bluuebunny/crossref_metadata_2025 huggingface dataset:
Maintenance Treatment of Gastroesophageal Reflux Disease: An Evaluation of Continuous and On-Demand Therapy with Rabeprazole 20 mg
Authors: Morgan David G , O’Mahony Michael FJ , O’Mahony William F , Roy Jean , Camacho Fernando , Dinniwell Julie , Horbay GLA , Husein-Bhabha Farah A ,   for the RAB-GRD-3002 Study Group
Published: March 2016

OBJECTIVE: To evaluate continuous therapy (COT) and on-demand therapy (ODT) with rabeprazole 20 mg for maintenance in uninvestigated gastroesophageal reflux disease (GERD).

METHODS: This randomized, open-label study enrolled 331 GERD (heartburn-predominant) patients with a pre-existing proton pump inhibitor history of one month or longer, to an acute four-week trial with 20 mg rabeprazole daily for heartburn management. Patients who achieved satisfactory heartburn control during the acute phase (three days or less of heartburn, with no more than one episode rated as moderate, and heartburn rated satisfactorily or completely controlled with minimal rescue antacid use in the seven days preceding randomization) were randomly assigned to six months of rabeprazole 20 mg given as either daily COT or daily ODT, which was initiated upon symptom recurrence and stopped upon symptom resolution. Rescue antacid usage was permitted and tracked. Primary efficacy was measured as the proportion of heartburn-free days over six months.

RESULTS: For the 268 patients, the mean percentage of heartburn-free days for the COT group and for the ODT group were 90.3%±14.8% and 64.8%±22.3%, respectively (P<0.0001). COT was associated with an increased number of medication intake days (154±40.2) versus ODT (68±46.1), with less heartburn episodes observed with COT versus ODT, respectively (n=7, n=26, P<0.0001). Ninety-two per cent of COT patients and 79% of ODT patients were either ‘satisfied’ or ‘very satisfied’ with treatment. The mean usage of antacids was low and similar in both groups. COT and ODT regimens were safe and well-tolerated, with a similar incidence of adverse events.

CONCLUSION: Results based on symptom assessments favour COT with rabeprazole 20 mg for maintenance therapy in patients with uninvestigated GERD; however, both therapy types are safe and acceptable treatment options for selected patients.
Canadian Home Total Parenteral Nutrition Registry: Preliminary Data on the Patient Population
Authors: Raman Maitreyi , Gramlich Leah , Whittaker Scott , Allard Johane P
Published: March 2016

BACKGROUND: Long-term administration of home total parenteral nutrition (HTPN) has permitted patients with chronic intestinal failure to survive for prolonged periods of time. However, HTPN is associated with numerous complications, all of which increase morbidity and mortality. In Canada, a comprehensive review of the HTPN population has never been performed.

OBJECTIVES: To report on the demographics, current HTPN practice and related complications in the Canadian HTPN population.

METHODS: This was a cross-sectional study. Five HTPN programs in Canada participated. Patients’ data were entered by the programs’ TPN team into a Web site-based registry. A unique confidential record was created for each patient. Data were then downloaded into a Microsoft Excel (Microsoft Corp, USA) spreadsheet and imported into SPSS (SPSS Inc, USA) for statistical analysis.

RESULTS: One hundred fifty patients were entered into the registry (37.9% men and 62.1% women). The mean (± SD) age was 53.0±14 years and the duration requiring HTPN was 70.1±78.1 months. The mean body mass index before the onset of HTPN was 19.8±5.0 kg/m2. The primary indication for HTPN was short bowel syndrome (60%) secondary to Crohn’s disease (51.1%), followed by mesenteric ischemia (23.9%). Complications: over one year, 62.7% of patients were hospitalized at least once, with 44% of hospitalizations related to TPN. In addition, 28.6% of patients had at least one catheter sepsis (double-lumen more than single-lumen; P=0.025) and 50% had at least one catheter change. Abnormal liver enzymes were documented in 27.4% of patients and metabolic bone disease in 60% of patients, and the mean Karnofsky score was 63.

