bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology and Clinical Features of Methicillin‐Resistant Staphylococcus aureus in the University Hospital, Jeddah, Saudi Arabia
Authors: Madani Tariq A
Published: March 2016

OBJECTIVE: To describe the prevalence, demography and clinical characteristics of patients who were colonized or infected with methicillin‐resistant Staphylococcus aureus (MRSA) in 1998 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

PATIENTS AND METHODS: Results of MRSA‐positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the King Abdulaziz University Hospital Infection Control Department′s records. Charts of patients were reviewed.

RESULTS: Of 292 S aureus isolates identified, 111 (38%) were MRSA, or 6.0 MRSA isolates/1000 admissions, which represented a marked increase over MRSA prevalence in 1988 (less than 2%). Nosocomial acquisition occurred in 74.8% of isolates. All age groups were affected, but 45.9% of patients were in the ′extremes of age′ group (younger than one or older than 60 years of age). The prevalence was highest in the medical ward (27%), followed by the paediatrics combined medical and surgical ward (20.7%), the outpatient department (18%), the adult surgical ward (17.1%) and the intensive care units (17.1%). Two‐thirds (66.7%) of cases represented infection and the remainder represented colonization. Surgical wounds (31.1%), the chest (27%) and endovascular catheters (20.3%) were the most common sites of infection. Bacteremia occurred in 27% of patients. Local signs (68.9%) and fever (60.8%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 28.4% and 6.8% of cases, respectively. Of 74 patients with MRSA infection and 37 patients with MRSA colonization, 91.9% and 56.8% received antibiotics in the preceding six weeks, respectively (P<0.0001). The total mortality of patients with MRSA infection was 60.8%; 37.8% of deaths were the result of MRSA infection and 23% were the result of other diseases.

CONCLUSIONS: The prevalence of MRSA is high and rapidly increasing at King Abdulaziz University Hospital, as it is worldwide. Control measures to prevent the spread of MRSA in hospitals should continue with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.
A Diathesis‐Stress Model of Chronic Pain and Disability following Traumatic Injury
Authors: Turk Dennis C
Published: March 2016

One of the perplexing features of pain is the wide variability in patients′ responses to ostensibly the same extent of physical pathology. A range of cognitive, affective and behavioural factors are related to the perception of pain, maintenance of pain and disability, exacerbation of pain and response to treatment. Moreover, there is some evidence that individual differences and prior learning history also have a significant influence on the experience of pain and related disability. The role of these psychological factors in the maintenance of disability following traumas such as motor vehicle accidents and work‐related injuries has generated considerable interest. This paper provides a brief overview of a set of predisposing factors, cognitive processes and behavioural principles that appear to be particularly important in the maintenance of disability following trauma. In particular, anxiety sensitivity, anticipation and avoidance of fear or harm, catastrophizing ideation, causal attributions for symptoms, self‐efficacy and operant conditioning are discussed. Each of these factors is integrated in a diathesis‐stress model that emphasizes the interaction of predisposing factors with a trauma, setting in motion a cascade of interpretive cognitive processes and reinforcement contingencies that maintain disability following the trauma. This model proposes a sequential process to explain the variation observed among people following a relatively minor trauma. The model is intended to be heuristic. It may be a useful conceptualization that can serve to guide prevention efforts and the development of treatment interventions.
Lactic Acidosis in Asthma: Report of Two Cases and Review of the Literature
Authors: Prakash Suma , Mehta Sanjay
Published: March 2016

Lactic acidosis is commonly associated with states of hypoxia and decreased tissue perfusion. Elevated lactic acid levels have also been observed in individuals who are not septic and who are normotensive, but who have received systemic adrenergic agonist therapy. This report presents two patients with acute asthma treated with very large doses of aerosolized and systemic salbutamol, who developed lactic acidosis despite normal systemic hemodynamics and adequate oxygenation. Lactic acidosis was clinically important because it contributed to respiratory failure in one patient, and complicated the assessment and management of acute, severe asthma in the other patient.
The Buccale Puzzle: The Symbiotic Nature of Endogenous Infections of the Oral Cavity
Authors: Ruby John , Barbeau Jean
Published: March 2016

The indigenous, ′normal′ microflora cause the majority of localized infectious diseases of the oral cavity (eg, dental caries, alveolar abscesses, periodontal diseases and candidiasis). The same microflora also protect the host from exogenous pathogens by stimulating a vigorous immune response and providing colonization resistance. How can a microflora that support health also cause endogenous oral disease? This paradoxical host‐symbiont relationship will be discussed within the dynamic of symbiosis.

Symbiosis means ′life together′ ‐ it is capable of continuous change as determined by selective pressures of the oral milieu. Mutualistic symbiosis, where both the host and the indigenous microflora benefit from the association, may shift to a parasitic symbiosis, where the host is damaged and the indigenous microflora benefit. Importantly, these are reversible relationships. This microbial dynamism, called amphibiosis, is the essential adaptive process that determines the causation of endogenous oral disease by a parasitic microflora or the maintenance of oral health by a mutualistic microflora.

