bluuebunny/crossref_metadata_2025 huggingface dataset:
Work‐Related Respiratory Disorders in Persons Employed in Quebec Cotton Textile Mills – 1980 to 1995
Authors: Bégin Raymond , Desmeules Marc , Gauthier Jean-Jacques , Ostiguy Gaston
Published: March 2016

Byssinosis, a chronic lung disease of cotton mill workers, is characterized by repeated episodes of reversible airway obstruction, which can lead to permanent alterations of lung function. When this occurs in Quebec the worker must be removed from further exposure in accordance with the provincial compensation rules. The current Quebec Occupational Safety and Health Regulation has a permissible exposure limit of 500 μg/m3, resulting in a prevalence rate of byssinosis of 2% to 5% in cotton workers. In this study the incidence of new respiratory disorders in persons employed in Quebec cotton mills from 1980 to 1995 was assessed and factors that identified byssinosis cases were analyzed. Incidence of the disease was assessed on the basis of cases referred to the Commission de Santé & Sécurité au travail du Québec (Quebec Workers’ Compensation Board) from all Quebec textile plants. Analyses of age, years of employment, job description, smoking history, bronchial reactivity and lung function before and at work were used for diagnostic purposes. Incidence of new byssinosis cases from 1990 to 1995 was 2.8 cases per year per 5000 workers, slightly above the incidence from 1980 to 1989, at 1.7 cases per year. The incidence of chronic cases was stable at 1.5 cases per year, whereas that of early cases increased from 0.3 cases per year (1980 to 1989) to 1.25 cases per year (1990 to 1995). In comparison with chronic byssinosis cases, the average time of work before symptom appearance was 17±4 versus 32±1 years, P<0.001. Bronchial reactivity to methacholine (PC20) at work was below 2 mg/mL in 100% of byssinosis cases versus 14% in subjects not diagnosed with byssinosis. Decreases in forced expiratory volume in 1 s (FEV1) at work averaged 30% in the byssinosis and 6% in the nonbyssinosis subjects; peak flow rates were not different between those with and those without byssinosis. Early byssinosis cases were from three distinct plants in different townships, and 45% of cases worked in cardroom occupations. PC20 equal to or less than 2 mg/mL at work was strongly associated with the decrease in FEV1 during a work shift. In conclusion, current cotton processing work in Quebec is associated with a significant incidence of byssinosis. PC20 of 2 mg/mL or less at work was closely associated with airflow limitation at work.
Polymerase Chain Reaction‐And Rna Hybridization‐Based Method for the Investigation of Deep‐Seated Candidiasis
Authors: Couroux Peter R , Hussain Zafar , Rutledge Frank , Lannigan Robert , Ralph Edward D , Nancekivell Barbara , Austin Thomas W
Published: March 2016

OBJECTIVE: To determine the usefulness of a polymerase chain reaction (PCR) and RNA hybridization method for the diagnosis of invasive candidiasis and to compare its sensitivity with blood cultures.

DESIGN: Blood cultures and a blood sample for PCR were taken from patients with suspected invasive candidiasis. A 105 base pair conserved segment within the rDNA of Candida species was amplified. The amplicon was detected by hybridization and gel electrophoresis.

SETTING: Intensive care units of two tertiary care hospitals.

PATIENTS: One hundred and eighteen patients 16 years of age or older with four more risk factors for invasive candidiasis were enrolled. Present or recent past treatment with broad spectrum antibiotics, cancer chemotherapy, immunosuppressive drugs, granulocytopenia or granulocytosis, intravascular catheterization, tracheal intubation, recent abdominal surgery and parenteral nutrition were considered risk factors.

RESULTS: Forty‐three patients had invasive candidiasis. PCR detected infections in 28 and 26 patients (sensitivity 65.1% and 60.4%) by hybridization and gel electrophoresis, respectively. The sensitivity of blood cultures was 58.1%. Of 25 patients with positive blood cultures, 17 were positive by PCR with the hybridization method. Eleven patients with invasive candidiasis had negative blood cultures but were positive by PCR.

CONCLUSION: PCR, especially with a hybridization detection method, is more sensitive than blood culture for invasive candidiasis and may facilitate the diagnosis of nonfungemic disease.
Pseudomonas Aeruginosa and Cystic Fibrosis: Antibiotic Therapy and the Science behind the Magic
Authors: MacDonald Noni E
Published: March 2016

Respiratory failure secondary to chronic bronchiectasis is the cause of death in more than 90% of patients with cystic fibrosis (CF). The predominant microbes involved in CF lung disease are unusual: Pseudomonas aeruginosa, Staphylococcus aureus and Burkolderia cepacia. While antimicrobial therapy has been a component of CF care programs for decades, randomized controlled studies in the 1980s and early 1990s failed to show consistent measurable benefit. Research that stemmed from the discovery of the CF gene has shed new light on the inter‐relationship of these microbes and the respiratory epithelial lung changes secondary to the CF gene. Five mechanisms have been proposed to explain the increased P aeruginosa colonization of the lower airway in CF. Recent research has also shown that antimicrobial therapy in CF may be effective not through eradication of the organism but by decreasing bacterial density and exoproduct production in the lung and thus decreasing inflammatory stimulus; by protecting against the consequences of an overexhuberant host response and in patients with stop mutations, potentially by correcting the gene defect. This tale of misunderstanding of the role and value of antimicrobial therapy in CF care illustrates the importance of ensuring close communiation between clinicians and researchers. The randomized controlled studies of the 1980s were not designed to answer the ‘right’ questions. The clinicians’ observations that the CF patients did improve with antimicrobial therapy have been validated by recent studies using different endpoints.
Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1
Authors: Holton Donna , Paton Shirley , Gibson Helen , Taylor Geoffrey , Whyman Carol , Yang TC
Published: March 2016

OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.

