Publications by authors named "Heidi Oi-Yee Li"

17 Publications

  • Page 1 of 1

Are improvements in melasma severity correlated with improvements in quality of life? A systematic review.

Dermatol Ther 2021 May 30:e15011. Epub 2021 May 30.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1111/dth.15011DOI Listing
May 2021

Early Warning of Infection in Patients Undergoing Hematopoietic Stem Cell Transplantation Using Heart Rate Variability and Serum Biomarkers.

Transplant Cell Ther 2021 May 5. Epub 2021 May 5.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Departments of Critical Care Medicine and Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.

Early warning of infection is critical to reduce the risk of deterioration and mortality, especially in neutropenic patients following hematopoietic stem cell transplantation (HCT). Given that heart rate variability (HRV) is a sensitive and early marker for infection, and that serum inflammatory biomarkers can have high specificity for infection, we hypothesized their combination may be useful for accurate early warning of infection. In this study, we developed and evaluated a composite predictive model using continuous HRV with daily serum biomarker measurements to provide risk stratification of future deterioration in HCT recipients. A total of 116 ambulatory outpatients about to undergo HCT consented to collection of prospective demographic, clinical (daily vital signs), HRV (continuous electrocardiography [ECG] monitoring, laboratory [daily serum samples frozen at -80 °C]), and infection outcome variables (defined as the time of escalation of antibiotics), all from 24 hours pre-HCT to the onset of infection or 14 days post-HCT. Indications for antibiotic escalation were adjudicated as "true infection" or not by 2 blinded HCT clinicians. A composite time series of 8 HRV metrics was created for each patient, and the probability of deterioration within the next 72 hours was estimated using logistic regression modeling of composite HRV and serum biomarkers using a rule-based naïve Bayes model if the HRV-based probability exceeded a median threshold. Thirty-five patients (30%) withdrew within <24 hours owing to intolerability of ECG monitoring, leaving 81 patients, of whom 48 (59%) had antibiotic escalation adjudicated as true infection. The combined HRV and biomarker (TNF-α, IL-6, and IL-7) predictive model began increasing at ∼48 hours on average before the diagnosis of infection, could distinguish between high risk of impending infection (>90% incidence of subsequent infection within 72 hours), average risk (∼50%), and low risk (<10%), with an area under the receiver operating characteristic curve of 0.87. However, given that prophylactic predictive ECG monitoring and daily serum collection proved challenging for many patients, further refinement in measurement is necessary for further study.
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http://dx.doi.org/10.1016/j.jtct.2021.04.023DOI Listing
May 2021

Microneedling as an Adjuvant to Local Therapies for Vitiligo: A Systematic Review and Meta-Analysis.

Dermatol Surg 2021 Apr 27. Epub 2021 Apr 27.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada Faculty of Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada Division of Dermatology, The University of Ottawa, and The Ottawa Hospital, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1097/DSS.0000000000003048DOI Listing
April 2021

Microneedling as an adjuvant to topical therapies for melasma: A systematic review and meta-analysis.

J Am Acad Dermatol 2021 Apr 12. Epub 2021 Apr 12.

SkinCare Physicians, Chestnut Hill, Massachusetts; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Brown Medical School, Providence, Rhode Island. Electronic address:

Background: Microneedling as an adjuvant to topical medications has shown promising but variable results in the treatment of melasma.

Objective: To conduct a systematic review and meta-analysis on the efficacy of microneedling as an adjuvant to topical therapies for the treatment of melasma.

Methods: This study followed PRISMA guidelines. All comparative, prospective studies on the use of topical interventions with microneedling for the treatment of melasma were included. Studies involving radiofrequency microneedling were excluded.

Results: Twelve eligible studies comprising 459 patients from 7 different countries were included. Topical therapies included topical tranexamic acid, vitamin C, platelet-rich plasma, non-hydroquinone-based depigmentation serums, and hydroquinone-based depigmenting agents. Topical therapy with microneedling improved melasma severity with a large effect (standardized mean difference >0.8) beyond 8 weeks, with best results seen at 12 weeks. Compared to topical therapy alone, topical therapy with microneedling resulted in an additional improvement in melasma severity with a moderate effect at 8 weeks and a large effect at 12-16 weeks. Microneedling was well tolerated across studies, with no serious adverse events reported.

