Background Sublingual hematoma, or pseudo-Ludwig’s angina, is a rare but potentially life-threatening condition that mimics Ludwig’s angina. Prompt differentiation between hemorrhagic and infectious etiologies of floor of mouth swelling is crucial for appropriate airway and therapeutic management (Baharloo et al., 2020; Cheng et al., 2021; Marin et al., 2020). Case report We report the case of a 19-year-old male who sustained mandibular trauma in a motor vehicle accident. He presented with progressive submental swelling, muffled voice, and elevation of the tongue, raising suspicion for Ludwig’s angina. Imaging revealed mandibular symphysis and condylar fractures with sublingual hematoma, but no evidence of abscess or gas formation. Flexible endoscopy showed posterior tongue displacement without laryngeal involvement. The patient was managed conservatively with corticosteroids, antifibrinolytics, and antibiotics. Airway intervention was not required. Definitive surgical fixation of mandibular fractures was performed after clinical stabilization. The hematoma resolved completely without complication. Discussion This case highlights the diagnostic challenge in distinguishing pseudo-Ludwig’s angina from true deep neck infections. While both conditions may present with similar clinical findings, imaging and endoscopy play vital roles in guiding management (Alamoudi & Hariri, 2022; Brotfain et al., 2012). Unlike Ludwig’s angina, sublingual hematomas often respond to conservative therapy and rarely necessitate surgical airway intervention unless rapidly expanding or causing obstruction (Lovallo et al., 2013). Conclusion Sublingual hematoma secondary to mandibular trauma should be considered in the differential diagnosis of floor-of-mouth swelling. Early imaging and interdisciplinary evaluation are essential to avoid misdiagnosis and unnecessary invasive procedures.

Background Agitated adult trauma patients are common in Canadian emergency departments. Cooperation and monitoring constraints can delay essential imaging and risk missed injury. Objective To synthesize current guidance and evidence into an educational framework for timely, safe imaging when the trauma exam is unreliable due to agitation. Methods Narrative review using targeted searches of guideline/agency sources and peer-reviewed trials/meta-analyses on agitation control, extended Focused Assessment with Sonography in Trauma (eFAST), and selective versus whole-body computed tomography (CT). Outputs were a conceptual evidence map and a worked case. Results Current research prioritizes parallel resuscitation with early eFAST. Unstable, eFAST-positive patients usually proceed to hemorrhage control rather than CT. For stable or stabilized adults with an unreliable exam, brief, monitored behavioural control creates a one-trip imaging window under continuous SpO₂/NIBP/ECG (± capnography). Teams select an up-front imaging approach: selective CT once cooperation returns and injuries localize, or whole-body CT when multi-region injury is likely or unreliability persists. The scanner-side bundle includes named monitoring responsibility, an airway plan, and dose-optimized protocols. Downstream steps include interventional radiology--supported non-operative strategies for eligible solid-organ injury, a 24-48 hour tertiary trauma survey, and a structured psychiatry handoff to limit re-sedation. Conclusions In agitated adult trauma, a single, monitored trip to obtain the necessary imaging after brief, guideline-aligned behavioural control may improve safety and throughput. For clinicians, the framework clarifies roles. For patients, it may shorten time to definitive imaging and reduce complications. Prospective, multi‑centre evaluation aligned with local policy is needed to measure effects on time‑to‑CT, adverse events, and missed injuries.

Dr. David Malkin is a Professor of Pediatrics and Medical Biophysics at the University of Toronto, and both a Staff Oncologist and Senior Scientist at The Hospital For Sick Children (SickKids). He holds the CIBC Children’s Foundation Chair in Child Health Research and is the Director of the Cancer Genetics program at SickKids. He is also the co-lead for the SickKids Precision Child Health initiative. He co-directs the SickKids Cancer Sequencing (KiCS) program and the pan-Canadian PRecision Oncology For Young peopLE (PROFYLE) initiative, both of which are establishing pipelines to incorporate next generation sequencing (NGS) into clinical trials for Canadian children and young adults with hard-to-cure cancers. Dr. Malkin’s research focuses on genetic mechanisms of cancer susceptibility, particularly in the context of TP53 and Li-Fraumeni syndrome. Additionally, it explores the application of genomics to surveillance and treatment approaches for individuals at genetic risk for cancer. He is recognized internationally for his expertise in cancer genetics, pediatric oncology, and cancer predisposition.