DESIGN: Retrospective questionnaire.

PARTICIPANTS: All members of the Community and Hospital Infection Control Association‐Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.

OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.

RESULTS: Questionnaires were received from 319 hospitals. Ninety‐nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty‐one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.

CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.
Primary Pulmonary Hypertension and Human Immunodeficiency Virus Infection
Authors: Conly J , Hilsden R , Deneer H , Etches I , Moyana T
Published: March 2016

This report details the case of a 42‐year‐old homosexual Caucasian male with infection due to human immunodeficiency virus type 1 (HIV‐1) who presented with a four‐month history of progressive dyspnea and was found to have clinical and hemodynamic evidence of severe pulmonary hypertension. He had had no opportunistic infections, and had a T helper lymphocyte count of 200×106/L. Extensive clinical laboratory and radiological evaluations revealed no underlying cause. Microscopic examination of postmortem lung tissue revealed findings consistent with grade V pulmonary hypertension. Electron microscopic analysis and polyermase chain reaction detection of HIV‐DNA from dissected pulmonary arterioles failed to provide any supportive evidence to suggest productive infection of the pulmonary arteriolar endothelial cells by HIV‐1. Although HIV‐1 likely plays a role in the pathogenesis of primary pulmonary hypertension, evidence for direct infection of pulmonary vessel endothelium was lacking in this case. The pathogenesis of primary pulmonary hypertension associated with HIV remains obscure.
Cost Effectiveness Analysis of Azithromycin and Doxycycline for Chlamydia Trachomatis Infection in Women: A Canadian Perspective
Authors: Marra Fawziah , Marra Carlo A , Patrick David M
Published: March 2016

OBJECTIVE: To assess the cost effectiveness of azithromycin versus doxycycline therapy for cervical Chlamydia trachomatis infections in Canada.

DESIGN: A predictive decision analytic model using previously published clinical and economic evaluations, expert opinion and costs of medical care in Canada.

POPULATION: A hypothetical cohort of 5000 women followed over 10 years.

INTERVENTIONS: Two diagnostic strategies were compared, laboratory confirmed diagnosis (LCD) and presumptive diagnosis (PD) of C trachomatis infection. Under each strategy, two treatment alternatives were analyzed, a single 1 g dose of azithromycin and a seven‐day course of doxycycline as 100 mg twice daily.

RESULTS: Despite a fourfold higher acquisition cost, under base case conditions, for both diagnostic strategies, the azithromycin treatment alternative was more cost effective than the doxycycline alternative. For the LCD model, the cost per cure for patients receiving azithromycin was $184.76 compared with $240.59 for patients receiving doxycycline, resulting in an incremental cost of $55.83. For the PD model, the cost per cure for patients treated with azithromycin was $51.48 compared with $51.82, resulting in an incremental cost of $0.34. For the hypothetical cohort of 5000 women, the use of azithromycin translates into a projected annual cost savings of $279,150 and $1,700 for the LCD and PD models, respectively. In one‐way sensitivity analyses for the LCD model, no clinically plausible changes in the base case estimates changed the results of the cost effectiveness outcome. In the PD model, clinically plausible changes in the probabilities of doxycycline cure, pelvic inflammatory disease, sequelae and chlamydia infection were found to alter the cost effectiveness outcome.

CONCLUSIONS: Based on the results from our model, the azithromycin strategy should be employed for the treatment of laboratory confirmed cases. However, for presumptive cases, azithromycin should be used only if the probabilities of C trachomatis and pelvic inflammatory disease are more than 19%, doxycycline effectiveness is less than 78%, or the cost of azithromycin is less than $19.00.
The Ozone Layer and Metered Dose Inhalers
Authors: Boulet Louis-Philippe
Published: March 2016

The stratospheric ozone layer plays a crucial role in protecting living organisms against ultraviolet radiation. Chlorofluorocarbons (CFC) contained in metered‐dose inhalers (MDIs) contribute to ozone depletion and in accordance with the Montreal Protocol on Substances That Deplete the Ozone Layer established 10 years ago, phase‐out strageies have been developed worldwide for this category of agents. Alternatives to CFC‐containing inhalers have been developed, such as powder inhalers and those using hydrofluoroalkanes (HFAs) as propellants, which have been shown to be as safe and effective as CFC‐containing inhalers and even offer interesting advantages over older inhalers. The transition to non‐CFC MDIs requires a major effort to make the new products available and to ensure adequate comparision with the previous ones. It also requires a harmonization of actions taken by industry, government, licencing bodies and patients or health professional associations to ensure adequate information and education to the public and respiratory care providers.
Vocal Cord Paralysis and Respiratory Muscle Weakness: An Unusual Presentation of Chronic Polyneuropathy
Authors: Chau LKL , Webb KA , Jackson AC , O′Donnell DE
Published: March 2016

A case of chronic polyneuropathy that manifested with an unusual combination of vocal cord paralysis and respiratory muscle weakness is reported. In addition, results of an exercise test carried out to assess the severity and mechanisms of exertional breathlessness in this unique condition with combined obstructive and restrictive disorders are described.
Current Indications for the Use of Clindamycin: A Critical Review
Authors: Smieja Marek
Published: March 2016

OBJECTIVES: To review the literature and develop evidence‐based guidelines for the use of the antibiotic clindamycin.

