Timothy Mailman

Dalhousie University, Halifax, Nova Scotia, Canada

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Publications (7)6.82 Total impact

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    ABSTRACT: Background: Lyme disease is an emerging problem in Nova Scotia. Lyme arthritis is a late manifestation of Lyme disease. Objective: To describe the demographic characteristics, referral patterns and clinical course of children diagnosed with Lyme arthritis in a tertiary care pediatric rheumatology clinic in Nova Scotia. Methods: In the present retrospective chart review, subjects diagnosed with Lyme arthritis between 2006 and 2013 were identified through the clinic database. Demographic variables, referral patterns, clinical presentation and information regarding treatment course and outcome were collected. Results: Seventeen patients were identified; 76% presented in 2012 and 2013. In 37.5% of cases, the referring physician suspected Lyme disease. Most patients presented with one or more painful and/or swollen joints; 94% had knee involvement. Only three of 17 patients had a history of erythema migrans and four of 17 recalled a tick bite. Five patients had a history of neurological manifestations consistent with Lyme disease, although, none had a diagnosis made at the time. Arthritis usually resolved after treatment with standard antibiotics; however, at last follow-up, two patients had antibiotic refractory Lyme arthritis, with one having joint damage despite aggressive arthritis treatment. Conclusion: A significant increase in cases of Lyme arthritis has recently been recognized in a pediatric rheumatology clinic in Nova Scotia. A history of a tick bite or erythema migrans were not sensitive markers of Lyme arthritis, and this diagnosis was often not considered by the referring physician. Educational initiatives should be undertaken to increase local awareness of this treatable cause of arthritis in children.
    No preview · Article · Nov 2015 · Paediatrics & Child Health
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    ABSTRACT: Background/Purpose:Lyme disease (LD) is an emerging problem in the Canadian province of Nova Scotia with a sharp rise in reported cases over the past 2 years, including cases referred to the pediatric rheumatology clinic in Halifax, the sole pediatric rheumatology referral centre in the province. This increase is likely related to an increase in the number and size of endemic areas in the province; it is expected that cases will continue to rise. We sought to characterize the demographics, clinical presentation, treatment course and musculoskeletal outcome of children with LD in our clinic.Methods:Subjects with a diagnosis of LD since 2008 were identified in the pediatric rheumatology clinic database. The medical records of patients with LD were reviewed for demographic variables, referral patterns, clinical presentation, investigations, treatment course, and outcome.Results:Seventeen patients were identified; all patients were referred for evaluation of arthritis. 76% of patients presented in 2012 and 2013. Median age was 11.5 years (2.6–15.8), 16 were male. All lived in known endemic areas with Lunenburg county being most common (59%); 76% did not recall a tick bite. Subjects were referred by their family physician (7), emergency department (4), orthopedic surgery (4), and infectious diseases (2). The median number of physician visits for MSK symptoms prior to rheumatology consult was 2 (range 1 to >5). Only one patient was referred with a known diagnosis of LD; LD was suspected in 37.5% of the remaining cases based on referral information. Six patients had prior joint aspiration, 2 of whom were treated for septic arthritis. Pain and/or swelling were reported by all patients; in those with swelling 47% were persistent/53% episodic. The median number of joints involved was 1, with 94% having knee involvement. Patients reported MSK–symptoms for a median of 2 months (range 0.1–11) prior to referral to rheumatology. Four patients had a history of neurologic manifestations of LD prior to MSK presentation, none of which were recognized as LD. ECG was done in 13 cases and was normal. Three patients had a history of erythema migrans. 14/17 patients have completed antibiotic treatment. Arthritis resolved in 50% of patients after 1 course of antibiotics and 29% after 2 courses. A third course of antibiotics was required in 21% of patients for persistent arthritis. Two patients continued to have arthritis following completion of antibiotic therapy. At a median of 5 months (range 0–50) following treatment, there are 2 patients with persistent synovitis and functional limitations; one having evidence of joint damage despite extensive arthritis treatment (NSAID, steroid injection, DMARDs and a biologic).Conclusion:Increasing numbers of children with Lyme arthritis are being seen in the pediatric rheumatology clinic in Nova Scotia. LD was not considered as a diagnosis in the majority of cases by the referring physician. A quarter of patients also had a history of unrecognized neurologic manifestations of LD. In keeping with published North American reports, most patients had an excellent outcome however a proportion continued to have arthritis and disability following antibiotic therapy.
    No preview · Article · Mar 2014 · Arthritis and Rheumatology
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    Luke F Reynolds · Timothy L Mailman · Douglas D McMillan
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    ABSTRACT: Serum gentamicin concentrations (GSCs) are frequently obtained before and after gentamicin administration to newborns with, or at high risk for, sepsis. To determine whether performing a peak GSC assay when the trough GSC is within the guidelines for care would add clinically relevant information for health care workers. A retrospective review of the IWK Health Centre (Halifax, Nova Scotia) laboratory database for peak and trough GSC for infants <28 days after birth was performed. Of 5253 paired samples of trough and peak GSCs, 3001 (57%) had trough GSCs ≤2 μg/mL. Of these, only nine (0.3%) had a peak GSC >10 μg/mL. Performing a peak GSC measurement does not provide further clinically important data and increases patient morbidity and hospital costs.
    Preview · Article · Jun 2012 · Paediatrics & Child Health
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    Joanne M. Langley · Timothy L. Mailman

    Full-text · Article · Jan 2012 · Canadian family physician Médecin de famille canadien
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    Jennifer Ahmed · Timothy Mailman · Joanne M Langley

    Full-text · Article · Aug 2008 · The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada
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    Full-text · Article · Feb 2008 · The Canadian journal of infectious diseases & medical microbiology = Journal canadien des maladies infectieuses et de la microbiologie medicale / AMMI Canada
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    Joanne M Langley · Timothy L Mailman

    Preview · Article · Oct 2007 · Canadian family physician Medecin de famille canadien