Complex microbial consortiums, existing as a biofilm, usually provide the interfaces that initiate and perpetuate the infectious assault on host tissue. The ecology of the various oral microhabitats is critical for the development of the appropriate selecting milieux for pathogens. The microbiota associated with dental caries progression are primarily influenced by the prevailing pH, whereas periodontal diseases and pulpal infection appear to be more dependent on redox potential. Candidiasis results from host factors that favour yeast overgrowth or bacterial suppression caused by antibiotics. Oral health or disease is an adventitious event that results from microbial adaptation to prevailing conditions; prevention of endogenous oral disease can occur only when we realize that ecology is the heart of these host‐symbiont relationships.
Can Pain‐Related Fear Be Reduced? The Application of Cognitive‐Behavioural Exposure in Vivo
Authors: Vlaeyen Johan WS , de Jong Jeroen R , Onghena Patrick , Kerckhoffs-Hanssen Maria , Kole-Snijders Ank MJ
Published: March 2016

Although cognitive‐behavioural treatments of patients with chronic pain generally are reported to be effective, customization might increase their effectiveness. One possible way to customize treatment is to focus the intervention on the supposed mechanism underlying the transition from acute to chronic pain disability. Evidence is accumulating in support of the conjecture that pain‐related fear and associated avoidance behaviours are crucial in the development and maintenance of chronic pain disability. It seems timely to apply this knowledge to the cognitive‐behavioural management of chronic pain. Two studies are presented here. Study 1 concerns a secondary analysis of data gathered in a clinical trial that was aimed at the examination of the supplementary value of coping skills training when added to an operant‐behavioural treatment in patients with chronic back pain. The results show that, compared with a waiting list control, an operant‐behavioural treatment with or without pain‐coping skills training produced very modest and clinically negligible decreases in pain‐related fear. Study 2 presents the effects of more systematic exposure in vivo treatment with behavioural experiments in two single patients reporting substantial pain‐related fear. Randomization tests for AB designs revealed dramatic changes in pain‐related fear and pain catastrophizing. In both cases, pain intensity also decreased significantly, but at a slower pace. Differences before and after treatment revealed clinically significant improvements in pain vigilance and pain disability.
Perceived Cognitive Deficits, Emotional Distress and Disability following Whiplash Injury
Authors: Sullivan Michael JL , Hall Erin , Bartolacci Rosita , Sullivan Maureen E , Adams Heather
Published: March 2016

OBJECTIVES: To describe the pattern of perceived cognitive deficits in patients with whiplash injury, to examine the relation between perceived cognitive deficits and disability, and to examine the determinants of perceived cognitive deficits in patients with whiplash injury.

PARTICIPANTS: A total of 81 individuals participated in the study. There were 29 patients (13 men, 16 women) with a diagnosis of whiplash, grade I or II. Patients with work‐related soft‐tissue injuries (n=24) and nonclinical controls (n=28) were included as comparison groups.

METHODS: Participants completed measures of perceived cognitive deficits, pain severity, depression, anxiety and pain‐related disability.

RESULTS: Both patient groups scored significantly higher than the nonpatient control group on the measure of perceived cognitive deficits, but did not differ significantly from each other. Perceptions of cognitive deficits were significantly correlated with pain‐related disability. A hierarchical regression examining the relative contribution of anxiety, depression and pain showed that only anxiety and depression contributed significant unique variance to the prediction of perceived cognitive deficits.

DISCUSSION: The potential benefits of focusing interventions on the management of anxiety and depression in the rehabilitation of patients with whiplash injuries are discussed.
Patterns of Susceptibility in an Outbreak of Bordetella pertussis: Evidence from a Community‐Based Study
Authors: Moore David M , Mathias Richard G
Published: March 2016

OBJECTIVE: To describe an outbreak of Bordetella pertussis and to assess which factors were associated with the development of clinical pertussis in children and adults during the outbreak.

DESIGN: A case series was described to define the epidemiology of the pertussis outbreak. A school‐based survey of children was used to measure the incidence of clinical pertussis over the previous six months. Vaccination records from the local public health facility were used to look at the relationship between age and vaccination parameters, and susceptibility to clinically diagnosed pertussis. A cross‐sectional survey of teachers, parents and some hospital workers was used to assess these associations in adults.

SETTING: An outbreak of pertussis in an isolated northern community in British Columbia.

POPULATION STUDIED: All children in the community who attend daycare, kindergarten or school, and their parents were surveyed. In addition, some health care workers and mothers of preschool children were surveyed.

MAIN RESULTS: A total of 31 suspected cases of pertussis were identified over a three‐month period. Ninety per cent of the affected children who had available vaccination records had received four or five doses of pertussis vaccine. Sixty per cent of the town′s 209 children returned completed surveys. Of these, 69% had available vaccination records. Thirty‐six children (28%) reported symptoms that fit the case definition for pertussis over the previous three months. Attack rates were highest for the group of children aged 10 to 14 years. In a multivariate logistic regression analysis, receiving prophylactic medication and an increased number of years from the last vaccine dose were found to be significant predictors for developing pertussis. Thirty‐four per cent of the estimated 291 adults in the community returned completed surveys. The attack rate of pertussis in the adults was only 9%. Being a member of the school staff and/or having a household contact with pertussis were significant predictors of developing pertussis.

