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

In the winter and spring of 2012 I was privileged to be part of the executive working group that organized the fourth Canadian Conference on the Diagnosis and Treatment of Dementia (CCCDTD4) which took place in May 2012. The process as described in both of the initial publications that came out in the fall of 2012 included many participants from all of those physician groups involved in caring for those at risk of dementia, as well as those not-for-profit organizations involved in educating the public.

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

¹James Gregor, MD,²Co-authors: John Howard, MD, Nitin Khanna, MD, and Nilesh Chande, MD,

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Abstract: Informed patients are one of the most important assets available in the management of patients with ulcerative colitis. Clinical experience reinforces that most patients have similar questions upon diagnosis. Anticipating these questions and tailoring them to a particular patient's disease severity and extent should not only streamline follow-up but also mitigate confusion and augment the benefit of the plethora of information available in the 21st century. Using our local experience, we have defined the 10 most common questions asked by patients and modified the answers, where necessary, to improve their specificity to patients with ulcerative proctitis, left-sided ulcerative colitis, and pancolitis.

Key Words: ulcerative colitis, patient, questions, classification, management.

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Patients can be relatively ill informed regarding the nature of their UC, its management, and its ultimate prognosis.

Generally, disease extent is divided into three categories: ulcerative proctitis, left-sided disease, and pancolitis.

A simple approach with frequently asked questions (FAQs) is a highly desirable and efficient means of transmitting information.

Clinical experience reinforces that most patients have similar questions upon diagnosis with UC.

Anticipating these questions and tailoring them to a particular patient's disease severity and extent should streamline follow-up and also mitigate confusion.

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Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

Geoffrey C. Nguyen, MD, PhD,

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Abstract: 5-Aminosalicylates (5-ASAs) are considered first-line therapy for mild to moderate ulcerative colitis because of their proven effectiveness and safety profile, even in pregnancy. One formulation, however, contains dibutyl phthalate (DBP) in its coating. Though DBP may cause disruptions in utero reproductive development and other congenital abnormalities in rodents, it is unclear whether it leads to physiologically significant fetal abnormalities in humans. The US Food and Drug Administration has changed its classification for DBP-containing 5-ASAs from pregnancy category B to pregnancy category C to reflect a greater degree of uncertainty regarding its effect in humans. For pregnant women with ulcerative colitis, the most important message is to take their inflammatory bowel disease (IBD) medications to prevent disease relapse, which may have the most adverse effects on pregnancy. Physicians should, however, discuss with young women who are taking 5-ASA with DBP the benefits and risks of switching to another formulation of 5-ASA without the DBP compound.

Key Words: phthalates, 5-aminosalicylate, ulcerative colitis, dibutyl phthalate, pregnancy.

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5-Aminosalicylates (5-ASAs) are effective for the treatment of mild to moderate ulcerative colitis and are generally regarded as safe to use, even during pregnancy.

Dibutyl phthalate (DBP) is found in the coating of certain formulations of 5-ASA, and in rodents has been shown to be associated with developmental and congenital abnormalities.

Though phthalates have been shown to be associated with some indicators of reduced masculinization among male fetuses, there is insufficient evidence to prove that it leads to significant harmful effects.

There are several formulations of 5-ASA that do not contain DBP.

Asacol, which contains DBP, is categorized as a pregnancy category C drug, while most other 5-ASAs are in pregnancy category B.

It should be emphasized to pregnant women that taking medications for their inflammatory bowel disease is important because the disease has a strong impact on, not just their health, but the health of their fetus too.

Women of child-bearing age who are taking a DBP-containing 5-ASA should have a discussion regarding the benefits and risks of switching to another 5-ASA, preferably before pregnancy.

To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

Brian Bressler, MD, MS, FRCPC,

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Abstract: A 28-year-old male presented to our office for a consultation about his bloody bowel movements. Colonoscopy revealed moderately active left-sided ulcerative colitis extending from the anal verge up to the mid-descending colon. He was prescribed both oral and rectal 5-ASAs for induction therapy, and is in remission. Appropriate patient education has helped him realize that the best chance of staying in remission is to continue on his medical therapy.

Key Words: ulcerative colitis, 5-aminosalicylate, medication adherence, dysplasia surveillance, rectal inflammation.

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Stool samples should be tested for infectious causes of bloody diarrhea.

Treatment with steroids should be avoided, if possible, as this medication carries the most risk.

In most cases, clinical remission is an acceptable outcome.