CONCLUSIONS: In the present population sample, the data suggest that HTPN is associated with significant complications and health care utilization. These results support the use of a Canadian HTPN registry to better define the HTPN population, and to monitor complications for quality assurance and future research.
Prevalence of Methicillin‐Resistant Staphylococcus aureus in a Canadian Inner‐City Shelter
Authors: Szakacs Tom A , Toye Baldwin , Turnbull Jeffrey M , Muckle Wendy , Roth Virginia R
Published: March 2016

BACKGROUND: Methicillin‐resistant Staphylococcus aureus (MRSA) colonization is increasingly of concern in community settings. However, despite a recent outbreak in Calgary, Alberta, data on the prevalence of MRSA in Canadian communities are lacking. Globally, few studies have been performed in high‐risk groups such as inner‐city populations.

METHODS: A cross‐sectional study of the prevalence of MRSA among residents and staff at three Ottawa, Ontario, shelters was conducted. All participants completed a questionnaire, and provided nasal swabs as well as one of rectal, anal or groin swabs.

RESULTS: Among 84 participants, the prevalence of MRSA colonization was 2.4%. Among the resident subgroup, the prevalence was 4.5%, while no MRSA isolates were found among 40 staff participants. All isolates were USA100 (CMRSA‐2) subtypes.

CONCLUSIONS: The prevalence of MRSA colonization among residents is higher than baseline population rates, but is consistent with other inner‐city populations. Although community outbreaks of USA300 and USA400 strains are increasingly reported, movement of nosocomial strains (ie, USA100 [CMRSA‐2]) into communities remains an important avenue in the spread of MRSA and underscores the importance of nosocomial MRSA control.
Serological Evidence of Hepatitis E Virus Infection in an Indigenous North American Population
Authors: Minuk GY , Sun A , Sun DF , Uhanova J , Nicolle LE , Larke B , Giulivi A
Published: March 2016

BACKGROUND: Hepatitis E virus (HEV) infections are thought to be uncommon in North America. Recently, HEV transmission has been reported following the consumption of deer meat. Because deer are closely related to caribou and caribou meat is a staple of the Canadian Inuit and the American Eskimo diet, the present study explored the seroprevalence of HEV infection in an isolated Canadian Inuit community.

METHODS: Stored sera were thawed and tested for immunoglobulin (Ig) G and IgM anti-HEV by ELISA, and tested for HEV-RNA by reverse transcriptase polymerase chain reaction.

RESULTS: The study consisted of 393 sera (representing approximately 50% of the community’s inhabitants). Eleven samples (3%) were IgG anti-HEV-positive. Their mean age was 29±8 years and three were male. Two of 11 (18%) were also IgM anti-HEV-positive. All IgG anti-HEV-positive individuals were HEV-RNA-negative. Liver biochemistry was normal in all. Seven of 11 (64%) were also positive for anti-hepatitis A virus, five (46%) were hepatitis B virus seropositive and none (0%) were positive for anti-hepatitis C virus. There were no associations between infections with HEV and other hepatropic viruses. Serological testing was negative for HEV infection in 25 caribou from an adjacent region.

CONCLUSION: The results of the present study showed that serological evidence of HEV infection was present in 3% of the observed Canadian Inuit population; the presence of IgM anti-HEV suggested recent infection and HEV did not appear to coinfect with other common hepatotropic viruses. The source of HEV infection in the population remains unclear. These findings are interesting but preliminary. Additional data are required to determine whether HEV infections are responsible for otherwise unexplained acute hepatitis in the Canadian Inuit population and visitors returning from northern North American communities.
Aspiration in the Context of Upper Gastrointestinal Endoscopy
Authors: Thomson A , Tye-Din J , Tonga S , Scott J , Mclaren C , Pavli P , Lomas F
Published: March 2016

BACKGROUND: Pulmonary aspiration is a life-threatening complication of upper gastrointestinal endoscopy, the incidence of which has not been determined. Endoscopy-related aspiration has not been studied in procedures in which patients swallow a radiolabelled potential aspirate immediately before endoscopy and undergo nuclear scanning postprocedure.