Conclusions: Immunity to pertussis appears to wane during childhood. Peak susceptibility appears to be during early adolescence. Adults do not seem to be at greater risk than adolescents for developing the disease, but it seems unlikely that this is due to better immunity. Rather, it is probably related to a lower risk of exposure to pertussis and a lower rate of progression to symptomatic disease when adults are infected.
Faster Onset of Bronchodilation with Formoterol than with Salmeterol in Patients with Stable, Moderate‐Severe Copd: Results of a Randomized, Double‐Blind Clinical Study
Authors: Kottakis John , Cioppa Giovanni Della , Creemers Jacques , Greefhorst Louis , Leclerc Violette , Pistelli Riccardo , Overend Tim , Till Denise , Rapatz Günter , LeGros Vincent , Bouros Demosthenes , Siafakas Nikolaos
Published: March 2016

OBJECTIVES: To compare the onset and magnitude of bronchodilation after dry powder inhalations of formoterol fumarate (Foradil Aerolizer) versus salmeterol xinofoate (Serevent Diskus) with respect to normalized (*) forced expiratory volume in 1 s area under the curve 0 to 1 h after inhalation (FEV1 AUC*0-1 h).

DESIGN: A double‐blind, double‐dummy, multicentre, randomized, placebo controlled, single‐dose, five‐period crossover study.

SETTING: Five centres in four countries ‐‐ one centre each in France, Greece and Italy, and two centres in the Netherlands.

PATIENTS: Forty‐seven patients aged 42 to 80 years (mean age 63.5 years) with chronic obstructive pulmonary disease (COPD) stage II and III, and mean baseline FEV1 1.17 L (range 0.56 to 1.77 L).

INTERVENTIONS: Patients inhaled single doses of formoterol dry powder (12 and 24 μg), single doses of salmeterol (50 and 100 μg) and matching placebo on five separate days.

MAIN RESULTS: The estimates of treatment difference in absolute terms (0.086 L) and percentage change from predose baseline (7.8%) for the primary end point, FEV1 AUC*0-1 h, showed that formoterol 12 μg was statistically significantly superior to salmeterol 50 μg (P=0.0044 and P=0.0021, respectively). In addition, both doses of formoterol were statistically superior to placebo for both absolute improvement and percentage change (P=0.0001). The analysis of secondary variables also confirmed the superiority of formoterol over salmeterol.

CONCLUSIONS: Formoterol is associated with a faster onset of bronchodilation than salmeterol in patients with COPD.
Hospitalizations for Diarrhea in Quebec Children from 1985 to 1998: Estimates of Rotavirus‐Associated Diarrhea
Authors: Buigues René-Pierre , Duval Bernard , Rochette Louis , Boulianne Nicole , Douville-Fradet Monique , Déry Pierre , Serres Gaston De
Published: March 2016

OBJECTIVE: To characterize the incidence and duration of hospitalization due to diarrhea and to assess the proportion of hospitalizations that are attributed to rotavirus‐associated diarrhea.

DESIGN: Retrospective study of hospitalization data.

SETTING: Hospitals located in Quebec.

POPULATION STUDIED: Children from one to 59 months of age who were discharged from hospital from April 1, 1985 to March 31, 1998.

MAIN RESULTS: There were 63,827 hospitalizations for diarrhea over the study period, for an average of 4910 hospitalizations/year. The epidemic curve showed a periodicity with regular alternation of high and low annual peaks. The number of hospitalizations for rotavirus‐associated diarrhea was estimated according to three different methods. The estimates varied between 1353 and 1849 hospitalizations due to rotavirus‐associated diarrhea/year over the 13‐year period, with good agreement between the results of the three methods for a one‐month to five years of age incidence of 320 hospitalizations for rotavirus‐associated diarrhea/100,000 children. The average duration of hospital stay decreased from 5.2 days in 1985 to 3.3 days in 1998.

CONCLUSIONS: The present article shows the importance of diarrhea hospitalizations among children and the alternating peak‐year periodicity.
The Relationship among the Inspiratory Muscle Strength, the Perception of Dyspnea and Inhaled Beta2‐Agonists in Patients with Asthma
Authors: Weiner Paltiel , Magadle Rasmi , Beckerman Marinella , Berar-Yanay Noa
Published: March 2016

BACKGROUND: It is well documented that the perception of dyspnea (POD), subjectively reported by patients, is related to the activity and strength of the inspiratory muscles, and influences the use of ′as needed′ beta2‐agonists.

STUDY OBJECTIVE: To investigate the relationship among the increase in inspiratory muscle strength after specific inspiratory muscle training, beta2‐agonist consumption and the POD in patients with persistent, mild to moderate asthma.

METHODS: Inspiratory muscle strength, daily beta2‐agonist consumption and the POD were measured in 30 patients with mild to moderate asthma. Patients were then randomly assigned to two groups: one group received specific inspiratory muscle training until an increase of more than 20 cm H2O was reached, and one group was a control group and received sham training. Inspiratory muscle strength, the POD and daily beta2‐agonist consumption were assessed during and after the training period.

