bluuebunny/crossref_metadata_2025 huggingface dataset:
Association ofApolipoprotein A1-C3Gene Cluster Polymorphisms with Gallstone Disease
Authors: Dixit Manjusha , Choudhuri Gourdas , Saxena Rajan , Mittal Balraj
Published: March 2016

INTRODUCTION: Genetic polymorphisms in apolipoprotein genes may be associated with alteration in lipid profile and susceptibility to gallstone disease.

AIM: To determine the association betweenapolipoprotein A1(APOA1) (−75 guanine [G] to adenine [A] and +83/84 M2+/−,MspI) andapolipoprotein C3(APOC3) (SstI) polymorphisms with gallstone disease.

METHODS:MspIpolymorphisms of theAPOA1gene andSstIpolymorphisms ofAPOC3were analyzed in DNA samples of 214 gallstone patients and 322 age- and sex-matched healthy controls. All statistical analyses were performed using SPSS version 11.5 (SPSS, USA) and Arlequin version 2.0 (Arlequin, Switzerland).

RESULTS: TheAPOA1−75 G/A polymorphism was significantly associated with gallstone disease. Patients with the GG genotype (P=0.015) and G allele carriers (P=0.004) had a significantly higher risk of gallstone disease (1.087-fold and 1.561-fold, respectively), whereas patients with AA genotypes (P=0.011) and A allele carriers (P=0.004) were protected (OR 0.230 and 0.641, respectively) against gallstone disease.APOA1+83 M2+/−andAPOC3 SstIpolymorphisms were not associated with gallstone disease. Case-control analysis of haplotypes showed a significant association in males only. G-M2+-S1 conferred risk for gallstone disease (P=0.036; OR 1.593, 95% CI 1.029 to 2.464), while A-M2+-S1 was protective (P=0.002; OR 0.370, 95% CI 0.197 to 0.695) against gallstone disease. InAPOA1−75-APOA1+83bilocus haplotypes, G-M2+was associated (P=0.0001) with very high risk (OR 3.173, 95% CI 1.774 to 5.674) for gallstone disease in males only.APOA1−75-APOC3SstIhaplotypes also showed significant association whileAPOA1+83-APOC3SstIhaplotypes showed no association with gallstone disease.

CONCLUSIONS: TheAPOA1−75 G/A polymorphism is associated with gallstone disease and shows sex-specific differences. On the other hand,APOA1M2+/−andAPOC3 SstIpolymorphisms may not be associated with gallstone disease. Haplotype analysis is a better predictor of risk for gallstone disease.
Symposium on Obesity and Asthma –November 2, 2006
Authors: Boulet Louis-Philippe , Hamid Qutayba
Published: March 2016

Asthma and obesity are frequently associated, and obesity has been considered a factor contributing to both an increase in severity of asthma and to its development. The present document summarizes the proceedings of a symposium held in Montreal, Quebec, on November 2, 2006, under the auspices of the Réseau en santé respiratoire du Fonds de la recherche en santé du Québec in collaboration with the McGill University – Strauss Severe Asthma Program, Université Laval (Quebec City) and Université de Montréal. It includes an overview of the various aspects of the relationships between asthma and obesity with regard to animal models; genetic, hormonal and physiological determinants; influence of comorbidities (eg, sleep apnea syndrome); epidemiology; clinical and psychological features; and management of asthma in the obese population.
Gallbladder Carcinoma Associated with Anomalous Pancreaticobiliary Duct Junction
Authors: Kang Chang Moo , Kim Kyung Sik , Choi Jin Sub , Lee Woo Jung , Kim Byong Ro
Published: March 2016

BACKGROUND: Anomalous pancreaticobiliary ductal junction (APBDJ) is believed to be one of the risk factors for gallbladder carcinoma. The present study aims to delineate the gallbladder carcinoma characteristics associated with APBDJ.

PATIENTS AND METHODS: Patients with gallbladder carcinoma associated with APBDJ between August 1992 and February 2005 were retrospectively reviewed. Two types of APBDJ classifications were considered: right-angle type (C-P) and acute-angle type (P-C).

RESULTS: Ten of 218 patients (4.6%) with gallbladder carcinomas were associated with APBDJ. All patients were female with a mean age of 55.4 years (range 41 to 72 years). Gallstones were absent in nine patients. Seven patients (70%) had the P-C type and three patients (30%) had the C-P type. Survival differences between the P-C type and the C-P type of gallbladder carcinomas were noted (P = 0.0269). Patients with incidentally detected gallbladder carcinoma had superior survival (P = 0.0316).

CONCLUSION: Gallbladder carcinomas associated with APBDJ were significantly related to relatively young female patients without gallbladder stones. Survival outcomes in these patients were not different from those of gallbladder carcinoma without APBDJ. In particular, the P-C type of APBDJ seemed to be more associated with relatively advanced gallbladder carcinomas, and patients with incidentally detected gallbladder carcinomas with APBDJ had superior survival.
Demographic and Psychosocial Predictors of Acute Perioperative Pain for Total Knee Arthroplasty
Authors: Roth Maya L , Tripp Dean A , Harrison Mark H , Sullivan Michael , Carson Patricia
Published: March 2016

BACKGROUND: As the North American population ages, the prevalence of knee osteoarthritis and the surgical interventions (ie, total knee arthroplasty [TKA]) aimed at correcting pain and disability will also rise proportionally. Therefore, efforts to better understand the factors associated with surgical outcomes are warranted. To date, no studies have examined the impact of psychosocial factors on acute postoperative TKA pain.