METHODS: A pilot study was conducted in which 200 MBq of non-absorbable technetium-99m phytate in 10 mL of water was administered orally to 50 patients who were about to undergo endoscopy. Gamma camera images were obtained to ensure that there had been no aspiration before endoscopy. After endoscopy, a repeat scan was performed. Fluid aspirated through the endoscope was also collected and analyzed for radioactivity using a hand-held radiation monitor.

RESULTS: No evidence of pulmonary aspiration was found in any of the patients studied. The mean estimated percentage of the initially administered radioactivity aspirated through the endoscope was 2.66% (range 0% to 10.3%).

CONCLUSION: The present pilot study confirms earlier observations that clinically significant aspiration in the context of upper gastrointestinal endoscopy is uncommon. The incidence of aspiration may, however, be different in acutely bleeding patients undergoing endoscopy. For logistic reasons, this group could not be studied.
Consumption of Pure Oats by Individuals with Celiac Disease: A Position Statement by the Canadian Celiac Association
Authors: Rashid Mohsin , Butzner Decker , Burrows Vernon , Zarkadas Marion , Case Shelley , Molloy Mavis , Warren Ralph , Pulido Olga , Switzer Connie
Published: March 2016

The treatment of celiac disease is a strict adherence to a gluten-free diet for life. In the past, oats were considered to be toxic to individuals with celiac disease and were not allowed in a gluten-free diet. However, recent evidence suggests that oats that are pure and uncontaminated with other gluten-containing grains, if taken in limited quantities, are safe for most individuals with celiac disease. For adults, up to 70 g (1/2 to 3/4 cup) of oats per day and for children, up to 25 g (1/4 cup) per day are safe to consume. These oats and oat products must fulfill the standards for a gluten-free diet set by the Canadian Food Inspection Agency and Health Canada. The Canadian Celiac Association, in consultation with Health Canada, Agriculture & Agri-Food Canada and the Canadian Food Inspection Agency, has established requirements for growing, processing, and purity testing and labelling of pure oats. These strategies have led to the production of pure, uncontaminated oats for the first time in Canada. Oats and oat products that are safe for consumption by individuals with celiac disease and dermatitis herpetiformis are now commercially available in Canada.
An Empirical Continuous Positive Airway Pressure Trial for Suspected Obstructive Sleep Apnea
Authors: Skomro Robert P , Cotton David J , Gjevre John A , Grover Vaneeta K , McNab Brian D , Reid John K , Ward Heather A
Published: March 2016

BACKGROUND: Standard practice in obstructive sleep apnea (OSA) management requires that a positive diagnostic, overnight polysomnography (PSG) test be obtained before initiating treatment. However, long waiting times due to lack of access to PSG testing facilities may delay the initiation of definitive treatment for OSA.

OBJECTIVES: To evaluate the response of patients who had a high clinical suspicion for OSA and who were waiting for a PSG test to an empirical continuous positive airway pressure (CPAP) trial.

METHODS: A retrospective study of all patients who had been offered empirical CPAP therapy for suspected OSA was conducted. After outpatient assessment, 183 patients with a high pretest probability of having OSA began empirical CPAP testing using an arbitrary CPAP pressure. The presence of OSA, the accuracy of empirical CPAP pressure prescription, the adherence to empirical CPAP and the improvement in daytime somnolence were evaluated at the time of PSG.

RESULTS: Of 183 patients on a CPAP trial, 91% had OSA, which was at least moderate (more than 15 apneas and hypopneas per hour of sleep) in 75% of the patients. Eighty per cent of the patients had significant daytime somnolence (Epworth Sleepiness Scale [ESS] greater than 10, mean ± SD ESS 14±5), which improved with CPAP (ESS 9.0±5, P<0.01). In 40% of the patients, the arbitrary CPAP pressure was lower than that determined by manual titration. Adherence to a trial of CPAP (longer than 2 h/night) predicted OSA with a sensitivity of 82% and a specificity of 41%; the positive and negative predictive values were 92% and 22%, respectively.