Limitations: Heterogeneity in study designs did not allow for a comparison of the efficacy of various topical therapies with microneedling.

Conclusion: Microneedling is useful adjuvant to topical therapies for the treatment of melasma.
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http://dx.doi.org/10.1016/j.jaad.2021.03.116DOI Listing
April 2021

Lasers as an adjuvant for vulvar lichen sclerosus: A systematic review and meta-analysis.

J Am Acad Dermatol 2021 Mar 5. Epub 2021 Mar 5.

SkinCare Physicians, Chestnut Hill, Massachusetts; Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut; Brown Medical School, Providence, Rhode Island.

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http://dx.doi.org/10.1016/j.jaad.2021.02.081DOI Listing
March 2021

YouTube as a Source of Patient Information for Mohs Micrographic Surgery: A Systematic Analysis.

Dermatol Surg 2021 Apr;47(4):552-554

Division of Dermatology, University of Ottawa, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1097/DSS.0000000000002900DOI Listing
April 2021

Variation in management of post-operative atrial fibrillation (POAF) after thoracic surgery.

Gen Thorac Cardiovasc Surg 2021 Jan 5. Epub 2021 Jan 5.

Division of Thoracic Surgery, Department of Surgery, The Ottawa Hospital, University of Ottawa, Ottawa, Canada.

Objectives: New-onset post-operative atrial fibrillation (POAF) is a frequent adverse event following major thoracic surgery and is associated with increased risk of perioperative morbidity, length of stay and stroke. It is managed initially with rate and rhythm control therapy; however, optimal duration and the need for anticoagulation are poorly understood. This study aims to assess practice variation regarding POAF management and duration.

Methods: This retrospective, single-center cohort study included patients who underwent major thoracic surgery and developed POAF between 2008 and 2017, managed with rate and rhythm control therapy alone. Demographic, clinical, and surgical variables/outcomes, POAF management, and incidence of POAF recurrence in the 30-day post-operative period were collected. Chi-square and T-tests determined significance.

Results: Of 2054 patients undergoing thoracic surgery, 155 (75%) patients developed POAF. Different rate and rhythm control agents were used, most commonly metoprolol. 107 (69%) continued rate and rhythm control therapy upon hospital discharge for a mean of 56 days. Among the 48 patients with discontinuation of rate and rhythm control therapy on discharge, none demonstrated recurrence of POAF; in contrast to 3 of 107 patients who continued on therapy. Among patients with CHADS-VASc score ≥ 2, 15% were prescribed anticoagulation on discharge.

Conclusions: Use of rate and rhythm control therapy and anticoagulation for POAF is significantly varied in practice. Many patients are not continued on rate and rhythm control after hospital discharge, which does not appear to impact risk of POAF recurrence. Further research to inform guidelines for POAF management, including therapy duration and indications for anticoagulation is warranted.
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http://dx.doi.org/10.1007/s11748-020-01574-1DOI Listing
January 2021

Intergenerational Benefits of Student Volunteerism in Medical Education.

Acad Med 2021 02;96(2):e9

Fourth-year medical student, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1097/ACM.0000000000003849DOI Listing
February 2021

Hidradenitis suppurativa and major adverse cardiac events: A systematic review and meta-analysis.

J Am Acad Dermatol 2021 Mar 8;84(3):844-848. Epub 2020 Oct 8.

Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Division of Dermatology, The Ottawa Hospital, Ottawa, Ontario, Canada. Electronic address:

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http://dx.doi.org/10.1016/j.jaad.2020.10.005DOI Listing
March 2021

Socioeconomic Status and Melanoma in Canada: A Systematic Review.

J Cutan Med Surg 2021 Jan-Feb;25(1):87-94. Epub 2020 Sep 21.