RESULTS: There was no good correlation between the baseline maximal inspiratory pressure and the POD, or between the baseline maximal inspiratory pressure and the mean daily beta2‐agonist consumption. However, there was a significant correlation between the POD and the mean daily beta2‐agonist consumption. The increase in inspiratory muscle strength after the inspiratory muscle training was closely correlated with the decrease in the POD (P<0.001) and the decrease in beta2‐agonist consumption (P<0.001).

CONCLUSIONS: The present study shows that, in patients with mild to moderate, persistent asthma, there is a correlation between the POD and the mean daily beta2‐agonist consumption. When the inspiratory muscles are strengthened, there is a significant decrease in the POD and in beta2‐agonist consumption.
Distribution of Serogroups of Neisseria meningitidis and Antigenic Characterization of Serogroup Y Meningococci in Canada, January 1, 1999 to June 30, 2001
Authors: Tsang Raymond SW , Squires Susan G , Zollinger Wendell D , Ashton Fraser E
Published: March 2016

The relative frequency of serogroups of Neisseria meningitidis associated with meningococcal disease in Canada during the period January 1, 1999 to June 30, 2001 was examined. Of the 552 strains of N meningitidis collected from clinical specimens of normally sterile sites, 191 (34.6%), 276 (50.0%), 61 (11.1%) and 23 (4.2%) were identified by serological and molecular methods as serogroups B, C, Y and W135, respectively. About half (50.8%) of the serogroup Y isolates were isolated in the province of Ontario. The two most common serotypes found were 2c and 14. Most of the serogroup Y strains isolated from patients in Ontario were serotype 2c, while serotype 14 was the most common serotype associated with disease in the province of Quebec. The two most common serosubtypes found among the serogroup Y meningococci were P1.5 and P1.2,5. Laboratory findings, based on antigenic analysis, did not suggest that these serogroup Y strains arise by capsule switching from serogroups B and C strains. This study documented a higher incidence of finding serogroup Y meningococci in clinical specimens from patients in Ontario compared to the rest of Canada, and parallels the increase in serogroup Y meningococcal disease reported in some parts of the United States.
Massive Hemoptysis from Pulmonary Artery Aneurysms
Authors: Bozkurt A Kürşat
Published: March 2016

Aneurysms of the pulmonary arteries are rare. The author reports a case of a patient with bilateral pulmonary artery aneurysms, in whom the nature of the lesions was not known. Pulmonary artery aneurysms should be included in the differential diagnosis of lung masses.
Guidance on patient Identification and Administration of Recombinant Human Activated protein C for the Treatment of Severe Sepsis
Authors: Garber Gary , Gibney RT Noel , Light Bruce , Martin Claudio , Cunningham Kenneth , Guimond Jean-Gilles , Magder Sheldon , Russell James
Published: March 2016

Approximately one‐third of cases of severe sepsis result in death. Endogenous activated protein C (ApC) plays a key role in the regulation of the inflammation, fibrinolysis and coagulation associated with severe sepsis. In a recently published phase III trial, protein C Worldwide Evaluation in Severe Sepsis (pROWESS), intravenous administration of recombinant human ApC (rhApC) 24 µg/kg/h for 96 h to patients with severe sepsis resulted in a 6.1% reduction in absolute mortality and a 19.4% reduction in the relative risk of death from any cause within 28 days (number needed to treat = 16). This dose is now being applied in clinical practice.

rhApC is recommended for the treatment of severe sepsis (sepsis associated with acute organ dysfunction) occurring as a result of all types of infection (Gram‐negative bacterial, Gram‐positive bacterial and fungal). A panel of Canadian clinicians experienced in the treatment of severe sepsis and the management of critical care patients has developed this consensus document to assist clinicians in appropriate patient selection and management of potential challenges associated with rhApC therapy.
A Troubling Story: Insurance and Medical Research in Saskatchewan
Authors: Merskey Harold , Teasell Robert W
Published: March 2016

It is standard teaching that medicine and health care function in a social setting, and the pain literature is full of material on social and psychological factors. In Pain Research & Management, we drew attention to the impact of social influences on medical thinking and the readiness with which sections of the medical profession sided with paymasters for insurance companies (1). At that time, we were well aware of the most troubling story in decades in the fields of pain, insurance and medical research (2,3). In her commentary in this issue of Pain Research & Management, Lorie Terry (pages 101 to 106) provides information about why the scientific commentators have been radically critical of an article by Cassidy et al, published in The New England Journal of Medicine (2), on the basis of both internal evidence and additional information that accrued, some of which was available at the time of the article′s publication and some of which subsequently became public.
Interpreting the Meaning of Pain Severity Scores
Authors: Hodgins Marilyn J
Published: March 2016

Poor pain management practices are generally discussed in terms of barriers associated with the patient, clinician and/or health care organization. The impact of deficiencies in the tools that are used to measure pain are seldom addressed. Three factors are discussed that complicate the measurement of pain: the nature of pain, the lack of meaning associated with scores generated by pain scales, and treatment goals that lack specificity and are not linked to patients′ pain scores. The major premise presented in the present article is that the utility of pain measurement is limited because health care professionals do not have a common understanding of the meaning of scores generated by pain measurement tools, especially within the acute care setting. To address this issue, approaches to establishing instrument validity need to be broadened to include the examination of the meaning and consequences of these measurements within a specific context. Substantive improvements in pain management are unlikely to occur until criteria are identified to link explicitly the scores generated by pain measurement tools to treatment goals.
Respiratory Symptoms and Lung Function in Poultry Confinement Workers in Western Canada
Authors: Kirychuk Shelley P , Senthilselvan Ambikaipakan , Dosman James A , Juorio Victor , Feddes John JR , Willson Philip , Classen Henry , Reynolds Stephen J , Guenter Wilhelm , Hurst Thomas S
Published: March 2016

OBJECTIVE: To determine whether poultry production methods impact respiratory health, and whether poultry farmers have more respiratory symptoms and lower lung function than comparison control groups.

