features, investigations, and treatment are discussed. If this condition is not treated properly, it can lead to a series of serious complications. A review of the literature is presented to avoid such complications.
Key Words: PCC (periorbital cellulitis with chemosis), OC (orbital cellulitis), preseptal cellulitis, OA (orbital abscess), SPA (subperiosteal abscess), ethmoidal sinusitis, periorbital swelling.