27337 Division of Surgical Oncology, Department of Surgery, The Ottawa Hospital, ON, Canada.

As melanoma is one of the leading cancers in average years of life lost per death from disease, screening and early diagnosis are imperative to decrease morbidity and mortality. Socioeconomic status (SES) has been shown to be associated with melanoma incidence. However, it is unclear if this association holds true in universal healthcare systems where screening, diagnostic, and treatment services are available to all patients. The objective of this systematic review was to evaluate the evidence on the association of SES and melanoma incidence in Canada. A comprehensive search of PubMed and EMBASE yielded 7 studies reporting on melanoma incidence or outcomes with respect to SES in Canada. High SES was associated with increased melanoma incidence across all studies, which encompassed all Canadian provinces, and time periods spanning from 1979 to 2012. Studies also reported an increasing incidence of melanoma over time. There were substantial discrepancies in melanoma incidence across Canadian provinces, after controlling for SES and demographic characteristics. Populations of lower SES and living within certain healthcare regions had increased risks of advanced melanoma at diagnosis. This review highlights the potential for inequities in access to care even within a universal healthcare system. Future research is needed to characterize specific risk factors within different patient groups and within the universal health system context in order to implement targeted strategies to lower melanoma incidence, morbidity, and mortality.
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http://dx.doi.org/10.1177/1203475420960426DOI Listing
September 2020

Intraoperative balloon occlusion of the aorta for blood management in sacral and pelvic tumor resection: A systematic review and meta-analysis.

Surg Oncol 2020 Dec 22;35:156-161. Epub 2020 Aug 22.

Faculty of Medicine, University of Ottawa, Ottawa, Canada; Division of General Surgery, University of Ottawa, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada. Electronic address:

Background: Neoplasms of the sacrum and pelvis are challenging to manage due to their complex vascularity and size and are at high risk of bleeding during resection. Intra-aortic balloon occlusion (IABO) has been used in trauma to control massive blood loss, but its efficacy and safety in oncologic sacral and pelvic surgery are unknown. The primary objective of this systematic review and meta-analysis was to assess the effectiveness of IABO in providing hemorrhage control during resection of sacral and pelvic tumors.

Methods: This PROSPERO pre-registered study meta-analyzed all studies reporting on the use of IABO in the setting of pelvic and sacral tumour resection, in accordance with the PRISMA guidelines. The primary outcome of the meta-analysis was intraoperative blood loss, with secondary outcomes consisting of transfusion volume, post-operative blood loss, operative time, complication rate, and mortality.

Results: Across studies, IABO was associated with a large, significant reduction in intraoperative blood loss (SMD -0.81, 95% CI -1.01 to -0.60, P < 0.0001) and transfused red blood cell volume (SMD 0.92, 95% CI -1.30 to -0.53, P < 0.0001). Two studies reported that complication rates were comparable between patients receiving IABO and patient receiving conventional surgery (Odds ratio = 1.29, 95% CI: 0.59 to 2.83, P = 0.52). All studies descriptively reported improved visualization of the operative field with IABO.

Conclusions: Our findings demonstrated that IABO is an effective technique to decrease blood loss and transfusion requirements during sacral and pelvic tumor surgery. Future clinical trials should be conducted to establish the safety of this method and explore potential contraindications.
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http://dx.doi.org/10.1016/j.suronc.2020.08.016DOI Listing
December 2020

Medical Education Amid the COVID-19 Pandemic: New Perspectives for the Future.

Acad Med 2020 11;95(11):e11-e12

Second-year medical student, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada., First published online July 8, 2020.

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http://dx.doi.org/10.1097/ACM.0000000000003594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7363369PMC
November 2020

Long-term social distancing during COVID-19: A social isolation crisis among seniors?

CMAJ 2020 05;192(21):E588

Research assistant, Department of Health Sciences, Carleton University, Ottawa, Ont.

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http://dx.doi.org/10.1503/cmaj.75428DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7259965PMC
May 2020

YouTube as a source of information on COVID-19: a pandemic of misinformation?

BMJ Glob Health 2020 05;5(5)

Department of Medicine, Ottawa Hospital, Ottawa, Ontario, Canada.

Introduction: The COVID-19 pandemic is this century's largest public health emergency and its successful management relies on the effective dissemination of factual information. As a social media platform with billions of daily views, YouTube has tremendous potential to both support and hinder public health efforts. However, the usefulness and accuracy of most viewed YouTube videos on COVID-19 have not been investigated.

Methods: A YouTube search was performed on 21 March 2020 using keywords 'coronavirus' and 'COVID-19', and the top 75 viewed videos from each search were analysed. Videos that were duplicates, non-English, non-audio and non-visual, exceeding 1 hour in duration, live and unrelated to COVID-19 were excluded. Two reviewers coded the source, content and characteristics of included videos. The primary outcome was usability and reliability of videos, analysed using the novel COVID-19 Specific Score (CSS), modified DISCERN (mDISCERN) and modified JAMA (mJAMA) scores.

