A student-run scientific publication since 1923 University of Toronto Medical Journal Table of Contents PREFACE REVIEWS 3 Preface from the Editors 53 Zika virus: a current review of literature Bera Ubeyd Yildiz and Keramettin Yanik 57 Neurological sequelae of pediatric Plasmodium falciparum EDITORIAL TEAM cerebral malaria in Sub-Saharan Africa: A brief overview 4 2018-2019 Editorial Team Kelly A. A. Leslie 62 Closing the gap between industry and consumers in sunscreen application AWARDS David Jung and Aryan Riahi 5 Award Winning Articles COMMENTARIES PRIMARY RESEARCH 65 O Cannabis: What have we done by legalizing marijuana 6 Knowledge, practices, and attitudes of certified medical in pregnancy? marijuana consultants in Washington state Daniel B. Hardy Louise Kaplan, Tracy Klein, Marian Wilson, Janessa Graves 69 Freedom of expression litigation and the harms of cannabis 13 Knowledge, attitudes and current practices of Palestinian Melanie L. McPhail and Jacob J. Shelley internists toward aspirin prescription Iyad Ali, Hamzeh Al Zabadi, Nisreen R. Dayyeh 74 Cannabis and driving research: Lessons from an unlikely teacher 17 ‘Wrong treatment’: Doctors’ take on medical futility in a Liliana Alvarez low-resource ICU Tonia Chinyelu Onyeka, Ikem Okonkwo, Uzochukwu, 78 Growing up high: Understanding the impacts of Aniebie, Innocent Ugwa, Felix Chukwuneke, David Agom adolescent cannabis use on mental health and brain Development 23 Effect of weight loss diets on biochemical parameters Steven R. Laviolette and anthropometric measurements in prolactinoma patients Esen Yesil, Gül Kızıltan, Cüneyd Anıl, Mehtap Akçil Ok, Nilüfer Bayraktar PERSPECTIVES 83 Palliative care for homeless patients: A practical approach 29 Perioperative blood loss in South African primary hip for medical students arthroplasty patients Mithunan Ravindran, Nishwa Shah, Naheed Dosani Mohamed S. Khattab and Yoshan Moodley 85 A medical student’s comparison between pre-medical and pre-clinical education Yue Bo Yang REVIEWS 35 Current status and prospects for the application of cannabinoids in organ transplantation INTERVIEWS Brian Earl 87 Interview with Dr. Snead Happy Inibhunu and Annie Yu 41 Effectiveness of an educational intervention to increase human papillomavirus knowledge in high-risk populations: 91 Interview with Dr. Ruth Ross A systematic review Mana Modares and Jeff Park Edwin N. Mogaka, Ahmed A. Fadairo, Kristin L. Cannon, Olusola A. Sadiku 95 Interview with Dr. Alan Bell Nicholas Scrivens 48 Physicians in prehospital care: A review of the clinical and economic evidence Daniel Kapustin, Sparsh Shah All articles are externally peer-reviewed with the exception of poetry, short stories and book reviews. All manuscripts are internally reviewed. Informed consent practices and any conflicts of interest are specified in the articles if applicable. Front cover illustration by Li Mona UTMJ • Volume 96, Number 3, June 2019 1 Office of Health Professions Student Affairs Supporting Your Success http://www.md.utoronto.ca/OHPSA WELLNESS • Prevention, Self-care, Stress Management, Wellness workshops • Events and group sessions • Short-term counselling • Private location and after-hours appointments available LEARNING • Academic Success workshops • Study skills seminars • Study Strategies, Time Management • Learning Assessments • Group and individual appointments CAREER • Group and individual sessions COACHING • Lunch & Learn/Evening workshops • Careers in Medicine Program (CaRMS) preparation • Career Fairs and Sampling • Skills for interviews, resume and letter writing • Weekend/telephone appointments available LIFE • Leadership, Volunteerism, Charity • Community Involvement, Special Events • Access and Outreach • Social Responsibility Students We Serve Doctor of Medicine Program Occupational Therapy, Physical Therapy, Speech-Language Pathology Medical Radiation Sciences Physician Assistant Program ____________________________________________________________________ Contact Visit our website for online information and forms http://www.md.utoronto.ca/OHPSA E-mail: [email protected] Telephone: 416.978.2764 C. David Naylor Building, 6 Queen’s Park Crescent West, 3rd Floor, Room 306 Preface Preface Dear UTMJ Reader, We are excited to present Volume 96, Issue 3 of the University of emerging research addresses many of the gaps that currently exist Toronto Medical Journal, which focuses on the important and timely on this topic. In this issue of the University of Toronto Medical Journal, topic of Cannabis. Research has identified several potentially we will highlight recent advances in cannabis research and discuss beneficial effects of cannabis and cannabis-based products, with the impact of legalization in Canada. promising applications for various