DESIGN: Cross‐sectional study.

SETTING: Provinces of Saskatchewan, Alberta and Manitoba during the winters of 1997 to 1999. POPULATION: Three hundred three poultry workers, 241 grain farmers and 206 nonfarming control subjects were studied. Poultry workers were further classified according to the poultry housing type in which they worked, ie, workers who worked with poultry raised on the floor (floor‐based operations), which included broiler/roaster, broiler/breeder and turkey operations (n=181), and workers who worked with poultry raised in a caged setting (cage‐based operations), which included egg operations (n=122).

INTERVENTIONS: Subjects completed a respiratory health questionnaire, which included questions on the poultry operation and work habits, and participated in lung function testing.

MAIN RESULTS: Overall, this study indicated that poultry workers report greater prevalences of current and chronic respiratory symptoms than control populations, and that the type of production method (cage‐based versus floor‐based) appears to influence the prevalence of respiratory symptoms and lung function values. Workers from cage‐based operations report greater prevalences of current cough and wheeze, as well as lower mean values for forced expiratory volume in the first second (FEV1), forced expiratory flow at 25% to 75% of vital capacity (FEF25‐75) and FEV1/FVC than workers from floor‐based facilities. Workers from cage‐based facilities also reported greater prevalences of current and chronic cough and phlegm, as well as significantly lower FEF25‐75 and FEV1/FVC values than nonfarming control subjects. Furthermore, grain farmers had lower FVC and FEV1 values than nonfarmers.

CONCLUSIONS: The results suggest that the type of poultry production system (ie, floor‐ versus cage‐based) appears to have an effect on the respiratory response of workers from these facilities. Further studies are required to understand the physiological mechanisms of respiratory dysfunction and the relationships concerning workplace exposure among poultry workers.
Predeominace of Herpes Simplex Virus Type 1 from Patients with Genital Herpes in Nova Scotia
Authors: Forward Kevin R , Lee Spencer HS
Published: March 2016

The epidemiology of genital herpes is changing with evidence to suggest an increasing incidence of herpes simplex virus type 1 (HSV‐1) infections. The results of 6529 HSV genital cultures taken between April 1998 and December 2001 were reviewed. Overall, HSV‐1 was recovered more often than HSV‐2; 1213 versus 1045. This trend was particularly striking in young women 30 years of age or less, in whom 70.8% of isolates were HSV‐1. In men of the same age range, 45% of isolates were HSV‐1. The proportion of women with HSV‐1 declined from 73.7% in those younger than 31 years of age to 4.5% in those older than 60 years of age.

These observations have important implications. The decline in the relative proportion of HSV‐1 isolates from young adults may be the result of changing sexual practices, changing susceptibility or increased exposure to HSV‐1 during vaginal intercourse. In this setting HSV‐2 vaccines may be less likely to produce the desired reduction in the overall prevalence of genital herpes infections.
Invasive Streptococcus pneumoniae Infection Causing Hemolytic Uremic Syndrome in Children: Two Recent Cases
Authors: Vanderkooi Otto G , Kellner James D , Wade Andrew W , Jadavji Tajdin , Midgley Julian P , Louie Thomas , Tyrrell Gregory J
Published: March 2016

INTRODUCTION: Streptococcus pneumoniae is an uncommon cause of hemolytic uremic syndrome (HUS) with a unique pathophysiology that differs from Shiga toxin‐related HUS.

METHODS: Case descriptions for each patient are provided. Each strain of S pneumoniae was subjected to a pulsed‐field gel electrophoresis (PFGE) analysis, Shiga toxin assay and polymerase chain reaction to detect Shiga toxin genes. A review of the current literature was conducted.

CASE PRESENTATIONS: Two patients with S pneumoniae‐related HUS that presented to the Alberta Children′s Hospital, Calgary, Alberta, within four weeks of each other in 2001 are described. Both presented with pneumonia and empyema with associated HUS. Both patients required dialysis, one patient for 10 days and the other for 18 days. Neither patient demonstrated evidence of Shiga toxin‐related disease. S pneumoniae isolated from blood or pleural fluid was penicillin susceptible. One isolate was serotype 3 and the other was serotype 14. The two strains had different PFGE patterns. Both patients recovered well with no persistent renal dysfunction.