Results: Of 150 videos screened, 69 (46%) were included, totalling 257 804 146 views. Nineteen (27.5%) videos contained non-factual information, totalling 62 042 609 views. Government and professional videos contained only factual information and had higher CSS than consumer videos (mean difference (MD) 2.21, 95% CI 0.10 to 4.32, p=0.037); mDISCERN scores than consumer videos (MD 2.46, 95% CI 0.50 to 4.42, p=0.008), internet news videos (MD 2.20, 95% CI 0.19 to 4.21, p=0.027) and entertainment news videos (MD 2.57, 95% CI 0.66 to 4.49, p=0.004); and mJAMA scores than entertainment news videos (MD 1.21, 95% CI 0.07 to 2.36, p=0.033) and consumer videos (MD 1.27, 95% CI 0.10 to 2.44, p=0.028). However, they only accounted for 11% of videos and 10% of views.

Conclusion: Over one-quarter of the most viewed YouTube videos on COVID-19 contained misleading information, reaching millions of viewers worldwide. As the current COVID-19 pandemic worsens, public health agencies must better use YouTube to deliver timely and accurate information and to minimise the spread of misinformation. This may play a significant role in successfully managing the COVID-19 pandemic.
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http://dx.doi.org/10.1136/bmjgh-2020-002604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228483PMC
May 2020

Management of congenital cutaneous candidiasis in a healthy term baby: A case report.

SAGE Open Med Case Rep 2019 11;7:2050313X19876707. Epub 2019 Sep 11.

Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

The management of congenital cutaneous candidiasis in a healthy term neonate of normal birth weight is unclear. Often, healthy term neonates undergo extensive evaluation followed by systemic treatment, which may not be clinically warranted. Here, we present a case of a healthy term neonate with congenital cutaneous candidiasis, whose work-up was minimally invasive and was successfully treated with one oral dose of antifungals and topical antifungals, as well as a review of the literature.
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http://dx.doi.org/10.1177/2050313X19876707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6740067PMC
September 2019

Treatment of -Induced Rash and Mucositis With Cyclosporine [Formula: see text].

J Cutan Med Surg 2019 Nov/Dec;23(6):608-612. Epub 2019 Sep 10.

Division of Rheumatology and Dermatology, Children's Hospital of Eastern Ontario, Ottawa, Canada.

Background: -induced rash and mucositis (MIRM) is a relatively newly recognized clinical entity that typically presents with predominant mucositis accompanied by variable cutaneous involvement 7-9 days after the onset of prodromal symptoms. There are no evidence-based guidelines for treatment, and current standards of care may include supportive therapy, antibiotics, corticosteroids, and intravenous immunoglobulin .

Objective: This case series aims to describe the potential efficacy of cyclosporine A (CsA) in the treatment of MIRM.

Methods: The present case series details our use of CsA early in the course of MIRM in 3 pediatric patients.

Results: Rapid clinical resolution was observed following CsA therapy.

Conclusions: We suggest that early initiation of CsA may be an effective therapeutic option for MIRM.
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http://dx.doi.org/10.1177/1203475419874444DOI Listing
August 2020

Treatment of Darier's disease with oral magnesium: a case report.

SAGE Open Med Case Rep 2018 10;6:2050313X18795071. Epub 2018 Sep 10.

Division of Dermatology, The Ottawa Hospital, Ottawa, ON, Canada.

Darier's disease, an autosomal dominant genodermatosis, arises from a mutation in the gene that codes for sarco/endoplasmic reticulum Ca-ATPase in the endoplasmic reticulum and is characterized by greasy keratotic papules commonly found in seborrheic regions. Conventional treatments, including topical corticosteroids, antibiotics, antifungals and retinoids, often have limited efficacy. The present article reports the novel use of oral magnesium chloride supplementation (300 mg daily) in the treatment of Darier disease. After 5 years of limited improvement using conventional therapies, significant improvements in neck lesions were observed within 1 month of starting oral magnesium chloride. This suggests that oral magnesium chloride may be an effective therapeutic option for Darier disease, although further in vitro and clinical trials are necessary to evaluate its clinical efficacy.
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http://dx.doi.org/10.1177/2050313X18795071DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6134490PMC
September 2018