OBJECTIVES: The primary objective was to examine the associations among catastrophizing, negative mood, demographics and acute postoperative pain following TKA. Ancillary analyses examined the association of preoperative psychological variables with postoperative pain.

METHODS: Patients completed questionnaire packages 2 h before their surgery and on three consecutive postoperative days while in the hospital. The questionnaire packages included the Short Form –McGill Pain Questionnaire, the Pain Catastrophizing Scale and the Shortened Version of Profile of Mood States. The Mini‐Mental State Examination was also administered. Demographic data were extracted from patients’ medical charts.

RESULTS: Associations among catastrophizing, negative mood and pain were established. Regressions showed that younger age predicted greater preoperative and postoperative day 1 pain; catastrophizing predicted preoperative and postoperative day 2 pain; and negative mood predicted postoperative day 3 pain. Catastrophizing and negative mood were highly correlated at several assessment points. Preoperative variables did not predict postoperative pain.

CONCLUSION: These results have postoperative pain management implications. Heightened attention to psychosocial variables, such as postoperative catastrophizing and negative mood, may be useful in identifying patients at risk for greater postoperative pain.
Upper Gastrointestinal Bleeding Secondary to an Aberrant Right Subclavian Artery-Esophageal Fistula: A Case Report and Review of the Literature
Authors: Millar Adam , Rostom Alaa , Rasuli Pasteur , Saloojee Nav
Published: March 2016

An aberrant right subclavian artery (ARSA) is a common aortic arch abnormality. A case of a 57-year-old man presenting with melena and hypotension secondary to an ARSA-esophageal fistula is reported. The current report is unique because it is the first reported case of ARSA-esophageal fistula associated with prior esophagectomy and gastric pull-up. A MedLine search was performed for ARSA-esophageal fistula cases, which were then compared with the present case. Because this patient had no vascular conduits, nasogastric or endotracheal tubes, the fistula likely occurred secondary to the previous surgery. This case is unusual because the patient survived the original hemorrhage associated with the ARSA-esophageal fistula.

An ARSA-esophageal fistula is a rare, but potentially fatal cause of upper gastrointestinal bleeding. A high index of suspicion is needed to make the diagnosis. This condition should be considered in patients with risk factors combined with hemodynamically significant gastrointestinal bleeding.
Colonic Polyps in Children and Adolescents
Authors: Durno Carol A
Published: March 2016

Colonic polyps most commonly present with rectal bleeding in children. The isolated juvenile polyp is the most frequent kind of polyp identified in children. ‘Juvenile’ refers to the histological type of polyp and not the age of onset of the polyp. Adolescents and adults with multiple juvenile polyps are at a significant risk of intestinal cancer. The challenge for adult and pediatric gastroenterologists is determining the precise risk of colorectal cancer in patients with juvenile polyposis syndrome. Attenuated familial adenamatous polyposis (AFAP) can occur either by a mutation at the extreme ends of the adenomatous polyposis coli gene or by biallelic mutations in themutY homologue (MYH)gene. The identification ofMYH-associated polyposis as an autosomal recessive condition has important implications for screening and management strategies. Adult and pediatric gastroenterologists need to be aware of the underlying inheritance patterns of polyposis syndromes so that patients and their families can be adequately evaluated and managed. Colonic polyps, including isolated juvenile polyps, juvenile polyposis syndrome, FAP, AFAP andMYH-associated polyposis, are discussed in the present review.
Ethnocultural and Sex Characteristics of Patients Attending a Tertiary Care Pain Clinic in Toronto, Ontario
Authors: Mailis-Gagnon Angela , Yegneswaran Balaji , Nicholson Keith , Lakha SF , Papagapiou Marios , Steiman Amanda J , Ng Danny , Cohodarevic Tea , Umana Margarita , Zurowski Mateusz
Published: March 2016

BACKGROUND: Ethnocultural factors and sex may greatly affect pain perception and expression. Emerging literature is also documenting racial and ethnic differences in pain access and care.

OBJECTIVE: To define the sex and ethnocultural characteristics of patients attending a tertiary care, university‐affiliated pain clinic in Toronto, Ontario.

METHODS: Data were collected on 1242 consecutive, new patients seen over a three‐year period at the Comprehensive Pain Program (CPP) in downtown Toronto. Data were compared with the Canada 2001 Census.

RESULTS: English‐speaking, Canadian‐born patients constituted 58.6% of the CPP population, similar to the 2001 Canadian Census data for the Greater Toronto Area. Certain visible minority groups (Indo‐Pakistani and Chinese) were significantly under‐represented, while European groups were over‐represented. While women outnumbered men, they presented with lower levels of physical pathology in general, particularly in certain ethnic groups. Patients from Europe (representing primarily immigrants who arrived in Canada before 1960), were older, by 10 years to 15 years, than the average CPP population, and had a much higher incidence of physical or medical disorders.

CONCLUSIONS: The implications of the study and the importance of sex and ethnicity in terms of presentation to Canadian pain clinics are discussed. Future well‐designed studies are needed to shed light on the role of both patients’ and physicians’ ethnicity and sex in pain perception and expression, decision‐making regarding pain treatments and acceptance of pain treatments.
Nocturnal Oxygen Therapy in Patients with Chronic Obstructive Pulmonary Disease: A Survey of Canadian Respirologists
Authors: Lacasse Yves , Sériès Frédéric , Martin Sylvie , Maltais François
Published: March 2016

BACKGROUND: Current evidence does not clearly support the provision of nocturnal oxygen therapy in patients with chronic obstructive pulmonary disease (COPD) who desaturate during sleep but who would not otherwise qualify for long‐term oxygen therapy (LTOT).