We are honoured to share the first issue of the 103rd volume of the University of Toronto Medical Journal (UTMJ), which explores the rapidly evolving and impactful field of Precision Medicine. Precision medicine — grounded in tailoring care to the unique characteristics of each patient — has transformed the management of many life-altering illnesses. Since the publication of Vol. 97 No. 1: Personalized Medicine in 2020, the landscape has advanced dramatically. The adoption of artificial intelligence (AI), next-generation omics technologies, and other cutting-edge approaches has accelerated the bench-to-bedside pipeline globally. In light of these developments, we felt it both timely and essential as a journal to revisit this theme and examine how these innovations are reshaping the future of clinical medicine. Importantly, the role of patient-centered care in precision medicine cannot be understated. By marrying precision medicine principles with an understanding of each patient’s values, lived experiences, and unique challenges, we can enter an era where everyone gets the care they deserve.

Type 2 diabetes (T2D) is a heterogeneous metabolic disorder with diverse etiologies, clinical trajectories, and treatment responses. Traditional management strategies adopt a one-size-fits-all approach, primarily focused on lowering hyperglycemia, but this paradigm overlooks important inter-individual differences that influence outcomes and long-term complications. Recent advances in systems biology and computational analytics have enabled novel approaches to disease subtyping, with the aim of stratifying patients into biologically and clinically meaningful groups. This narrative review synthesizes current evidence on clustering methods applied to T2D subtyping. Hard clustering approaches, such as k-means and hierarchical clustering, have most often been used to define phenotypic subtypes based on clinical traits, including age of onset, body mass index, insulin resistance, and beta (β)-cell function. While these models provide discrete categories that can be easily interpreted, they may oversimplify disease heterogeneity. In contrast, soft clustering techniques, including archetype analysis and latent class models, allow individuals to exhibit characteristics across multiple clusters, reflecting overlapping biological pathways. Genetic clustering has further revealed stable, mechanistically distinct endotypes, with potential to guide treatment selection and refine risk prediction. The clinical translation of T2D subtyping holds promise for tailoring interventions to underlying pathophysiology, improving therapeutic efficacy, and reducing adverse outcomes. However, challenges remain, including validation in diverse populations, cost-effectiveness considerations, and the need for prospective clinical trials stratified by subtype. Subtyping represents an important step toward precision medicine in T2D, with the potential to transform clinical care from uniform management to individualized treatment strategies.

Background Physician advocacy—recognized as a desired competency by both the CanMEDS framework and the Medical Council of Canada—can play a role in prioritizing health in public policy. However, there are clashing perspectives regarding physicians’ political participation, and the level of physician participation in Canadian politics remains unclear. The purpose of this retrospective descriptive review was to carry out historical documentation of the Canadian physicians elected as Members of Parliament (MPs) or appointed as Senators and identify trends in sociodemographic characteristics and political participation. Methods We identified Canadian physician parliamentarians and collected sociodemographic characteristics using publicly available data sources—specifically, the Library of Parliament’s Parliamentarians database, Canadian newspaper archives, biographies available on the parliamentarians’ official websites, and public registers for licensed physicians. Findings were tabulated and summarized using descriptive statistics and graphical presentation. Results We found that to date, 220 of 4,695 (4.69%) MPs, and 64 of 1,006 (6.4%) Senators have been physicians. Most physician decision-makers are men (96.8%), represent a riding in Ontario (38.6%) or Quebec (27.7%), and tend to run for office more than once (90%). We also found that since the first Parliament in 1867, there has consistently been at least one physician in the House of Commons, though there has been a steep decline in political participation since the 17th Parliament. Discussion Our study is the first to present a complete list of Canadian physicians elected to serve as MPs, or appointed to serve as Senators. We found that there has always been a physician in the House of Commons and the Senate: in fact, physicians are over-represented in Parliament compared to the general population. Despite over-representation, we note a decline in physician political participation, likely due to the increased rigor of standards to qualify as a physician and the challenges faced in political participation. This suggests a need to continue sustaining interest in pursuing political participation and advocacy among the current and next generation of physicians.