In patients newly diagnosed with left-sided ulcerative colitis, if macroscopic evidence of inflammation stops before 35 cm from the anal verge, it is critical to take biopsies in the proximal left colon in normal-appearing mucosa to determine whether a patient with left-sided disease will require dysplasia surveillance.

Patient education at each follow-up visit helps to ensure medication adherence.

We need to help patients understand that UC can be managed with medication, but not cured.

To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.

Publication of THE LATEST IN ULCERATIVE COLITIS CARE supplement was made possible by an unrestricted educational grant from Aptalis Pharma

A. Hillary Steinhart, MD,

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Abstract: Although medical therapy for ulcerative colitis is usually effective at inducing clinical remission, numerous studies have shown that patients in clinical remission may have ongoing and varying degrees of mucosal inflammation. It appears that patients who have greater degrees of active mucosal inflammation, despite the absence of clinical symptoms, are at higher risk of developing a symptomatic flare in the near term. In patients with UC, the level of calprotectin in stool correlates not only with the degree of clinical severity but also with the presence or absence of mucosal inflammation. These findings raise the possibility of using fecal calprotectin as a non-invasive means of monitoring patients in clinical remission and adjusting treatment in those who demonstrate a rise in fecal calprotectin, before symptoms recur.

Key Words: ulcerative colitis, fecal calprotectin, flare prediction, mucosal inflammation, non-invasive monitoring.

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Patients who experience a symptomatic flare after having been in clinical remission often have increased mucosal inflammation that predates the flare—sometimes by several months.

With the importance of mucosal healing acknowledged, there has been increasing interest in more frequent assessment of mucosal healing and mucosal inflammation.

This has led to the examination of a number of non-invasive and less expensive means of assessing these parameters.

The presumption is that if such risk factors can be identified, then effective interventions can be applied earlier in the course of disease in order to prevent a clinical flare.

In patients with UC, the level of fecal calprotectin correlates not only with the degree of clinical severity but also with the presence of absence of mucosal inflammation.

These findings raise the possibility of using fecal calprotectin as a non-invasive means of monitoring patients in clinical remission, and adjusting treatment in those who demonstrate a rise in fecal calprotectin, before symptoms recur.

To have access to full article that these tools were developed for, please subscribe. The cost to subscribe is $80 USD per year and you will gain full access to all the premium content on www.healthplexus.net, an educational portal, that hosts 1000s of clinical reviews, case studies, educational visual aids and more as well as within the mobile app.

Tiffany W. Chow, MD, MSc, Baycrest Health Sciences Rotman Research Institute, and Ross Memory Clinic; University of Toronto Depts. of Medicine (Neurology Division) and Psychiatry (Geriatric Psychiatry Division).

Abstract
Much of the published clinical research in dementia has focused on diagnostic biomarkers and neuroimaging analyses that are not yet validated for routine clinical practice or on unsuccessful clinical drug trials. Primary care providers can nonetheless make a significant difference in the management of patients with dementia and their families, based on appropriate referrals of non-Alzheimer's dementia cases to specialists and supporting informal caregivers.
Frontotemporal degeneration, a non-Alzheimer's dementia that strikes in the 6th decade of life, provides many opportunities for the entire healthcare team to educate and back families up through a harrowing neurodegenerative illness. This paper is intended to highlight for primary care physicians what can be done and how to accomplish it through a team approach. Some concepts, such as a switch from medicalized views of "behavioural and psychiatric symptoms of dementia" to "Responsive Behaviours" can be generalized across dementia etiologies, but the age at onset and marked social disability and dysfunction caused by frontotemporal degeneration warrant some additional guidelines to assure the safety and highest quality of life possible for the patient and those around him. In particular, refitting a day program to accommodate clients with frontotemporal degeneration and attending to the needs of children who find themselves in informal caregiver roles are addressed.
Keywords: caregiver, dementia, frontotemporal dementia, primary progressive aphasia.

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
Periorificial dermatitis is a common eczematous eruption on the face. Clusters of follicular papules, vesicles, and pustules on an erythematous base are usually found in a perioral distribution. Other common locations include the nasolabial folds and periocular area. An underlying cause may not be found in all cases, but the use of topical corticosteroids on the face may precede onset of symptoms. Periorificial dermatitis is diagnosed clinically and no specific investigation is required. Topical anti-inflammatory therapies (such as metronidazole and erythromycin) are appropriate in mild cases. In severe cases, systemic treatments such as tetracycline or one of its derivatives are beneficial. Patients should be warned that symptoms might worsen before improvement is apparent. This complication is more commonly seen when topical corticosteroids are withdrawn.
Keywords: periorificial dermatitis, perioral dermatitis, facial rash, steroid-induced.