CONCLUSIONS: At the time of PSG testing, OSA was present in 91% of the patients who had received empirical CPAP. An empirical CPAP provided satisfactory interim treatment for excessive somnolence, despite the fact that the CPAP pressure was suboptimal in 40% of the patients.
Accidental Ingestion of 35% Hydrogen Peroxide
Authors: Pritchett Sean , Green Daniel , Rossos Peter
Published: March 2016

Hydrogen peroxide is a commonly used oxidizing agent with a variety of uses depending on its concentration. Ingestion of hydrogen peroxide is not an uncommon source of poisoning, and results in morbidity through three main mechanisms: direct caustic injury, oxygen gas formation and lipid peroxidation. A case of a 39-year-old man who inadvertently ingested 250 mL of unlabelled 35% hydrogen peroxide intended for natural health use is presented. Hydrogen peroxide has purported benefits ranging from HIV treatment to cancer treatment. Its use in the natural health industry represents an emerging source for accidental poisonings.
Helicobacter pyloriInfection in Ontario: Prevalence and Risk Factors
Authors: Naja Farah , Kreiger Nancy , Sullivan Terrence
Published: March 2016

BACKGROUND:Helicobacter pylorihas been classified by the World Health Organization as a type I carcinogen. Nearly 50% of the world’s population is estimated to be infected withH pylori. Prevalence patterns of the infection are different between developing and developed countries. The present study had two objectives – to estimate the prevalence ofH pyloriinfection in Ontario, and to evaluate the relationship between the infection and various demographic characteristics and selected lifestyle factors.

METHODS: Ten microlitres of plasma were aliquoted from stored blood of 1306 men and women, 50 to 80 years of age, from Ontario. The blood samples belonged to control patients of a colorectal cancer population-based study group. Serological testing was used to detectH pyloriinfection; information was obtained on dietary intake and lifestyle habits, as well as past and present medical history, education, income, number of siblings, ethnicity and place of birth.

RESULTS: The overall weighted seroprevalence ofH pyloriwas 23.1% (95% CI 17.7% to 29.5%), with men having higher infection rates (29.4%, 95% CI 21.1% to 39.3%) than women (14.9%, 95% CI 10.1% to 21.4%). Seroprevalence of the infection increased significantly with age and number of siblings. Increased risk was also associated with being nonwhite, being born outside of Canada and immigrating at 20 years of age or older. An inverse association with seroprevalence was found for education and alcohol consumption.

CONCLUSION: The prevalence ofH pyloriinfection in Ontario is comparable with that of other developed countries. Age, sex, number of siblings, ethnicity, place of birth and age at immigration are among the factors associated withH pyloriinfection.
Effects of Changes in Lung Volume on Oscillatory Flow Rate During High‐Frequency Chest Wall Oscillation
Authors: Butcher Scott J , Pasiorowski Michal P , Jones Richard L
Published: March 2016

BACKGROUND: The effectiveness of high‐frequency chest wall oscillation (HFCWO) in mucolysis and mucous clearance is thought to be dependant on oscillatory flow rate (Fosc). Therefore, increasing Fosc during HFCWO may have a clinical benefit.

OBJECTIVES: To examine effects of continuous positive airway pressure (CPAP) on Fosc at two oscillation frequencies in healthy subjects and patients with airway obstruction.

METHODS: Five healthy subjects and six patients with airway obstruction underwent 12 randomized trials of HFCWO (CPAP levels of 0 cm H2O, 2 cm H2O, 4 cm H2O, 6 cm H2O, 8 cm H2O and 10 cm H2O at frequencies of 10 Hz and 15 Hz) within a body plethysmograph, allowing measurements of changes in lung volume. Fosc was measured by reverse plethysmography using a 20 L isothermic chamber near the mouth. At the end of each randomized trial, an inspiratory capacity manoeuvre was used to determine end‐expiratory lung volume (EELV).