While nerve blocks have proven effective in managing pre- and postoperative knee pain, their application in managing sickle cell vaso-occlusive crises is not widely explored. This case presents a novel application of a motor-sparing combination of knee nerve blocks including the iPACK, genicular blocks, and a block to the vastus intermedius to treat debilitating knee pain in a 21-year-old male who was opioid-refractory. This intervention provided improved analgesia leading to a notable improvement in the patient’s functional ability. This case highlights the potential of this specific regional anesthetic technique as an effective and safe alternative to systemic opioid therapy for regional sickle cell-related pain.

Dr. Mamatha Bhat is a Hepatologist and Clinician-Scientist affiliated with the Ajmera Transplant Centre at the University Health Network (UHN). She is also a scientist at the Toronto General Hospital Research Institute (TGHRI) and an Associate Professor of Medicine at the University of Toronto. Dr. Bhat serves as Director of the Clinician-Scientist Training Program for the Department of Medicine, Partnership & Engagement Lead for the Temerty Centre for AI Research and Education in Medicine (T-CAIREM), and past Chair of the International Liver Transplant Society Basic and Translational Science Research Committee. Dr. Bhat completed her medical training at McGill University. She then completed a Transplant Hepatology fellowship at the Mayo Clinic. This was followed by a CIHR Fellowship for Health Professionals, through which she completed a PhD in Medical Biophysics. Dr. Bhat’s research program aims to improve long-term outcomes for patients undergoing liver transplantation by developing artificial intelligence tools that integrate clinical and omics data. Her vast contributions to the field of liver transplant research have been recognized internationally.

Canada faces a critical paradox in healthcare: while physician shortages escalate, thousands of qualified, internationally trained medical graduates (IMGs) residing in Canada remain sidelined. This underutilization of talent persists despite the rising demand for doctors, particularly in rural and underserved regions. Structural barriers such as restrictive residency quotas, inconsistent provincial licensing systems, and concerns about training variability impede IMG integration. Although IMGs undergo rigorous credential assessments, bridging programs, national licensing exams, and supervised practice readiness pathways, they remain disproportionately excluded from licensure compared to Canadian medical graduates (CMGs). Critics often cite issues of patient safety, communication barriers, and legal liability; however, evidence indicates that IMGs who pass Canadian regulatory filters perform comparably to domestically trained physicians. Programs like Practice-Ready Assessment (PRA) and national exams ensure competency and support public trust. Furthermore, language proficiency and cultural training are now mandatory in many provinces, facilitating equitable care delivery. Despite these safeguards, IMGs are restricted to less than 10% of residency positions, contributing to underemployment and exacerbating physician shortages. Policy reforms such as expanding residency capacity, implementing alternative licensure pathways, and recalibrating perceptions of IMGs can bridge the workforce gap without compromising quality or fairness. This commentary suggests that leveraging IMGs is a practical strategy for sustainable healthcare delivery. Embracing IMG integration upholds Canada’s multicultural identity and enhances the health system’s resilience. With thoughtful policy design and cultural change, Canada can convert this latent talent into a driving force for equitable, high-quality care nationwide.

Temporal bone squamous cell carcinoma is a rare, aggressive malignancy often misdiagnosed due to its nonspecific symptoms resembling chronic ear infections. Malignant transformation from long-standing cholesteatoma, though rare, has been reported. Early diagnosis remains challenging due to the tumour’s deep location, histological heterogeneity, and biopsy limitations. A 61-year-old man with a history of childhood cholesteatoma surgery and chronic otorrhea presented with a postauricular ulcer and severe otalgia. Initial biopsy of an external auditory canal mass was inconclusive, delaying diagnosis. Imaging revealed extensive temporal bone destruction and a temporal lobe abscess. A repeat biopsy confirmed temporal bone squamous cell carcinoma, with metastatic spread to the lungs and liver. He received palliative chemotherapy but succumbed to the disease. Chronic inflammation from cholesteatoma may contribute to malignant transformation. Tumour-related inflammation, anatomical constraints, and histological heterogeneity complicate diagnosis. Multiple biopsies are often required, but false negatives are common due to sampling challenges. Advanced imaging techniques, such as apparent diffusion coefficient mapping, may improve lesion characterization and biopsy accuracy. This case highlights the difficulty of diagnosing temporal bone squamous cell carcinoma in patients with chronic ear disease. Persistent otorrhea and otalgia should prompt heightened clinical vigilance. Early intervention, multidisciplinary management, and integrating advanced imaging techniques could facilitate timely diagnosis and improve outcomes.