CONCLUSIONS: S pneumoniae continues to be an uncommon but important cause of HUS. Most cases can be confirmed or at least considered probable without performing a renal biopsy.
Does Participation in a Pain Course Based on the International Association for the Study of Pain’s Curricula Guidelines Change Student Knowledge about Pain?
Authors: Strong Jenny , Meredith Pamela , Darnell Ross , Chong Marlene , Roche Patricia
Published: March 2016

BACKGROUND: The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the ′People in Pain′ course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement.

OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students′ knowledge about pain.

METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R‐PKAQ) pre‐ and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study.

RESULTS: Examination of the correlation matrix indicated substantial correlations between all R‐PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students′ knowledge on five of the six subscales of the R‐PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive‐behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance.

CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.
Pulmonary Function and Circulating Adhesion Molecules in Patients with Diabetes Mellitus
Authors: Boulbou Mary S , Gourgoulianis Konstantinos I , Petinaki Efthymia A , Klisiaris Vasilios K , Maniatis Antonios N , Molyvdas Paschalis A
Published: March 2016

BACKGROUND: Lung function in diabetes has been reported in several studies with contradictory results. Diabetes mellitus increases expression of adhesion molecules through hyperglycemia. These molecules play an important role in the pathophysiological dysfunction of the vasculature.

OBJECTIVE: To explore the possible relationship between lung function and circulating levels of adhesion molecules in diabetes.

METHODS: Sixteen type 1 diabetic patients, 33 type 2 diabetic patients and 22 healthy subjects matched for age and sex were studied. Spirometry measurements were performed and pulmonary diffusion capacity for carbon monoxide (DLco) was measured in sitting and supine positions by the single-breath method corrected by alveolar volume (VA). Glycosylated hemoglobin, retinopathy and nephropathy were included as parameters of metabolic control and diabetic complications. Circulating levels of soluble E-selectin and vascular cell adhesion molecule-1 (VCAM-1) were determined in all subjects.

RESULTS: Diabetic subjects showed lower variation in DLco and DLco/VA by changing posture from sitting to supine position (P=0.043 and P<0.001, respectively), and showed reduced total lung capacity (P<0.001) and forced expiratory volume in 1 s/forced vital capacity (P=0.009) compared with healthy control subjects. Serum concentrations of E-selectin were elevated in diabetic patients (P<0.001). There was no difference in serum VCAM-1 concentrations between diabetic and control subjects. On stepwise regression analysis, E-selectin concentrations were the most important contributing factor to the variation in DLco/VA.

CONCLUSIONS: Diabetic patients show lower pulmonary volumes and variation in DLco by changing posture from sitting to supine position, and they also show increased levels of E-selectin. A possible explanation is impaired pulmonary microvasculature, because adhesion molecules seem to be sensitive markers of endothelial activation and damage seen in diabetes.
Adjustable Maintenance Dosing with Budesonide/Formoterol Reduces Asthma Exacerbations Compared with Traditional Fixed Dosing: A Five‐Month Multicentre Canadian Study
Authors: FitzGerlad J Mark , Sears Malcolm R , Boulet Louis-Philippe , Becker Allan B , McIvor Andrew R , Ernst Pierre , Smiljanic-Georgijev Natasha M , Lee Joanna SM
Published: March 2016

BACKGROUND: Adjustable maintenance dosing with budesonide/formoterol in a single inhaler (Symbicort, AstraZeneca, Lund, Sweden) may provide a convenient means of maintaining asthma control with the minimum effective medication level.

Objectives: To compare adjustable and fixed maintenance dosing regimens of budesonide/formoterol in asthma.

METHODS: This was an open‐label, randomized, parallel‐group, multicentre, Canadian study of asthma patients (aged 12 years or older, postbronchodilator forced expiratory volume in 1 s 70% or greater of predicted normal). Following a one‐month run‐in on budesonide/formoterol (100/6 µg or 200/6 µg metered doses, two inhalations twice daily), 995 patients were randomly assigned either to continue on this fixed dosing regimen or to receive budesonide/formoterol adjustable dosing (step down to one inhalation twice daily if symptoms were controlled or temporarily step up to four inhalations twice daily for seven or 14 days if asthma worsened). The primary efficacy variable was the occurrence of exacerbations (requiring oral or inhaled corticosteroids, emergency department treatment, serious adverse events or added maintenance therapy because of asthma).

RESULTS: With adjustable dosing, significantly fewer patients experienced exacerbations compared with fixed dosing (4.0% versus 8.9%, P=0.002; number needed to treat=21 [95% CI 13 to 59]). Patients required 36% fewer overall doses of budesonide/formoterol (2.5 versus 3.9 inhalations/day, P<0.001), and total costs per patient were lower (difference over five months CDN$‐141 [95% CI ‐$162 to ‐$116]). Asthma symptom severity (modified National Heart, Lung, and Blood Institute stage) was maintained or improved in 97% or greater of patients in both groups (pre‐run‐in to end of treatment). Both treatments were well tolerated.