OBJECTIVES: To characterize the perception and clinical practice of Canadian respirologists regarding the indications and prescription of nocturnal oxygen therapy in COPD, and to determine what Canadian respirologists consider an important treatment effect of nocturnal oxygen therapy in a randomized, placebo‐controlled trial.

METHODS: A mail survey of all the respirologists registered in the 2006 Canadian Medical Directory was conducted.

RESULTS: A total of 543 physicians were surveyed. The response rate was 60%, and 99% of the respondents indicated that the problem of nocturnal oxygen desaturation is clinically relevant. Eighty‐two per cent interpret oximetry tracings themselves, and 87% have access to a sleep laboratory. Forty‐two per cent believe that all COPD patients with significant nocturnal desaturation should have a polysomnography to rule out sleep apnea, and 41% would prescribe nocturnal oxygen therapy to active smokers. Assuming a risk of death or progression to LTOT of 40% over a three‐year period, the respirologists indicated that to declare nocturnal oxygen therapy effective in reducing the rate of major clinical events in a clinical trial, the minimal absolute risk difference of death or progression to LTOT between oxygen and room air breathing should be 14%.

CONCLUSIONS: Canadian respirologists are interested in the issue of nocturnal oxygen desaturation in COPD. There is variation in clinical practices among Canadian respirologists in several aspects of the management of this problem.
The effect of different strains ofHelicobacter pylorion platelet aggregation
Authors: Corcoran Paul A , Atherton John C , Kerrigan Steve W , Wadstrom Torkel , Murray Frank E , Peek Richard M , Fitzgerald Desmond J , Cox Dermot M , Byrne Michael F
Published: March 2016

BACKGROUND AND AIMS:Helicobacter pyloriis the major causative agent in peptic ulcer disease and is strongly implicated in the development of gastric cancer. It has also been linked, less strongly, to cardiovascular disease. The mechanisms by which certain strains ofH pyloriinduce platelet aggregation through interactions with platelet glycoprotein Ib have been previously described.

METHODS: In the present study, 21 different strains ofH pylori, varying in their vacuolating toxin gene, cytotoxic-associated gene A status and other pathogenicity factors, were tested for their ability to induce platelet aggregation.

RESULTS: Ten of the 21 strains induced platelet aggregation, a response that appeared to be independent of their vacuolating toxin gene and cytotoxic-associated gene A status.

CONCLUSIONS: Platelet aggregation has been suggested to be one of the possible mechanisms involved in the effects on the cardiovascular system induced byH pylori. Our results suggest that any putative roleH pyloriplays in cardiovascular disease may be strain dependent. Further work to identify theH pylorifactors involved in induction of platelet aggregation may allow for identification of ‘higher risk’ strains for cardiovascular disease.
Paradoxical Embolization in an Adult Cystic Fibrosis Patient
Authors: Lawati Nabil M Al , Wilcox Pearce
Published: March 2016

Cystic fibrosis patients with an implantable venous access device (IVAD) and a patent foramen ovale (PFO) are at an increased risk of developing paradoxical embolism. A 33‐year‐old patient who had a cerebrovascular accident in the above setting is described. She had been anticoagulated because she had thrombosis of the tip of the indwelling catheter, and her PFO was closed percutaneuosly followed by replacement of her IVAD. She made a full neurological recovery. Echocardiography and prophylactic closure of the PFO, when present, as primary prevention for paradoxical embolism may be warranted in cystic fibrosis patients before placement of an IVAD.
Determinants of Antiviral Treatment Initiation in a Hepatitis C-infected Population Benefiting from Universal Health Care Coverage
Authors: Moirand Romain , Bilodeau Marc , Brissette Suzanne , Bruneau Julie
Published: March 2016

BACKGROUND AND AIMS: In view of increasing therapeutic efficacy, the delivery of hepatitis C virus (HCV) antiviral treatment is expected to increase. Yet practical experience reveals a low rate of treatment, particularly among intravenous drug users. The aim of the present study was to examine the prevalence of HCV treatment and identify factors associated with HCV treatment in a population of patients evaluated in an academic hepatology outpatient clinic between 2001 and 2002.

PATIENTS AND METHODS: The charts of HCV-infected patients who attended the outpatient clinic of the liver division between January 2001 and December 2002 were retrospectively reviewed. Regression analyses were conducted to compare patients according to HCV treatment initiation.

RESULTS: Of 378 eligible patients (past intravenous drug users 61%), 143 (38%) initiated antiviral treatment. Enrolment in a methadone maintenance program and a strong willingness to get treatment were independently associated with treatment initiation, while current intravenous drug use, alcoholic liver damage on biopsy, precarious housing arrangements and personality disorders were negatively associated with treatment initiation. Among patients who were offered treatment, 40% refused (they did not differ from the treated group for past or current substance abuse).

CONCLUSIONS: Only 38% of eligible patients initiated treatment; treatment refusal was very common. The results of the present study showed that a significant barrier to therapy involved patient perceptions.
Community‐Associated Methicillin‐Resistant Staphylococcus aureus Infections in Men Who Have Sex With Men: A Case Series
Authors: Sztramko R , Katz K , Antoniou T , Mulvey MR , Brunetta J , Crouzat F , Kovacs C , Merkley B , Tilley D , Loutfy Mona R
Published: March 2016

BACKGROUND: The purpose of the present study was to describe the clinical characteristics and management of community‐associated methicillin‐resistant Staphylococcus aureus (CA‐MRSA) infections among a cohort of men who have sex with men.