DATA SOURCES: A search of the MEDLINE database for randomized clinical trials, cohort studies and review articles that examine the therapeutic use or potential adverse effects of clindamycin was undertaken for the years 1966 to 1996. In addition, relevant citations obtained from the references cited in the identified reviews, book chapters and antibiotic guidelines were included.

DATA EXTRACTION: Selected articles examining the indications for or adverse effects from the prophylactic or therapeutic use of clindamycin were selected. A level of evidence was assigned to the indication according to published criteria.

DATA SYNTHESIS AND CONCLUSIONS: Randomized clinical trials (level 1 evidence) support the use of clindamycin in a number of common conditions, including preoperative prophylaxis, intra‐abdominal infections, recurrent group A streptococcal pharyngitis, Chlamydia trachomatis cervicitis and anaerobic lung infections. Cohort studies (level 2 evidence) support the use of clindamycin for bone and soft tissue infections. Expert opinion (level 3 evidence) supports the use of clindamycin for invasive group A streptococcal infection and the treatment of diabetic foot infections. Clindamycin’s disadvantages are its high cost, the common occurrence of rash and the predisposition of patients taking clindamycin to Clostridium difficile‐associated colitis. Based on cohort studies, the risk of severe diarrhea in out‐patients is as low as one per 1000, but the risk of in‐patients acquiring C difficile colonization may be as high as 30%.
Dead Space Ventilation Parallels Changes in Scintigraphic Vascular Obstruction at Recurrence of Pulmonary Embolism and after Thrombolytic Therapy: A Case Report
Authors: Rodger Marc A , Jones Gwynne , Raymond Francois , Lalonde Daniel , Proulx Mike , Huebsch Lothar , Bredeson Christopher
Published: March 2016

Physiological and alveolar dead space ventilation both increase in pulmonary embolism (PE) in proportion to the severity of vascular obstruction. The case of a patient with recurrent PE while on heparin therapy is presented. The recurrence was characterized clinically by severe pulmonary vascular obstruction and right heart dysfunction. The patient was treated with thrombolytic therapy, with excellent clinical and scintigraphic resolution. Dead space ventilation measurements at baseline, at the time of recurrence and after thrombolytic therapy are presented. The potential utility of dead space ventilation measurements for PE diagnosis and management are discussed.
Inhaled Drug Delivery: A Practical Guide to Prescribing Inhaler Devices
Authors: Ernst Pierre
Published: March 2016

Direct delivery of medication to the target organ results in a high ratio of local to systemic bioavailability and has made aerosol delivery of respiratory medication the route of choice for the treatment of obstructive lung diseases. The most commonly prescribed device is the pressurized metered dose inhaler (pMDI); its major drawback is the requirement that inspiration and actuation of the device be well coordinated. Other requirements for effective drug delivery include an optimal inspiratory flow, a full inspiration from functional residual capacity and a breath hold of at least 6 s. Available pMDIs are to be gradually phased out due to their use of atmospheric ozone‐depleting chlorofluorocarbons (CFCs) as propellants. Newer pMDI devices using non‐CFC propellants are available; preliminary experience suggests these devices greatly increase systemic bioavailability of inhaled corticosteroids. The newer multidose dry powder inhalation devices (DPIs) are breath actuated, thus facilitating coordination with inspiration, and contain fewer ingredients. Furthermore, drug delivery is adequate even at low inspired flows, making their use appropriate in almost all situations. Equivalence of dosing among different devices for inhaled corticosteroids will remain imprecise, requiring the physician to adjust the dose of medication to the lowest dose that provides adequate control of asthma. Asthma education will be needed to instruct patients on the effective use of the numerous inhalation devices available.
Imipenem and Meropenem: Comparison of In Vitro Activity, Pharmacokinetics, Clinical Trials and Adverse Effects
Authors: Zhanel George G , Simor Andrew E , Vercaigne Lavern , Mandell Lionell , the Canadian Carbapenem Discussion Group
Published: March 2016

OBJECTIVE: To compare and contrast imipenem and meropenem in terms of in vitro activity, pharmacokinetics, clinical efficacy and adverse effects.

DATA SELECTION: MEDLINE search from 1975 to 1997 and follow‐up of references.

DATA EXTRACTION: Clinical trials comparing imipenem with meropenem, or either imipenem or meropenem with standard therapy in the treatment of serious infections were selected.