CONCLUSIONS: Budesonide/formoterol adjustable maintenance dosing provided more effective asthma control than fixed dosing, with a lower overall drug dose and reduced total cost.
Nelfinavir and Non‐Nucleoside Reverse Transcriptase Inhibitor‐Based Salvage Regimes in Heavily Hiv Pretreated Patients
Authors: Baril Jean-Guy , Lefebvre Eric A , Lalonde Richard G , Shafran Stephen D , Conway Brian
Published: March 2016

OBJECTIVE: To assess the efficacy of nelfinavir mesylate (NFV) in combination with delavirdine mesylate(DLV) or efavirenz (EFV) and other antiretroviral agents following virological failure on other protease inhibitor (PI)‐based regimens.

DESIGN: Multicentre, retrospective chart review.

METHODS: One hundred‐one patients who were naive to both NFV and non‐nucleoside reverse transcriptase inhibitors (NNRTIs) and who initiated NFV plus DLV or EFV‐based salvage regimens were reviewed. Response to treatmentwas defined as a reduction in HIV ribonucleic acid (RNA) levels to unquantifiable levels (less than 50 copies/mL, less than 400 copies/mL, less than 500 copies/mL) on at least one occasion after the initiation of salvage therapy. Baseline correlates of response, including prior duration of HIV infection, prior number of regimens, viral load and CD4 cell counts were also evaluated.

RESULTS: Patients had a mean duration of HIV infection of 10 years, a mean duration of prior therapy of four years, a median of four prior nucleoside reverse transcriptase inhibitors and a median of two prior PIs. At the time of review the mean duration of salvage therapy was 63.4 weeks. Virological suppression was achieved in 59 (58.4%) patients within a mean of eight weeks and maintained for a mean of 44.9 weeks (themean follow‐up was78 weeks). Of the non‐responders, 16 (38%) achieved a less than 1 log10 decrease in HIV RNA levels. Although there was no association between baseline correlates, response rate (75.7%) was significantly higher in patients with HIV RNA levels of 50,000 copies/mL or lower and CD4 counts greater than 200 cells/mm3.

CONCLUSION: NFV/NNRTI‐based highly active antiretroviral therapy regimens are an effective therapy in many patients who have experienced virological breakthroughs on at least one prior PI‐based regimen.
Assessment of Two Alternative Sample Transport and Fixation Methods in the Microbiological Diagnosis of Bacterial Vaginosis
Authors: Eason Erica , Toye Baldwin , Wells George A , Senterman Mary
Published: March 2016

BACKGROUND: The standard method for specimen collection and transport for microbiological diagnosis of bacterial vaginosis is an air‐dried smear of vaginal secretions, promptly heat‐ or alcohol‐fixed, Gram‐stained and scored by Nugent′s criteria.

OBJECTIVE: Two alternative methods are evaluated: sending a swab in transport medium to be smeared and Gram‐stained in the laboratory two days later; and sending a smear of vaginal secretions sprayed with cytological fixative to the laboratory for Gram staining seven days later.

PATIENTS AND METHODS: One hundred fifty‐two women aged 18 years and older who attended a hospital colposcopy clinic or a community healthy sexuality clinic were studied. This was a prospective study: three vaginal swabs were taken from each patient and handled as described above. Each slide was blindly and independently interpreted by two microbiology technologists. The sensitivity, specificity and coefficient of agreement of the transported swab and cytologically fixed methods were compared with the air‐dried smear method.

RESULTS: Smears from swabs in transport medium and cytologically fixed smears both had 90% sensitivity and 97% specificity for bacterial vaginosis compared with diagnosis from air‐dried smears. Cohen′s kappa was 0.88 (95% CI 0.79 to 0.97) for each method. Inter‐rater reliability assessed over all slides (all sampling techniques) was excellent (kappa 0.94).

CONCLUSIONS: For the diagnosis of bacterial vaginosis, both alternative techniques provide results equivalent to air‐dried direct smears. A vaginal smear sprayed with cytological fixative provides immediate fixation of material to the slide, permits delays in swab transport and avoids the requirement for transport at a controlled temperature imposed by swabs.
Foreword
Authors: Murer E , Niederer P , Radanov B , Rumo-Jungo A , Sturzenegger M , Walz F
Published: March 2016

Widely known as whiplash, cervical acceleration/deceleration trauma typically occurs as a result of a rear end automobile collision. This might cause damage to vertebrae and cervical tissue in the neck, with no visible and easily attestable signs of injury. In recent years, whiplash has become a nightmare for doctors, lawyers, rehabilitation specialists, bioengineers and insurers, not only in Switzerland, but across the whole of western Europe, North America and Australia.
The Evidence for Brain Injury in Whiplash Injuries
Authors: Alexander Michael P.
Published: March 2016

The evidence that brain damage can occur in injuries that produce whiplash is reviewed. The clinical phenomena for the two injuries are the same. Pure whiplash injury implies no, or minimal head contact, but many patients also have head contact against a head rest or the steering wheel or windshield. The relative severity of the neck injury and the head injury distinguishes whiplash from mild closed head injury. If there is brain injury is some patients with whiplash, it, by definition, falls at the mildest end of the concussion spectrum. The relationship between these two injuries is examined.
Primary Chemoradiation as Definitive Treatment for Unresectable Cancer of the Trachea
Authors: Videtic Gregory MM , Campbell Carolyn , Vincent Mark D
Published: March 2016