PATIENTS AND METHODS: A retrospective chart review was conducted of patients with culture‐proven MRSA at Maple Leaf Medical Clinic (Toronto, Ontario) between November 2004 and December 2005. Cases were identified by individual physicians and by queries in the clinical management system. A standard data collection form was used to record patient demographics, potential risk factors for MRSA and course of illness. When available, antimicrobial sensitivities were recorded. DNA fingerprinting using pulsed‐field gel electrophoresis, and genetic analysis for SCCmec typing and detection of the Panton‐Valentine leukocidin cytotoxin were performed on six available isolates.

RESULTS: Seventeen patients with MRSA infection were identified, 12 (71%) of whom were HIV‐positive. The most common clinical presentation was abscess (35%), followed by furuncle (17%), folliculitis (17%), cellulitis (17%) and sinusitis (12%). The majority of MRSA isolates were resistant to ciprofloxacin (92%) and levofloxacin (77%). All isolates were susceptible to trimethoprim‐sulfamethoxazole, rifampin, linezolid, gentamicin and clindamycin, while the majority were susceptible to tetracycline (80%). All six isolates tested were SCCmec type IVa‐positive and Panton‐Valentine leukocidin‐positive, and had fingerprint patterns consistent with the CMRSA‐10 (USA300) clone.

CONCLUSION: The present study describes the clinical presentation and management of CA‐MRSA infections occurring in Toronto among men who have sex with men. The infections appear to have been caused by CMRSA‐10, which has caused the majority of CA‐MRSA outbreaks elsewhere.
The Challenges Facing Canadian Trialists in an Increasingly Competitive Global Market: What Can be Done to Remain Competitive?
Authors: Scheifele David W , Halperin Scott A , Ward Brian , Duval Bernard
Published: March 2016

Globally, the pharmaceutical industry is condensing into fewer, larger international corporations. This has occurred with the vaccine industry in Canada, where two domestic producers have been absorbed by international companies. This changes the relationship between Canadian vaccine researchers and corporate head office research directors, who carefully assign prelicensure studies to potential market countries around the globe. To succeed in attracting prelicensure vaccine studies, Canadian researchers need to be outstanding in quality, reliability and efficiency. The present article highlights strategies to help researchers remain internationally competitive for industry‐sponsored pharmaceutical studies.
Prevalence, Impact and Attitudes Toward Lower Gastrointestinal Dysmotility and Sensory Symptoms, and Their Treatment in Canada: A Descriptive Study
Authors: Hunt Richard H , Dhaliwal Surinder , Tougas Gervais , Pedro Carmen , Labbé Jean-Francois , Paul Heidi , Ennamorato Michael
Published: March 2016

OBJECTIVES: To investigate the impact of lower gastrointestinal (GI) symptoms in the general Canadian population, and to explore patient satisfaction with traditional therapies and the level of patient interest in new treatments.

PATIENTS AND METHODS: Stage 1: A telephone survey of a weighted sample of 1000 adults (18 years of age or older) was conducted to determine the prevalence of five GI symptoms – abdominal pain, abdominal discomfort, bloating, constipation or constipation with occasional diarrhea -- that were present for 12 weeks or more (not necessarily consecutive) over the past year. Respondents with only abdominal pain were excluded. Stage 2: A telephone survey of 689 women (18 to 64 years of age), experiencing the GI symptoms described in stage 1, was conducted to assess symptom impact and treatment satisfaction.

RESULTS: Overall, 5.2% of the Canadian population (2.3% men and 7.9% women) experienced one or more lower GI symptoms (excluding those reporting abdominal pain alone). In stage 2, 26.2% of respondents had previously been diagnosed with irritable bowel syndrome. Overall, 78.1% of participants experienced two or more symptoms. Bloating was the most common symptom (75.3%) and abdominal pain the most bothersome and most severe. Over the previous three months, 13.2% of respondents missed work or school and 28.8% were less productive. At least one physician (average of 2.2 physicians) was consulted for symptoms in 80.9% of respondents. Of the 63.8% women receiving treatment, most used nonprescription products. Patients receiving prescription treatments for constipation were most often dissatisfied (75%).

CONCLUSIONS: Abdominal pain and discomfort, bloating and constipation are common, frequently occurring symptoms in the Canadian population and have a high burden on work performance and health care seeking. Most patients were dissatisfied with traditional therapies.
Pain Characteristics and Demographics of Patients Attending a University‐Affiliated Pain Clinic in Toronto, Ontario
Authors: Mailis-Gagnon Angela , Yegneswaran Balaji , Lakha SF , Nicholson Keith , Steiman Amanda J , Ng Danny , Papagapiou Marios , Umana Margarita , Cohodarevic Tea , Zurowski Mateusz
Published: March 2016

BACKGROUND: Pain clinics tend to see more complex chronic pain patients than primary care settings, but the types of patients seen may differ among practices.

OBJECTIVE: The aim of the present observational study was to describe the pain and demographic characteristics of patients attending a university‐affiliated tertiary care pain clinic in Toronto, Ontario.

METHODS: Data were collected on 1242 consecutive new patients seen over a three‐year period at the Comprehensive Pain Program in central Toronto.

RESULTS: Musculoskeletal problems affecting large joints and the spine were the predominant cause of pain (more prevalent in women), followed by neuropathic disorders (more prevalent in men) in patients with recognizable physical pathology. The most affected age group was in the 35‐ to 49‐year age range, with a mean pain duration of 7.8 years before the consultation. While 77% of the Comprehensive Pain Program patients had relevant and detectable physical pathology for pain complaints, three‐quarters of the overall study population also had significant associated psychological or psychiatric comorbidity. Women, in general, attended the pain clinic in greater numbers and had less apparent physical pathology than men. Finally, less than one in five patients was employed at the time of referral.