DATA SYNTHESIS: Imipenem, the first carbapenem, was first marketed in 1987; meropenem was introduced to the market in 1996. In general, imipenem is more active against Gram‐positive cocci while meropenem is more active against Gram‐negative bacilli. The agents display similar pharmacokinetics. Clinical studies in patients with serious infections (intra‐abdominal infection, respiratory infection, septicemia, febrile neutropenia) report similar bacteriological and clinical cure rates with imipenem and meropenem. Meropenem is approved for the treatment of bacterial meningitis, whereas imipenem is not. Adverse effects are similar.

CONCLUSIONS: Current literature supports the use of imipenem at a dose of 500 mg every 6 h and meropenem at 1 g every 8 h for the treatment of severe infections. For the treatment of serious infections, imipenem (500 mg every 6 h or 2 g/day [$98/day]) is more economical than meropenem (1 g every 8 h or 3 g/day [$142/day]) based on acquisition cost.
Pulmonary Disease due to Mycobacterium malmoense in British Columbia
Authors: Al-Moamary Mohamed S , Black William , Elwood Kevin
Published: March 2016

Mycobacterium malmoense was first described in northern Europe and the United Kingdom in 1977. Since then, reports have appeared with increasing frequency. Cases have, however, rarely been reported from the United States, and, until now, none have been reported in Canada. This may reflect either true low prevalence of the disease or underdiagnosis by laboratories due to slow growth of the organism. This report describes a case of pulmonary disease caused by M malmoense in a 44‐year‐old man from British Columbia who was successfully treated with an 18‐month course of conventional antituberculous drugs combined with a macrolide. This is the first report of this disease in British Columbia and, to our knowledge, in Canada.
Recurrence of Intravenous Talc Granulomatosis following Single Lung Transplantation
Authors: Cook Richard C , Fradet Guy , English John C , Soos John , Müller Nestor L , Connolly Thomas P , Levy Robert D
Published: March 2016

Advanced pulmonary disease is an unusual consequence of the intravenous injection of oral medications, usually developing over a period of several years. A number of patients with this condition have undergone lung transplantation for respiratory failure. However, a history of drug abuse is often considered to be a contraindication to transplantation in the context of limited donor resources. A patient with pulmonary talc granulomatosis secondary to intravenous methylphenidate injection who underwent successful lung transplantation and subsequently presented with recurrence of the underlying disease in the transplanted lung 18 months after transplantation is reported.
A Cross‐Canada Survey of Cytomegalovirus Prevention and Treatment Practices in Bone Marrow Transplant Recipients
Authors: Humar Atul , Lipton Jeff , Messner Hans , McGeer Allison , Mazzulli Tony
Published: March 2016

OBJECTIVE: To gather information about cytomegalovirus (CMV) prevention and treatment practices in bone marrow transplantation (BMT) in Canada.

DESIGN: A questionnaire was mailed to all centres across Canada performing BMT in January 1998. A second mailing was sent three months later.

POPULATION STUDIED: Data on 15 centres performing allogeneic BMT (total patients 459) and 16 centres (total patients 703) performing autologous BMT were obtained.

RESULTS: For allogeneic BMT, all donors and recipients had pretransplant CMV serology performed. Nine centres gave CMV‐negative blood to only donor‐negative/recipient‐negative patients, four centres to all patients and two centres to other subgroups. All allogeneic BMT centres had a strategy for CMV prevention. Three centres used universal ganciclovir prophylaxis, while 12 centres used some form of pre‐emptive ganciclovir therapy based on weekly antigenemia assays (four centres), weekly polymerase chain reaction (two centres), CMV blood cultures (one centre), CMV throat and urine cultures (one centre), CMV screening bronchoscopy (two centres), or a combination of antigenemia plus bronchoscopy (two centres). The dose and duration of pre‐emptive ganciclovir varied considerably from centre to centre. In addition, many centres used high dose acyclovir universally for a variable period of time post‐BMT. For the treatment of CMV pneumonia, 14 centres used ganciclovir plus immunoglobulin (IG) and one centre used ganciclovir alone. Ganciclovir treatment duration ranged from two to 11 weeks and the number of doses of IG from three to 18. Thirteen of 16 autologous BMT centres screened patients for CMV pretransplant. Ten centres used CMV negative blood for some or all of their patients. Only one centre performed routine CMV monitoring after autologous BMT.

CONCLUSIONS: Practices for the prevention of CMV disease in BMT patients differ widely across centres, and further data may assist in developing a consensus regarding the optimal approach to CMV management.
Severe Exertional Dyspnea in a Patient with Localized Emphysema
Authors: Giustino Giuseppe , Webb Katherine A , Sutherland Kenneth B , O’Donnell Denis E
Published: March 2016

The case of a middle‐aged, male smoker who presented with progressive severe dyspnea is described. The cause of the progressive severe dyspnea remained unexplained after a comprehensive history, physical examination, chest radiograph, electrocardiogram and spirometry. Subsequent investigations resulted in a diagnosis of localized pulmonary emphysema. Detailed exercise testing helped uncover the physiological basis of the patient’s extreme dyspnea.
Gene Therapy for HIV Infections: Intracellular Immunization
Authors: Piché Alain
Published: March 2016