diseases, including childhood This is the final issue of theUniversity of Toronto Medical Journal’s epilepsy, multiple sclerosis, mood disorders, palliative care and 96th volume. We are very proud of the issues that we have published chronic pain.1 In 2001, the Marihuana Medical Access Regulations over this past year and would like to sincerely thank members of were enacted in Canada which allowed individuals to legally the editorial team for all of the hard work that went into preparing possess and use medicinal cannabis. Since this time, the number each issue. We are also grateful to the patrons that continue to of individuals authorized to use medicinal cannabis has grown support the University of Toronto Medical Journal and the authors that exponentially.2 However, the level of clinical evidence available to have allowed us to showcase their important work. We hope that support cannabis and cannabinoids as pharmacotherapy remains you enjoy reading this issue as much as we enjoyed preparing it. limited for most disorders.1 Concerns have also been raised regarding the potential adverse effects of cannabis use, including Appreciatively, the effects of smoke inhalation on the respiratory system, the risk for developing cannabis use disorder, the neurodevelopmental effects Mazen El-Baba and Mark Lukewich of cannabis on the adolescent brain and safety issues surrounding the potential for impaired driving.3 Not surprisingly, the clinical utility of cannabis and cannabis-based products remains an active area of debate among physicians.4 On October 17, 2018, Canada became the second country to formally legalize recreational cannabis use on a national scale. It References 1. Hill KP. Medical use of cannabis in 2019. JAMA. 2019; doi: 10.1001/ was anticipated that legalization of cannabis, and regulation of its jama.2019.11868. [Epub ahead of print] production and sale, would decrease adolescent access and reduce 2. Health Canada. 2019. Market data under the Access to Cannabis for Medical Purposes Regulations. Retrieved August 1, 2019 from https://www.canada.ca/ the harms associated with illegal distribution. Concerns have been en/health-canada/services/drugs-medication/cannabis/licensed-producers/ raised about the need to better understand the short-term and market-data.html. long-term consequences of cannabis use. Now more than ever, 3. Memedovich KA, Dowsett LE, Spackman E, Noseworthy T, Clement F. The adverse health effects and harms related to marijuana use: an overview review. patients are looking to healthcare professionals to educate them CMAJ Open. 2018; 6:E339–E346. about the harms and benefits of cannabis use for recreational and 4. Fitzcharles MA, Shir Y, Häuser W. Medical cannabis: strengthening evidence in medicinal purposes. It is important that we remain informed as the face of hype and public pressure. CMAJ. 2019; 191:E907-E908. UTMJ • Volume 96, Number 3, June 2019 3 A student-run scientific publication since 1923 University of Toronto Medical Journal 2018-2019 UTMJ Editorial Team Editors-in-Chief Copy Editors Mark Lukewich Anders Erickson Mazen El-Baba Connor Brenna Clemence Cote Erica Brant Spandana Amarthaluru Sylvie Bowden Associate Editors Zak Haj-Ahmad Adam Bobrowski Bahar Behrouzi Everett Claridge Joseph Jamnik Nicholas Scrivens Interview Editors Anna Kurdina Annie Yu Happy Inibhunu Jeff Park Section Editors Mana Modares Alexandra Florescu Meghan Kerr Indranil Balki Kathleen O’Brien Maria Leis Michael Kryshtalsky Rachel Greben Typesetting and Printing Ryan Ramos Type & Graphics Inc. Sahar Zarabi Sarah Ge Sina Hadipour-Lakmehsari Tanya Yeuchyk Vijay Sandhu University of Toronto Medical Journal, 1 King’s College Circle, Room 2260, Medical Sciences Building, Toronto, Canada M5S 1A8 E-mail: [email protected] • http://www.utmj.org • Phone: 416-946-3047 • Fax: 416-978-8730 4 UTMJ • Volume 96, Number 3, June 2019 A student-run scientific publication since 1923 University of Toronto Medical Journal Award Winning Manuscripts The University of Toronto Medical Journal (UTMJ) was established in 1923 and is Canada’s oldest student run medical journal. We strive to uphold the UTMJ’s legacy of excellence by publishing interesting and timely research articles for our esteemed readers. Medical trainees continue to be important contributors to many of the research articles published by the UTMJ. We recognize the value in student research and are proud to serve as an outlet for this work. The UTMJ recently established three awards to acknowledge outstanding submissions from medical trainees in each of our issues. We would like to congratulate the following award winners for the current issue on Artificial Intelligence in Healthcare: First Prize Freedom of Expression Litigation and the Harms of Cannabis Melanie