CONCLUSIONS: The relevance of the data in relation to other pain clinics is discussed, as well as waiting lists and other barriers faced by chronic pain patients, pain practitioners and pain facilities in Ontario and Canada.
Electronic Tools for Infectious Diseases and Microbiology
Authors: Burdette Steven D
Published: March 2016

Electronic tools for infectious diseases and medical microbiology have the ability to change the way the diagnosis and treatment of infectious diseases are approached. Medical information today has the ability to be dynamic, keeping up with the latest research or clinical issues, instead of being static and years behind, as many textbooks are. The ability to rapidly disseminate information around the world opens up the possibility of communicating with people thousands of miles away to quickly and efficiently learn about emerging infections. Electronic tools have expanded beyond the desktop computer and the Internet, and now include personal digital assistants and other portable devices such as cellular phones. These pocket‐sized devices have the ability to provide access to clinical information at the point of care. New electronic tools include e‐mail listservs, electronic drug databases and search engines that allow focused clinical questions. The goal of the present article is to provide an overview of how electronic tools can impact infectious diseases and microbiology, while providing links and resources to allow users to maximize their efficiency in accessing this information. Links to the mentioned Web sites and programs are provided along with other useful electronic tools.
Cancer Care Ontario Colonoscopy Standards: Standards and Evidentiary Base
Authors: Rabeneck Linda , Rumble R Bryan , Axler Jeff , Smith Anne , Armstrong David , Vinden Chris , Belliveau Paul , Rhodes Kay , Zwaal Caroline , Mai Verna , Dixon Peter , for Cancer Care Ontario’s Colonoscopy Standards Expert Panel
Published: March 2016

Colorectal cancer (CRC) is the most common cause of non‐tobacco‐related cancer deaths in Canadian men and women, accounting for 10% of all cancer deaths. An estimated 7800 men and women will be diagnosed with CRC, and 3250 will die from the disease in Ontario in 2007. Given that CRC incidence and mortality rates in Ontario are among the highest in the world, the best opportunity to reduce this burden of disease would be through screening. The present report describes the findings and recommendations of Cancer Care Ontario’s Colonoscopy Standards Expert Panel, which was convened in March 2006 by the Program in Evidence‐Based Care. The recommendations will form the basis of the quality assurance program for colonoscopy delivered in support of Ontario’s CRC screening program.
Painful Neuropathic Disorders: An Analysis of the RéGie De L’Assurance Maladie du QuéBec Database
Authors: Lachaine J , Gordon A , Choinière M , Collet JP , Dion D , Tarride J-E
Published: March 2016

BACKGROUND/OBJECTIVE:
Painful neuropathic disorders (PNDs) refer to neurological disorders involving nerves in which pain is a predominant symptom. In most cases, PNDs involve the peripheral nerves. Treatment of PNDs is likely to use large health care resources. However, little is known about the economic burden of PNDs in Canada.

METHOD: The present study was performed using data from a random sample of patients covered by the Régie de l’Assurance Maladie du Quebec drug plan. Subjects with a diagnosis of a peripheral PND were identified. Comorbidities, pain‐related medication use and resource utilization were compared between PND patients and control patients without PNDs matched for age and sex in a 1:1 ratio.

RESULTS: A total of 4912 patients with PNDs were identified. A higher level of comorbidities was found in the PND group (Von Korff chronic disease score 3.91 versus 2.54; P<0.001). The proportion of users of pain‐related medications was significantly higher in the PND cohort than in the control group (χ2; P<0.001). The average annual number of physician visits was also significantly higher in the PND group than in the control group (14.7 versus 6.4; P<0.001). From a health ministry perspective, costs of health care resources were significantly higher in the PND group ($4,163 versus $1,846; P<0.001). The proportion of potentially inappropriate medications was 34% among those 65 years of age or older.

CONCLUSIONS: PNDs are associated with a higher level of comorbidities, higher medical resources utilization and higher health care costs than non‐PND conditions.
Routine Surveillance for Bloodstream Infections in a Pediatric Hematopoietic Stem Cell Transplant Cohort: Do Patients Benefit?
Authors: Rigby Heather , Fernandez Conrad V , Langley Joanne , Mailman Tim , Crooks Bruce , Higgins Ann
Published: March 2016

BACKGROUND: Hematopoietic stem cell transplant (HSCT) recipients are at a high risk for late bloodstream infection (BSI). Controversy exists regarding the benefit of surveillance blood cultures in this immunosuppressed population. Despite the common use of this practice, the practical value is not well established in non‐neutropenic children following HSCT.

METHODS: At the IWK Health Centre (Halifax, Nova Scotia), weekly surveillance blood cultures from central lines are drawn from children following HSCT until the line is removed. A retrospective chart review was performed to determine the utility and cost of this practice. Eligible participants were non‐neutropenic HSCT recipients with central venous access lines. The cost of laboratory investigations, nursing time, hospital stay and interventions for positive surveillance cultures was calculated.

RESULTS: Forty‐three HSCTs were performed in 41 children. Donors were allogenic in 33 cases (77%) and autologous in 10 cases (23%). There were 316 patient contacts for surveillance cultures (mean seven per patient) and 577 central line lumens sampled. Three of 43 patients (7%) had clinically significant positive surveillance blood cultures. Bacteria isolated were Klebsiella pneumoniae (n=2) and Corynebacterium jeikeium (n=1). All follow‐up cultures before initiation of antimicrobial therapy were sterile. All three patients were admitted for antimicrobial therapy if they were not already hospitalized and/or had an uncomplicated course. The estimated total cost of BSI surveillance and management of asymptomatic infection over six years was $27,989.