RESULTS: EELV increased significantly (P<0.05) with each level of CPAP regardless of oscillation frequency. Fosc also significantly increased with CPAP (P<0.05) and it was correlated with EELV (r=0.7935, P<0.05) in obstructed patients but not in healthy subjects (r=0.125, P=0.343). There were no significant differences in perceived comfort across the levels of CPAP.

CONCLUSIONS: Significant increases in Fosc with CPAP‐induced increases in lung volume were observed, suggesting that CPAP may be useful as a therapeutic adjunct in patients who have obstructive airway disease and who require HFCWO.
Endoscopic Follow-Up of Positive Fecal Occult Blood Testing in the Ontario FOBT Project
Authors: Paszat Lawrence , Rabeneck Linda , Kiefer Lori , Mai Verna , Ritvo Paul , Sullivan Terry
Published: March 2016

BACKGROUND: The Ontario FOBT Project is a pilot study of fecal occult blood testing (FOBT) for colorectal cancer screening conducted among age-eligible volunteers (50 to 75 years) in 12 of 37 public health regions in Ontario.

METHODS: Volunteers responded to invitations from primary care practitioners (PCPs) in six regions, and from public health programs in the remaining regions. FOBT collection kits were distributed from routine laboratory specimen collection sites, to which completed kits were returned. Results were sent to PCPs in all 12 regions, with copies sent to the study office at Cancer Care Ontario (Toronto, Ontario). Follow-up of positive results was at the discretion of the PCPs. The study files contained the unique Ontario Health Insurance Numbers, the date of the analyses, the number of satisfactory slides and the results for each slide. The Ontario Health Insurance Numbers were encrypted for each participant, and along with the study file, were linked to medical billing claims, hospital records and aggregate demographic data.

RESULTS: Among participants with positive results (men 3.5% and women 2.2%), the median time from date of FOBT analysis to date of colonoscopy was 121 days among men and 202 days among women. At the end of follow-up, after positive FOBT (six to 17 months), 73% of men and 56% of women had proceeded to colonoscopy.

CONCLUSION: Although colonoscopy appeared to be acceptable to the majority of participants with positive FOBT, accessibility problems was the likely explanation for lengthy intervals between the date of positive FOBT and its performance. Differences between the experiences of men and women require further investigation.
The Myths and Realities of Hemochromatosis
Authors: Beaton Melanie D , Adams Paul C
Published: March 2016

Hemochromatosis is a common genetic condition and yet there are still a number of misperceptions surrounding the diagnosis and management of this condition. Hemochromatosis affects both men and women. Typical patients do not have alcoholism or viral hepatitis, and often have normal liver enzymes. Clinical expression is highly variable. Genetic testing is widely available and particularly useful in family studies. Hemochromatosis can be readily diagnosed and treated. The purpose of the present review is to address the medical myths and misconceptions of hemochromatosis.
Changes in Renal Function Following Administration of Oral Sodium Phosphate or Polyethylene Glycol for Colon Cleansing before Colonoscopy
Authors: Abaskharoun Ramy , Depew William , Vanner Stephen
Published: March 2016