Despite significant advances in the treatment of human immunodeficiency virus (HIV) infection in the past 10 years, it remains an incurable disease. The inability of traditional drug‐based therapies to inhibit HIV replication effectively for extended periods of time has stimulated intense research to develop novel approaches for this disease. Current understanding of HIV molecular biology and pathogenesis has opened the way for the development of gene therapy strategies for HIV infections. In this context, a number of intracellular immunization‐based strategies have been evaluated, and some of them have reached the stage of phase I/II human clinical trials. These strategies include the use of single‐chain antibodies, capsid‐targeted viral inactivation, transdominant negative mutants, ribozymes, antisense oligonucleotides and RNA decoys. While a number of issues remain to be studied before intracellular immunization can be applied to the treatment of HIV infections, the significant progress already made in this field is likely to lead to clinical applications.
Tuberculosis, the Canadian Lung Association/Canadian Thoracic Society and the New Millennium
Authors: Long Richard
Published: March 2016

The Canadian Association for the Prevention of Consumption and Other Forms of Tuberculosis, parent to both the Canadian Tuberculosis Association and the Canadian Lung Association (CLA) with its medical arm, the Canadian Thoracic Society (CTS), carried the Cross of Lorraine (Figure 1) and the crusade against tuberculosis (TB) in Canada during the twentieth century. For these societies, the battle was joined long before government ‐ public health and communicable disease control ‐ took up the cause. Allied or unallied with government, these societies were party to no small measure of success. TB mortality was 165/100,000 people in 1908; TB morbidity was just under seven/100,000 people in 1999. Yet, continued success is stalled; the incidence of TB in Canada has not changed for 15 years, and globally, TB is undergoing an unprecedented resurgence. Why is this so, and what of the role of the CLA and CTS in the fight against TB in the new millennium?
Use of Antiviral Prophylaxis in Influenza Outbreaks in Long Term Care Facilities
Authors: McGeer Allison , Sitar Daniel S , Tamblyn Susan E , Kolbe Faron , Orr Pamela , Aoki Fred Y
Published: March 2016

Influenza is a major cause of illness and death in residents of long term care facilities for the elderly, in part because residents′ age and underlying illness increase the risk of serious complications, and in part because institutional living increases the risk of influenza outbreaks. The administration of antiviral medications active against influenza to persons exposed to influenza has been shown to protect them effectively from illness, and mass antiviral prophylaxis of residents is an effective means of terminating influenza A outbreaks in long term care facilities. The only antiviral currently licensed in Canada for influenza prophylaxis is amantadine, a medication active against influenza A but not influenza B. The National Advisory Committee on Immunization recommends that amantadine prophylaxis be offered to residents when influenza A outbreaks occur in long term care facilities. However, there remain a number of unanswered questions about how best to use amantadine for controlling influenza A outbreaks in long term care facilities. In addition, two members of a new class of antivirals called neuraminidase inhibitors have recently been licensed in Canada for the treatment of influenza, and are effective in prophylaxis. Issues in the use of amantadine in the control of outbreaks of influenza A in long term care facilities for the elderly are reviewed, and the potential uses of neuraminidase inhibitors in this setting are discussed.
Exogenous Lipid Pneumonia Related to Smoking Weed Oil Following Cadaveric Renal Transplantation
Authors: Vethanayagam Dilini , Pugsley Stewart , Dunn EJ , Russell David , Kay J Michael , Allen Christopher
Published: March 2016

A 30‐year‐old female presented shortly after cadaveric renal transplantation with respiratory distress typical of a bacterial infection. Following initial improvement, she developed progressive respiratory failure, initially felt to be secondary to cytomegalovirus infection. Two bronchoalveolar lavages were nondiagnostic, and an open lung biopsy was performed, which revealed a pulmonary alveolar proteinosis (PAP) reaction and exogenous lipid pneumonia (ELP). The ELP was considered to be secondary to the use of marijuana, in the form of weed oil, that was smoked daily for over 10 years and stopped just before renal transplantation. This is the first description of both PAP and ELP following renal transplantation, and the first description of ELP related to smoking weed oil. Physicians should be aware of the different forms of marijuana available and of their potential medical complications.
Persistently HIV‐1 Seronegative Nairobi Sex Workers Are Susceptible to In Vitro Infection
Authors: Bienzle Dorothee , MacDonald Kelly S , Copeland Karen FT , Bwayo Job J , Plummer Francis A , Rosenthal Kenneth L
Published: March 2016

OBJECTIVE: To evaluate whether resistance to HIV‐1 infection in a subset of highly exposed sex workers correlates with resistance at the cellular level.

DESIGN: In vitro evaluation of susceptibility to infection by Kenyan HIV‐1 isolates and cellular production of potential mediators of resistance.

SETTING: Samples were collected in a primary care clinic in Nairobi.

PATIENTS: Thirteen individuals from a cohort of sex workers with a similar risk of acquiring HIV infection and six unexposed controls.

INTERVENTIONS: Subjects were provided with appropriate primary care and counselling on the prevention of sexually transmitted diseases.

RESULTS: No inherent cellular resistance to infection was identified. CD8+ cells from a subset of subjects strongly inhibited viral replication.