CONCLUSION: The present study suggests that BSI surveillance in children following HSCT engraftment has a very low yield and significant cost. It is unclear whether it contributes to improved patient outcomes.
Effect of a Fermented Milk CombiningLactobacillus AcidophilusCL1285 andLactobacillus Caseiin the Prevention of Antibiotic-Associated Diarrhea: A Randomized, Double-Blind, Placebo-Controlled Trial
Authors: Beausoleil Mélanie , Fortier Nadia , Guénette Stéphanie , L’Ecuyer Amélie , Savoie Michel , Franco Martin , Lachaîne Jean , Weiss Karl
Published: March 2016

BACKGROUND: Antibiotic-associated diarrhea is an important problem in hospitalized patients. The use of probiotics is gaining interest in the scientific community as a potential measure to prevent this complication. The main objective of the present study was to assess the efficacy and safety of a fermented milk combiningLactobacillus acidophilusandLactobacillus caseithat is widely available in Canada, in the prevention of antibiotic-associated diarrhea.

METHODS: In this double-blind, randomized study, hospitalized patients were randomly assigned to receive either a lactobacilli-fermented milk or a placebo on a daily basis.

RESULTS: Among 89 randomized patients, antibiotic-associated diarrhea occurred in seven of 44 patients (15.9%) in the lactobacilli group and in 16 of 45 patients (35.6%) in the placebo group (OR 0.34, 95% CI 0.125 to 0.944; P=0.05). The median hospitalization duration was eight days in the lactobacilli group, compared with 10 days in the placebo group (P=0.09). Overall, the lactobacilli-fermented milk was well tolerated.

CONCLUSION: The daily administration of a lactobacilli-fermented milk was safe and effective in the prevention of antibiotic-associated diarrhea in hospitalized patients.
Pharmacological Management of Chronic Neuropathic Pain – Consensus Statement and Guidelines from the Canadian Pain Society
Authors: Moulin DE , Clark AJ , Gilron I , Ware MA , Watson CPN , Sessle BJ , Coderre T , Morley-Forster PK , Stinson J , Boulanger A , Peng P , Finley GA , Taenzer P , Squire P , Dion D , Cholkan A , Gilani A , Gordon A , Henry J , Jovey R , Lynch M , Mailis-Gagnon A , Panju A , Rollman GB , Velly A
Published: March 2016

Neuropathic pain (NeP), generated by disorders of the peripheral and central nervous system, can be particularly severe and disabling. Prevalence estimates indicate that 2% to 3% of the population in the developed world suffer from NeP, which suggests that up to one million Canadians have this disabling condition. Evidence‐based guidelines for the pharmacological management of NeP are therefore urgently needed. Randomized, controlled trials, systematic reviews and existing guidelines focusing on the pharmacological management of NeP were evaluated at a consensus meeting. Medications are recommended in the guidelines if their analgesic efficacy was supported by at least one methodologically sound, randomized, controlled trial showing significant benefit relative to placebo or another relevant control group. Recommendations for treatment are based on degree of evidence of analgesic efficacy, safety, ease of use and cost‐effectiveness. Analgesic agents recommended for first‐line treatments are certain antidepressants (tricyclics) and anticonvulsants (gabapentin and pregabalin). Second‐line treatments recommended are serotonin noradrenaline reuptake inhibitors and topical lidocaine. Tramadol and controlled‐release opioid analgesics are recommended as third‐line treatments for moderate to severe pain. Recommended fourth‐line treatments include cannabinoids, methadone and anticonvulsants with lesser evidence of efficacy, such as lamotrigine, topiramate and valproic acid. Treatment must be individualized for each patient based on efficacy, side‐effect profile and drug accessibility, including cost. Further studies are required to examine head‐to‐head comparisons among analgesics, combinations of analgesics, long‐term outcomes, and treatment of pediatric and central NeP.
Fifteen Minutes of Left Prefrontal Repetitive Transcranial Magnetic Stimulation Acutely Increases Thermal Pain Thresholds in Healthy Adults
Authors: Borckardt Jeffrey J , Smith Arthur R , Reeves Scott T , Weinstein Mitchell , Kozel F Andrew , Nahas Ziad , Shelley Neal , Branham R Kyle , Thomas K Jackson , George Mark S
Published: March 2016

BACKGROUND: Transcranial magnetic stimulation (TMS) of the motor cortex appears to alter pain perception in healthy adults and in patients with chronic neuropathic pain. There is, however, emerging brain imaging evidence that the left prefrontal cortex is involved in pain inhibition in humans.

OBJECTIVE: Because the prefrontal cortex may be involved in descending pain inhibitory systems, the present pilot study was conducted to investigate whether stimulation of the left prefrontal cortex via TMS might affect pain perception in healthy adults.

METHODS: Twenty healthy adults with no history of depression or chronic pain conditions volunteered to participate in a pilot laboratory study in which thermal pain thresholds were assessed before and after 15 min of repetitive TMS (rTMS) over the left prefrontal cortex (10 Hz, 100% resting motor threshold, 2 s on, 60 s off, 300 pulses total). Subjects were randomly assigned to receive either real or sham rTMS and were blind to condition.

RESULTS: Subjects who received real rTMS demonstrated a significant increase in thermal pain thresholds following TMS. Subjects receiving sham TMS experienced no change in pain threshold.