Changes in renal function were compared in patients receiving oral sodium phosphate (NaP) for colon cleansing and those receiving large-volume polyethylene glycol (PEG) solution to determine whether oral NaP resulted in frequent renal damage that had gone clinically undetected. From 1995 to 2004, a cohort of consecutive patients who had serum creatinine (Cr) drawn immediately before colonoscopy and again after subsequent procedures three months to nine years later (almost 80% of patients between the first and fifth year) were identified. Chronic renal failure (CRF) was defined as an abnormal Cr at repeat measurement or an abnormal Cr clearance as estimated by the Cockroft-Gault equation at the time of repeat Cr measurement. Medications and medical comorbid conditions were recorded. Seven hundred sixty-seven patients (51% female and 49% male; 81% oral NaP and 19% PEG) with normal baseline Cr levels were identified through the endoscopy unit database at the Hotel Dieu Hospital, Queen’s University (Kingston, Ontario). Of these, 55 (7%) developed CRF. Forty-two (6.8%) patients receiving oral NaP developed renal failure compared with 13 patients (8.7%) receiving PEG (Fisher’s exact test; P=0.382), but the magnitude of CRF was small in each group (Cr level lower than 160 μmol/L). Using logistic regression analysis with the choice of preparation, medications and medical comorbid conditions as independent variables, only age and blood pressure were predictive of the development of renal failure (P=0.014 and P=0.001, respectively). Baseline Cr clearance was similiar in both the NaP and PEG groups and the absolute difference after colonoscopy did not differ. The present study concluded that the ingestion of oral NaP for colon cleansing before colonoscopy did not result in frequent renal damage that went clinically undetected.
Management and Treatment of Hepatitis C Virus in Patients with HIV and Hepatitis C Virus Coinfection: A Practical Guide for Health Care Professionals
Authors: Côté Pierre , Baril Jean-Guy , Hébert Marie-Nicole , Klein Marina , Lalonde Richard , Poliquin Marc , Rouleau Danielle , Therrien Rachel , Vézina Sylvie , Willems Bernard , Dion Harold , Junod Patrice , Lapointe Normand , Lévesque Dominic , Pinault Lyse , Tremblay Cécile , Trottier Benoît , Trottier Sylvie , Tsoukas Chris , Piché Alain
Published: March 2016

Concomitant HIV and hepatitis C virus (HCV) is a common yet complex coinfection. The present document is a practical guide for treating HCV infection in people coinfected with HIV. Effective antiretroviral therapies have prolonged survival rates for HIV‐infected people over the past decade, which have made latent complications of HCV major causes of morbidity and mortality in these patients. Advances in the treatment of HCV (eg, combined pegylated interferon and ribavirin) offer the possibility of eradicating HCV infection in coinfected persons. The treatment of HCV must be considered in all cases. Intensive management of the adverse effects of HCV treatment is one of the factors for the success of these therapies. HCV eradication is predicted to decrease the mortality associated with coinfection and reduce the toxicity of HIV treatment.
Comparative Efficacy of Two Doses of Nebulized Colistimethate for the Eradication of Pseudomonas Aeruginosa in Children with Cystic Fibrosis
Authors: Brochet Marie-Sophie , McDuff Anne-Catherine , Bussières Jean-François , Caron Elaine , Fortin Geneviève , Lebel Denis , Marcotte Jacques-Édouard
Published: March 2016

BACKGROUND: Cystic fibrosis (CF) affects the respiratory and digestive systems. It evolves toward deterioration of pulmonary function through colonization with Pseudomonas aeruginosa. There is no consensus with respect to its eradication. Nebulized colistimethate is used for eradication treatment, but the optimal dose and duration is yet to be determined.

OBJECTIVES: To compare the efficacy of two doses of nebulized colistimethate (30 mg versus 75 mg twice daily) for the eradication of P aeruginosa in children with CF and intermittent colonization.

METHODS: A cohort study with both historical (30 mg) and prospective (75 mg) arms was conducted from 1999 to 2003. Medical records were used to collect data.

RESULTS: Eighty‐one patients were recruited in the retrospective group, for a total of 111 treatment courses. Twenty patients were recruited in the prospective group, for a total of 20 events. There was no statistically significant difference in the rate of eradication of P aeruginosa at days 28 and 90, neither when comparing the doses of colistimethate nor duration of treatment. There was a statistically significant difference (P=0.004) between days 1 and 90 in all analyzed subgroups (regardless of dose or duration of treatment) for forced vital capacity only. In the group of patients in whom eradication was achieved at day 28 (after receiving a three‐week treatment course of colistimethate), 50% of patients developed a new infection 5.75 months later, on average, regardless of the dose administered. In the group of patients who achieved eradication at day 90 (after receiving a 15‐week treatment course of colistimethate), 50% of the 14 patients developed a new infection after an average period of 7.3 months (P=0.28).