A 64‐year‐old man was diagnosed with unresectable cancer of the trachea. He was treated definitively with a novel chemoradiation regimen. Cisplatin‐based chemotherapy (ChT) was given for two cycles as induction, followed by concurrent administration of this ChT with external beam radiotherapy (RT) (total dose 60 Gy). An unexpected partial tumour response was noted after the induction of ChT alone. Six weeks after finishing ChT/RT, complete response of the lesion was noted on computed tomography imaging. Two years later, the patient was free of disease. Primary chemoradiation appears to be effective in managing locally advanced tracheal cancer.
Antimicrobials in Acute Exacerbations of Chronic Obstructive Pulmonary Disease ‐ An Analysis of the Time to Next Exacerbation Before and After Implementation of Standing Orders
Authors: Goddard Rob D , McNeil Shelly A , Slayter Kathryn L , McIvor R Andrew
Published: March 2016

OBJECTIVE: To compare the mean time to next exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) before and after the implementation of standing orders.

SETTING: Tertiary care hospital, Halifax, Nova Scotia, Canada.

POPULATION STUDIED: The records of 150 patients were analyzed, 76 were in the preimplementation group, 74 in the postimplementation group.

INTERVENTION: The management and outcomes of patients admitted with an acute exacerbation of COPD before and after the implementation of standing orders were compared.

DESIGN: A retrospective chart review.

MAIN RESULTS: There was no difference in the mean time to next exacerbation between treatment groups (preimplementation group: 310 days, postimplementation group: 289 days, P=0.53). Antibiotics were used in 90% of the cases (preimplementation group: 87%, postimplementation group: 93%). The postimplementation group had a 20% increase in the use of first‐line agents over the preimplementation group. Overall, first‐line agents represented only 37% of the antibiotic courses.

CONCLUSIONS: The implementation of standing orders encouraged the use of first‐line agents but did not influence subsequent symptom resolution, length of hospital stay, or the infection‐free interval in patients with acute exacerbations of COPD.
Chronic Pain and Whiplash Associated Disorders: Rehabilitation and Secondary Prevention
Authors: Turk Dennis C.
Published: March 2016

One fundamental concept common to the rehabilitation of chronic pain patients is the understanding that patients with complex pain problems are best served by a team of specialists with different health care backgrounds. This approach to the management of chronic pain, especially as the result of a motor vehicle accident and associated whiplash, is addressed. Also described is a anxiety‐based model and the potential of this model to prevent chronicity.
Research Paradigms in Psychosomatic Medicine with Special Emphasis on Whiplash ‐ Cervical Hyperextension Flexion Injury (CHFI)
Authors: Merskey Harold
Published: March 2016

There have been a number of attempts, particularly in the last five decades to understand the origins of pain in terms of psychological or psychosomatic patterns. These include psychoanalytic explanations relying on hysterical mechanisms, and psychophysiological proposals. The occurrence of pain in the course of psychiatric illness and its remission after the illness, has long been known and is not a controversial issue. However, the reported explanations of pain without overt and obvious prior psychiatric illness have largely failed to convince a significant portion of the professional establishment. These explanations have very often coincided with the interests of insurance companies, whether those insurance companies were providing medical benefits, disability insurance or workers′ or accident compensation. Critical examination of the evidence generated by insurance company related research indicates profound weaknesses in it.
Pancoast′s Syndrome due to Metastatic Carcinoma from the Stomach
Authors: Kodama Takahide , Satoh Hiroaki , Homma Shinsuke , Sekizawa Kiyohisa
Published: March 2016

We describe here a case of Pancoast′s syndrome due to metastatic carcinoma from the stomach. Although obtaining a tissue diagnosis is often difficult with apical lesions, transbronchial or percutaneous needle biopsy is the procedure of choice since a certain number of these cases are potentially curable.
Computed Tomography and Bronchoscopy in Endobronchial Tuberculosis
Authors: Yanardag Halil , Tetikkurt Cüneyt , Tetikkurt Seza , Demirci Sabriye , Karayel Tuncer
Published: March 2016

BACKGROUND: The therapeutic response to endobronchial tuberculosis is usually evaluated by bronchoscopy. Currently, there are no published studies investigating the use of computed tomography for the evaluation of therapeutic response in endobronchial tuberculosis.

OBJECTIVE: A retrospective study was performed to evaluate the bronchoscopic and computed tomographic features of endobronchial tuberculosis before and after treatment. The aim of this study was to investigate the usefulness of computed tomography for the assessment of treatment.

METHODS: The clinical, pathological and bronchoscopic features of endobronchial tuberculosis were evaluated in 55 patients. The age range of the patients was 21 to 52 years. Computed tomography and bronchoscopy were performed before and after treatment.

RESULTS: Diagnosis of tuberculosis was confirmed by culture and histopathological examination. Bronchoscopic examination revealed 89 endobronchial lesions of various types in 55 patients. The exudative type was the most common. Follow‐up bronchoscopy revealed that exudative‐, ulcerative‐ and granular‐type lesions healed completely. Computed tomography performed after treatment correlated well with the follow‐up bronchoscopic findings.

CONCLUSION: The results suggest that follow‐up computed tomography is useful for the evaluation of therapeutic response and complications associated with endobronchial tuberculosis, and may replace bronchoscopy.