CONCLUSIONS: rTMS over the left prefrontal cortex increases thermal pain thresholds in healthy adults. Results from the present study support the idea that the left prefrontal cortex may be a promising TMS cortical target for the management of pain. More research is needed to establish the reliability of these findings, maximize the effect, determine the length of effect and elucidate possible mechanisms of action.
Understanding Allergic Asthma from Allergen Inhalation Tests
Authors: Cockcroft Donald W , Hargreave Fredrick E , O’Byrne Paul M , Boulet Louis-Philippe
Published: March 2016

The allergen challenge has evolved, in less than 150 years, from a crude tool used to document the etiology of allergen‐induced disease to a well‐controlled tool used today to investigate the pathophysiology and pharmacotherapy of asthma. Highlights of the authors’ involvement with the allergen challenge include confirmation of the immunoglobulin E‐dependence of the late asthmatic response, importance of (nonallergic) airway hyper‐responsiveness as a determinant of the airway response to allergen, identification of allergen‐induced increase in airway hyper‐responsiveness, documentation of beta2‐agonist‐induced increase in airway response to allergen (including eosinophilic inflammation), advances in understanding the pathophysiology and kinetics of allergen‐induced airway responses, and development of a muticentre clinical trial group devoted to using the allergen challenge for investigating promising new therapeutic strategies for asthma.
Primary Duodenal Mucosa-Associated Lymphoid Tissue (Malt) Lymphoma – a Rare Presentation of Gastric Outlet Obstruction
Authors: Tadmor Tamar , Rainis Tova , Bejar Jacob , Attias Dina , Lavy Alexandra
Published: March 2016

Malignant lymphoma of mucosa-associated lymphoid tissue (MALT) can arise in a variety of anatomical sites. The majority of these tumors arise in the stomach, with fewer than 30% arising in the small intestine. Primary duodenal MALT lymphoma is a very rare neoplasm. There are very few cases of duodenal MALT lymphoma reported in the literature. This is the third published case presenting clinically as a gastric outlet obstruction. The patient was successfully treated with a combination of chemotherapy and rituximab.
Photodynamic Therapy for Barrett’s Esophagus with High-Grade Dysplasia: A Cost-Effectiveness Analysis
Authors: Comay Dan , Blackhouse Gord , Goeree Ron , Armstrong David , Marshall John K
Published: March 2016

OBJECTIVES: To assess the cost-effectiveness of photodynamic therapy (PDT) and esophagectomy (ESO) relative to surveillance (SURV) for patients with Barrett’s esophagus (BE) and high-grade dysplasia (HGD).

METHODS: A Markov decision tree was constructed to estimate costs and health outcomes of PDT, ESO and SURV in a hypothetical cohort of male patients, 50 years of age, with BE and HGD. Outcomes included unadjusted life-years (LYs) and quality-adjusted LYs (QALYs). Direct medical costs (2003 CDN$) were measured from the perspective of a provincial ministry of health. The time horizon for the model was five years (cycle length three months), and costs and outcomes were discounted at 3%. Model parameters were assigned unique distributions, and a probabilistic analysis with 10,000 Monte Carlo simulations was performed.

RESULTS: SURV was the least costly strategy, followed by PDT and ESO, but SURV was also the least effective. In terms of LYs, the incremental cost-effectiveness ratios were $814/LY for PDT versus SURV and $3,397/LY for ESO versus PDT. PDT dominated ESO for QALYs in the base-case. The incremental cost-effectiveness ratio of PDT versus SURV was $879/QALY. In probabilistic analysis, PDT was most likely to be cost-effective at willingness-to-pay (WTP) values between $100/LY and $3,500/LY, and ESO was most likely to be cost-effective for WTP values over $3500/LY. For quality-adjusted survival, PDT was most likely to be cost-effective for all WTP thresholds above $1,000/QALY. The likelihood that PDT was the most cost-effective strategy reached 0.99 at a WTP ceiling of $25,000/QALY.

CONCLUSIONS: In male patients with BE and HGD, PDT and ESO are cost-effective alternatives to SURV.
Resource Implications for a Population-Based Colorectal Cancer Screening Program in Canada: A Study of the Impact on Colonoscopy Capacity and Costs in London, Ontario
Authors: Lau Agatha , Gregor James C
Published: March 2016

OBJECTIVE: Cancer Care Ontario has recommended a population-based colorectal cancer (CRC) screening program using fecal occult blood testing. Patients who test positive should undergo further investigation, preferably colonoscopy. So far, no studies have been performed to quantify the costs or demands on the health care system at the community level. The number of consultations, colonoscopies and polypectomies, and the corresponding direct medical costs generated by the CRC screening program, between 2006 and 2015 in London, Ontario, were estimated using a decision analysis model in comparison with the population health model.

METHODS: A faxed survey study was conducted to examine the current CRC screening practice among family physicians in London. Data from the survey and randomized studies were applied to a decision analysis model, which simulated the steps involved in population-based biennial and annual CRC screening between 2006 and 2015. The number of consultations, colonoscopies and polypectomies, and their associated costs were calculated.

RESULTS: For a cohort population of 140,000, between 50 and 74 years of age, in 2006 to 2015, it is estimated that an average of 412 consultations, 463 colonoscopies and 174 polypectomies will be performed per 100,000 screen eligible population per year in biennial screening, and double in annual screening, reflecting an average of 8.7% or 17.6% increase annually in outpatient colonoscopies, respectively, compared with 2003. A mean of $285,000 or $562,000 per year would be required to support the extra consultation and endoscopic procedures generated by the biennial or annual screening.