CONCLUSIONS: There is no difference in the efficacy between a 30 mg dose and a 75 mg dose of colistimethate for P aeruginosa eradication in children with CF and intermittent colonization.
Retrospective Review of Pediatric and Adult Autoimmune Hepatitis in Two Quaternary Care Centres in British Columbia: Increased Prevalence Seen in British Columbia’S First Nations Community
Authors: Chung Henry V , Riley Mark , Ho Jin K , Leung Benjamin , Jevon Gareth P , Arbour Laura T , Barker Colin , Schreiber Richard , Yoshida Eric M
Published: March 2016

BACKGROUND: It has been previously reported that British Columbia’s (BC’s) First Nations (Aboriginal) community has an increased risk of autoimmune diseases, including rheumatological conditions (rheumatoid arthritis, systemic lupus) and primary biliary cirrhosis. The researchers hypothesized that this community may also be at increased risk for autoimmune hepatitis (AIH).

METHODS: Independent, retrospective reviews of the databases of two separate tertiary/quaternary British Columbia university-affiliated health care institutions, the Adult Liver Transplant Program of the BC Transplant Society and the Division of Pediatric Gastroenterology, BC Children’s Hospital (Vancouver, BC), were performed. All patients referred with a diagnosis of probable or definite AIH who identified themselves as being of First Nations descent from 1988 to 2004 were reviewed. The liver transplant database records all adult patients in the province referred for transplant assessment. The pediatric database records all children referred to the BC Children’s Hospital.

RESULTS: A total of 68 adult patients with a definite or probable diagnosis of AIH were referred to the liver transplant program. Twelve patients (17.6%) were Aboriginal, 11 of which were female. Similarly, a total of 30 children with probable or definite AIH were identified from the pediatric database. Six of these cases (20%) were identified in Aboriginal children.

CONCLUSIONS: The findings suggest an increased prevalence of AIH among BC’s First Nations community. A disproportionate First Nations representation was found on independent review of two databases. Future studies are needed to determine the true prevalence of AIH in this community, and to uncover the genetic predisposition and the environmental triggers explaining this phenomenon.
Erlotinib‐Associated Acute Pneumonitis: Report of Two Cases
Authors: Vahid Bobbak , Esmaili Ali
Published: March 2016

Two cases of erlotinib‐associated acute pneumonitis are described. The first patient was started on erlotinib treatment for metastatic non‐small cell lung cancer. The second patient was treated with erlotinib for metastatic adenocarcinoma of unknown origin. Both patients developed dyspnea and hypoxemia five to six days after initiation of erlotinib treatment. In both cases, computed tomography scan of the chest showed extensive bilateral ground‐glass infiltrates consistent with pneumonitis. In both patients, acute pneumonitis resulted in respiratory failure requiring intubation and mechanical ventilation. Diffuse alveolar hemorrhage was excluded by bronchoscopy in both cases. Bronchoalveolar lavage cultures were negative. Erlotinib treatment was stopped and both patients were treated with corticosteroids. The first patient improved gradually and finally was discharged to a rehabilitation centre, but unfortunately the second patient died of Klebsiella sepsis. Naranjo causality scale in both cases suggested a probable association between erlotinib and pneumonitis. Literature on erlotinib‐associated pneumonitis is sparse. The clinical presentation and radiographic findings of erlotinib‐associated acute pneumonitis are described.
Use of Gabapentin for Perioperative Pain Control – a Meta‐Analysis
Authors: Peng Philip WH , Wijeysundera Duminda N , Li Carina CF
Published: March 2016

BACKGROUND: Gabapentin, an anticonvulsant, has recently been suggested as an effective postoperative ‘analgesic’ agent. The objective of the present study was to examine the analgesic effectiveness, opioid‐sparing effects and side effects associated with the use of gabapentin in a perioperative setting.