CONCLUSIONS: Lack of infection in this cohort was not attributable to factors inherent to CD4+ cells. Resistance to HIV infection is likely to be multifactorial, and products of CD8+ cells and unique features of mucosal sites probably contribute to this state.
2000 — A Pivotal Year for the CTS
Authors: Boulet Louis-Philippe
Published: March 2016

The year 2000 is becoming a pivotal one for the Canadian Thoracic Society (CTS), not only because of the joint annual meeting with the American Thoracic Society for the first time in many years or the beginning of new Canadian Institutes for Health Research (CIHR) activities, but also because of many other initiatives. I will briefly review some of those activities in the next few paragraphs.
Number 1: Chronic Obstructive Pulmonary Disease
Authors: Jones Norman L
Published: March 2016

With the editorial staff of the Canadian Respiratory Journal, I extend our best wishes for the New Year, and heartfelt thanks to everyone who has helped the Journal establish itself in the competitive field of quality, peerreviewed publications in chest medicine. It may seem odd to start the new millennium with an editorial eulogizing the past, but even in these "postmodern" days of chaos, complexity and ordered unpredictability, the past can be seen to have a huge influence on the present and the future. The importance of looking back on work that has influenced our present views on chest medicine, and why, was the main reason for the series inaugurated in the present issue ‐ "Modern Classics Revisited" (pages 71‐76).
Inspiratroy Capacity and Exercise Tolerance in Chronic Obstructive Pulmonary Disease
Authors: Milic-Emili Joseph
Published: March 2016

During the past half‐century, many studies have investigated the correlation of exercise tolerance to routine lung function in patients with obstructive pulmonary disease. In virtually all of these studies, the degree of airway obstruction was assessed in terms of forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). Because in most studies only a weak correlation was found between exercise tolerance and degree of airway obstruction, it has been concluded that factors other than lung function impairment (eg, deconditioning and peripheral muscle dysfunction) play a predominant role in limiting exercise capacity in patients with chronic airway obstruction. Recent work, however, suggests that in patients with chronic obstructive pulmonary disease, the inspiratory capacity is a more powerful predictor of exercise tolerance than FEV1 and FVC.
Tuberculosis among Aboriginal and Nonaboriginal Persons in British Columbia
Authors: Wang L , Noertjojo K , Elwood RK , FitzGerald J Mark
Published: March 2016

OBJECTIVE: To compare cases of tuberculosis (TB) diagnosed among aboriginal persons with a random sample of nonaboriginal persons diagnosed with TB, and evaluate the trends in rates of disease between both groups during the same period.

DESIGN: A case‐control study.

SETTING: A provincial TB control program.

PATIENTS AND METHODS: All patients with TB diagnosed among aboriginal persons in British Columbia between 1992 and 1996 were compared with control patients diagnosed during the same period. For each patient a control patient was identified.

INTERVENTION: The demographic details, type of disease, bacteriology, risk factors for TB, therapy received as well as mode of administration were documented. The number of contacts identified for each patient as well as the number of patients completing chemoprophylaxis were identified. The rates of disease during the same period were also documented.

RESULTS: During the study, 202 patients with TB were diagnosed among aboriginal persons and 201 controls were chosen. Apart from age at diagnosis (35.1±20 years versus 45.7±19.7), differences in the prevalence of lymphadenopathy (5.9% versus 16.4%, P=0.0008) and pleural disease (21.3% versus 16.4%, P=0.00008), there were no differences in presentation between aboriginal and nonaboriginal people. Aboriginal people were more likely to have a  history of contact with a patient with TB (53% versus 17.9%, PÃ0.05), to have received directly observed therapy (55% versus 33.8%, P=0.00002) and to have contacts who were purified protein derivative (PPD) positive (4±9 versus 2±3, P=0.002). These contacts were more likely to start isoniazid (2±3 versus 1±1, P=0.002). Overall, there was a significant decline in rates of TB among aboriginal persons compared with the general population, but there was a small increase in rates among all subjects in the final year of the study.

CONCLUSIONS: In the present study, significant variations in rates of TB among different population groups in British Columbia were found. During the study period, there was a greater decline in the rates of TB among aboriginal persons. A greater use of directly observed therapy and greater use of chemoprophylaxis occurred among aboriginal persons, which may have contributed to this decline, or alternatively, it simply reflects the natural evolution of the TB epidemic.
Difficult Asthma: Consider All of the Possibilities
Authors: Cicutto Lisa C , Chapman Kenneth R , Chamberlain Dean , Downey Gregory P
Published: March 2016

Asthma is a common respiratory disease that can often be managed successfully. However, there are patients that do not respond to the maximum doses of standard therapy and subsequently have a reduced quality of life. Many factors can contribute to a failure to respond to treatment, and a comprehensive approach is important when assessing and evaluating these patients. This report describes a patient referred for 'difficult to control asthma' who had multiple emergency department visits and hospitalizations. In addition to a history of wheezing, spirometry showed impaired flow and vital capacity was reduced. Further investigation showed a normal total lung capacity, and a computed tomography scan revealed main bronchus blockage by a tumour, which was confirmed by bronchoscopy. This led to a surgical resection of a mucoepidermoid carcinoma. This case highlights the need to consider all possibilities during the evaluation of patients with difficult asthma.
Nevirapine Use to Reduce Mother‐To‐Child Transmission of HIV in Canada
Authors: Committee for Canadian Paediatric AIDS Research Group
Published: March 2016