CONCLUSION: Population-based fecal occult blood testing screening for CRC appears to be a manageable strategy if a modest increase in endoscopic resources is allocated.
Asthma Symptoms Do not Predict Spirometry
Authors: Cowie Robert L , Underwood Margot F , Field Stephen K
Published: March 2016

BACKGROUND: Asthma is a disease characterized by variable airflow obstruction, but the measurement of airflow is often omitted in the process of diagnosis and management of the disease.

OBJECTIVES: Features of asthma severity and control were examined to determine the extent to which objective measurements, including forced expiratory volume in 1 s and forced expiratory volume in 1 s/forced vital capacity, correlated with other manifestations of the disease.

METHODS: Subjects were a consecutive sample of patients with asthma attending a university‐based asthma clinic. All subjects underwent routine assessment using a standard questionnaire and spirometry.

RESULTS: A total of 500 subjects were included in the present study, and their assessment showed that neither symptoms nor history could predict or be predicted by their measurements of lung function.

CONCLUSION: Routine measurement of lung function should be performed on subjects with asthma if normal or near‐normal lung function is a desired component of asthma control.
Colonoscopy and Flexible Sigmoidoscopy Practice Patterns in Ontario: A Population-Based Study
Authors: Schultz Susan E , Vinden Chris , Rabeneck Linda
Published: March 2016

OBJECTIVE: To conduct a population-based study on the provision of large bowel endoscopic services in Ontario.

METHODS: Data from the following databases were analyzed: the Ontario Health Insurance Plan, the Institute for Clinical Evaluative Sciences Physicians Database and Statistics Canada. The flexible sigmoidoscopy and colonoscopy rates per 10,000 persons (50 to 74 years of age) by region between April 1, 2001, and March 31, 2002, were calculated, as well as the numbers and types of physicians who performed each procedure.

RESULTS: In 2001/2002, a total of 172,108 colonoscopies and 43,400 flexible sigmoidoscopies were performed in Ontario for all age groups. The colonoscopy rate was approximately five times that of flexible sigmoidoscopy; rates varied from 463.1 colonoscopies per 10,000 people in the north to 286.8 colonoscopies per 10,000 people in the east. Gastroenterologists in all regions tended to perform more procedures per physician, but because of the large number of general surgeons, the total number of procedures performed by each group was almost the same.

CONCLUSION: Population-based rates of colonoscopies and flexible sigmoidoscopies are low in Ontario, as are the procedure volumes of approximately one-quarter of physicians.
ESBL Genotypes in Fluoroquinolone‐Resistant and Fluoroquinolone‐Susceptible ESBL‐Producing Escherichia coli Urinary Isolates in Manitoba
Authors: Lagacé-Wiens Philippe RS , Nichol Kim A , Nicolle Lindsay E , DeCorby Mel R , McCracken Melissa , Alfa Michelle J , Mulvey Michael R , Zhanel George G
Published: March 2016

OBJECTIVE: Extended‐spectrum beta‐lactamase (ESBL)‐producing Escherichia coli are increasingly common in nosocomial and community settings. Furthermore, fluoroquinolone (FQ) and even multidrug resistance (MDR) appear to be associated with certain ESBL genotypes. The purpose of the present study was to determine which ESBL genotypes are associated with FQ and MDR in E coli urinary isolates in Manitoba.

METHODS: The authors determined the antimicrobial susceptibility, genetic similarity and ESBL genotype of 27 FQ‐resistant and seven FQ‐susceptible, ESBL‐producing urinary isolates submitted to the clinical microbiology laboratories of two teaching hospitals between October 2000 and April 2005. Susceptibilities to beta‐lactams, FQs, trimethoprim‐sulfamethoxazole (SXT), doxycycline (DOX), gentamicin (GM) and tigecycline were determined by microbroth dilution; pulsed‐field gel electrophoresis (PFGE) was used to determine genetic relatedness, and ESBL genotype was determined by polymerase chain reaction and sequencing.

RESULTS: Of 34 ESBL‐producing organisms, 27 (79.4%) were found to be ciprofloxacin (CIP) resistant, 27 (79.4%) were SXT resistant, eight (23.5%) were GM resistant and 29 (85.3%) were DOX resistant. Twenty‐three (67.6%) had MDR, with concomitant resistance to CIP and SXT; 16 had concomitant resistance to CIP, SXT and DOX; and seven (20.6%) had MDR, with concomitant resistance to CIP, SXT, DOX and GM. All isolates were susceptible to tigecycline. Of 27 FQ‐resistant ESBL‐producing organisms, seven (25.9%) were genotype CTX‐M‐14, 19 (70.4%) were genotype CTX‐M‐15 and one (3.7%) was genotype CTX‐M‐24. Among the seven FQ‐susceptible strains, three (42.8%) expressed SHV‐type enzymes, three (42.8%) expressed TEM‐type enzymes and one (14.3%) expressed CTX‐M‐9. CTX‐M‐15 was the most common MDR‐associated genotype. Of a total of 19 strains, 18 (94.7%) were resistant to FQs and SXT; 15 (78.9%) were resistant to FQs, SXT and DOX; and five (26.3%) were resistant to FQs, SXT, DOX and GM. PFGE analysis revealed genetic similarity within CTX‐M‐15‐producing isolates only.

CONCLUSION: CTX‐M‐15 in E coli is strongly associated with an MDR phenotype compared with other genotypes. CTX‐M‐14 is associated with FQ resistance only. PFGE suggests clonality of CTX‐M‐15‐producing isolates within and among hospitals.