Nevirapine (NVP) is a non‐nucleoside reverse transcriptase inhibitor (NNRTI) that is used to treat adults and children with human immunodeficiency virus (HIV) infection. The drug was licensed in Canada in September 1998 and has been widely used in combination antiretroviral therapy regimens, usually along with two nucleoside reverse transcriptase inhibitors. NVP is, generally, well tolerated; however, up to 20% of patients may develop rash, with a severe rash occurring in 6% of patients and Stevens‐Johnson syndrome reported in 0.5% of patients. A large number of NNRTI mutations have been documented, and a single mutation, K103N, confers a degree of broad NNRTI resistance. Distinctions occur in resistance patterns to different NNRTIs (1).
Burden of Chickenpox on Families: A Study in Quebec
Authors: De Wals Philippe , Blackburn Manon , Guay Maryse , Bravo Gina , Blanchette Danièle , Douville-Fradet Monique
Published: March 2016

OBJECTIVE: To estimate the nonhospital costs of treating chickenpox and to ascertain the opinion of parents regarding the usefulness of vaccination. DESIGN: Retrospective postal survey. SETTING: Province of Quebec. PARTICIPANTS: Random sample of 3333 families with children aged six months to 12 years. OUTCOME MEASURES: For cases of chickenpox that occurred between September 1, 1997 and August 31, 1998, the use of health services, time away from school or work, patient care required, direct and indirect costs for the families and the health care system, and the opinion of parents regarding chickenpox and the vaccine were evaluated. RESULTS: The response rate was 64.7%, and 18.8% of households reported a history of chickenpox, a total of 693 cases. A physician was consulted in 45.8% of these cases, and medication was used in 91.7%. The frequency of hospitalizations was 0.6%. Time away from work or school caused by the disease was 4.1 days on average, with 46.5% of absences being attributed to the risk of contagion. The total average cost of a case of chickenpox was $225. Direct expenses for households accounted for 11% of the total cost, public sector direct costs 7%, indirect costs related to absence from work 38% and caregiving time 45%. A majority of parents (70%) were in favour of a systematic childhood immunization program. CONCLUSIONS: Chickenpox without complications is disruptive for families, but the direct costs for families and the public sector are relatively small.
The Impact of Nationally Coordinated Pharmacy‐Based Asthma Education Intervention
Authors: Diamond Shelley Anne , Chapman Kenneth Ross
Published: March 2016

OBJECTIVE: To assess the impact of a nationally coordinated pharmacy‐based educational intervention on self‐management behaviour and markers of asthma control in self‐referred patients with asthma.

DESIGN: An asthma clinic day was set up by a national chain of community pharmacies whereby pharmacists used a structured questionnaire to assess asthma control and self‐care among self‐referred patients with doctor‐diagnosed asthma. In a one‐on‐one counselling session, each patient′s educational needs were identified and the appropriate education offered. A telephone follow‐up 30 days later assessed the impact of teaching.

SETTING: Community pharmacies across Canada.

OUTCOME MEASURES: The follow‐up questionnaire quantified the number of wheezing episodes or other symptoms per week, the number of night‐time awakenings per week, and the frequency of use of reliever and preventive medications.

RESULTS: Of 4080 patients assessed, 22.2% used an inadequate inhaler technique, 16.4% used a short acting beta2‐agonist excessively and 21.0% were not using an inhaled corticosteroid daily despite a frequency of symptoms that would suggest that it was needed. Common educational interventions included a review of inhaler technique (41.9%), a recommendation for regular inhaled corticosteroids (31.5%) and a referral to the primary care physician (21.0%). Thirty days after the educational intervention, patients reported significant decreases in the frequency of daytime asthma symptoms, the frequency of nocturnal symptoms and the frequency with which short acting beta2‐agonists were used, while reporting significant increases in their use of preventive medication.

CONCLUSIONS: A brief assessment and an educational intervention in the community pharmacy can produce significant short term improvements in patient‐reported symptom control and appropriate self‐management behaviour.
Influence of Bulla Volume on Postbullectomy Outcome
Authors: Baldi S , Palla A , Mussi A , Falaschi F , Carrozzi L , Giuntini C , Angeletti CA
Published: March 2016

OBJECTIVE: To quantify the contribution of the resected volume and the presence of associated, functionally significant emphysema to the postoperative improvement of pulmonary function after resection of giant lung bullae.

DESIGN: Patients undergoing elective surgery for giant bullae who had had complete pulmonary function and radiographic studies performed were reviewed retrospectively.

SETTING: All 25 patients underwent surgery at the thoracic surgery unit of the University of Pisa, Pisa, Italy.

METHODS: Pulmonary function was assessed before and 12 months after surgery. On the chest radiograph, the location of bullae, and the signs of compression and emphysema were evaluated. The radiographic total lung capacity (TLCx-ray) and the volume of bullae were measured according to the ellipse method. Postoperatively, functional and radiographic changes were analyzed. The percentage change in forced expiratory volume in 1 s (deltaFEV1%) after surgery was the main outcome measure. The influence of factors related to emphysema and bulla volume on the functional improvement postbullectomy was assessed by stepwise multiple regression.

RESULTS: Before surgery, the TLCx-ray overestimated the TLC measured by nitrogen washout, with a mean difference between the two measurements of 1.095 L. A close relationship was found between the TLCx-ray and the plethysmographic TLC (n=6; r=0.95). After surgery, dyspnea lessened (P<0.05) and FEV1 increased (P<0.01). Statistically, the radiographic bulla volume was the single most important factor determining the deltaFEV1% (r=0.80, P<0.0001).

CONCLUSIONS: These findings suggest that the preoperative size of bullae is the most important contributor to the improvement in ventilatory capacity after bullectomy, and that it is possible to predict the expected increase of postoperative FEV1 from preoperative bulla volume.
The Use of Guidelines for the Empiric Treatment of Hospital‐Acquired Pneumonia
Authors: Miletin Michael S , Chan Charles K
Published: March 2016

BACKGROUND: Several practice guidelines for the empirical antimicrobial treatment of hospital‐acquired pneumonia (HAP) have been developed, but the acceptance and use of such guidelines are unknown.

OBJECTIVE: To assess physicians′ use of empirical HAP guidelines published by the American Thoracic Society (ATS) and by The University Health Network, Toronto, Ontario.

DESIGN: A retrospective assembly and chart review.

SETTING: A university teaching hospital.

PATIENTS: One hundred fifteen consecutive patients who had been diagnosed with pneumonia more than 48 h after admission to hospital over a 10‐month period.

RESULTS: The charts of 115 patients were reviewed. Seventy‐five patients (65%) were treated empirically. Forty patients (35%) were treated based on microbiological data that were available before the initiation of antibiotics. Patients who received nonempirical treatment for HAP had a significantly greater acuity of illness than the empirically treated group. Thirty‐seven patients (49%) who received empirical therapy were treated according to either ATS or hospital guidelines for HAP. The use of guideline‐concordant antimicrobial therapy had no measurable effect on in‐hospital mortality (eight of 37 patients [21.6%] versus seven of 38 patients [18.4%], P=0.96) or median length of stay (19 days versus 21 days, P=0.30). Patients whose treatment did not follow guideline recommendations tended to receive appropriate antimicrobial coverage more often than did those patients whose treatment was guideline concordant (15 of 18 patients [83%] versus six of 11 patients [55%], P=0.49).

CONCLUSIONS: Institutional and ATS guidelines for the empirical treatment of HAP are less widely used than would be predicted by chance at The University Health Network. The clinical utility of these guidelines remains to be proven.
Cystic Angiomatosis of the Bone Appearing as Intrathoracic Lung Masses
Authors: Pulido-Zamudio Tomas , Orr William , Lertzman Morley
Published: March 2016

A rare case of cystic angiomatosis of the bone (CAB) manifesting as bilateral intrathoracic masses is described. In 1996, a 47-year-old woman was referred to the chest clinic at St Boniface Hospital for evaluation of chronic cough, and her chest radiograph showed large, bilateral pleural-based intrathoracic masses. Ten years before, she had been diagnosed with CAB following bone biopsies of her hip and knee. Computed tomography revealed two chest wall masses with internal septations of bone. CAB is a rare, multicentric disease characterized by involvement of the vascular and lymphatic systems, producing diffuse cystic lesions in the skeleton. Although the ribs are frequently involved, the presentation with intrathoracic masses is uncommon.
A Perspective on Biosolids Management
Authors: Apedaile Erik
Published: March 2016

Wastewater treatment has evolved into an important mechanism that used to protect public health from infectious disease. In the 1850s, water drawn from the Thames River below London′s sewage outfall was found to be a source of a cholera outbreak (1). As a result, ′sewage farms′ were established to treat and dispose of wastewater. Gradually, more effective technologies, which required less land, were developed to treat wastewater. The processes of primary and secondary biological treatment eventually eliminated the need for sewage farms in the early part of the past century.
Appearances Can Be Deceiving: What Is the Diagnosis for this Community‐Acquired Pneumonia?
Authors: Lin Frank YH , Rotstein Coleman
Published: March 2016

A and asbestos exposure (in the 1970s) presented to the emergency department with a one‐month history of progressive dyspnea, right‐sided pleuritic chest pain, cough productive of white‐coloured sputum and malaise. His health problems had commenced four months before presentation while he was vacationing at a northern Ontario resort. At that time, he had felt unwell and had developed a fever with rightsided pleuritic chest pain that radiated to his right shoulder. The diagnosis was an upper respiratory tract infection, made by the local physician; the patient was treated with a 10‐day course of cephalexin. Although his condition had initially improved after the antibiotic therapy, during the month before presentation he had experienced increasing fatigue, cough with clear sputum production and a loss of appetite. He also developed worsening right‐sided pleuritic chest pain that radiated to the right shoulder, dyspnea and orthopnea. He had no nausea, vomiting, diarrhea or hemoptysis. However, he had lost 4 kg and had drenching night sweats over the previous three and a half months. Further history revealed that he had drunk well water during his vacation in northern Ontario and that several families who were with him at that time also became ill, although he was not aware of the nature of their symptoms.