METHODS: Following the Quality of Reporting of Meta‐analyses recommendations, nine electronic databases until February 2006 were searched, without language restriction, for randomized controlled trials comparing gabapentin with control for postoperative pain control. Outcome measures, namely, 24 h cumulative opioid consumption, visual analogue scale pain scores and adverse effects, were expressed as odds ratios, ratio of means or weighted mean differences (as appropriate), which were aggregated under the fixed or random effects models.

RESULTS: Gabapentin caused a 35% reduction in total opioid consumption over the first 24 h following surgery (ratio of means 0.65, 95% CI 0.59 to 0.72), a significant reduction in postoperative pain at rest (in the first 24 h) and with movement (at 2 h, 4 h and 12 h), regardless of whether treatment effects were expressed as ratios of means or weighted mean differences, and a reduction of vomiting (relative risk [RR] 0.73, 95% CI 0.56 to 0.95) and pruritus (RR 0.30, 95% CI 0.13 to 0.70). It was associated with a significant increase in dizziness (RR 1.40, 95% CI 1.06 to 1.84) and an increase in sedation of borderline significance (RR 1.65, 95% CI 1.00 to 2.74).

CONCLUSION: Gabapentin improves the analgesic efficacy of opioids both at rest and with movement, reduces analgesic consumption and opioid‐related adverse effects, but is associated with an increased incidence of sedation and dizziness.
The Cost of Lung Cancer in Alberta
Authors: Demeter Sandor J , Jacobs Philip , Chmielowiec Chester , Logus Wayne , Hailey David , Fassbender Konrad , McEwan Alexander
Published: March 2016

BACKGROUND: Lung cancer is the leading cause of cancer morbidity and mortality. In addition, lung cancer has a significant economic impact on society.

OBJECTIVE: To present an economic analysis of the actual care costs of lung cancer which will allow comparison with, and verification of, cost estimates that were developed through modelling and opinion.

METHODS: A chart review was conducted of incident cases (circa 1998) of primary bronchogenic lung cancer. Cases were censored at two years from the date of diagnosis. Relevant clinical and health utilization data were collected. Health utilization data included hospital and institutional outpatient (ie, ambulatory clinic) costs. Cost estimates were derived for over 200 specific health services. The present analysis was performed from the economic perspective of the health care institution.

RESULTS: A total of 13,389 health service events were captured with an estimated total cost of $8.4 million. Laboratory tests, diagnostic imaging and ambulatory visits constituted 86% of the service events while patient admissions and therapy constituted 76% of the costs. The vast majority of overall costs occurred just before, or within, three months of diagnosis. The median nonsmall cell lung cancer and small cell lung cancer case costs were $10,928 (range $9,234 to $11,047) and $15,350 (range $13,033 to $21,436), respectively.

CONCLUSION: The results agree with the literature that the majority of lung cancer case costs are realized around the date of diagnosis (ie, early phase). The present study illustrates Canadian health care system lung cancer case costs based on actual care received versus hypothetical care algorithms.
One Bite or Two? A Prospective Trial Comparing Colonoscopy Biopsy Technique in Patients with Chronic Ulcerative Colitis
Authors: Hookey Lawrence C , Hurlbut David J , Day Andrew G , Manley Paul N , Depew William T
Published: March 2016

BACKGROUND AND STUDY AIMS: Surveillance for mucosal dysplasia in patients with chronic ulcerative colitis requires numerous biopsies (often over 40). The aim of the present study was to determine if two biopsies could be obtained with jumbo forceps before removing them from the instrument (double biopsy technique), as opposed to one biopsy per pass, without sacrificing the histological quality of the biopsy material.

METHODS: Twelve patients with chronic ulcerative colitis underwent colonoscopy, and four-quadrant biopsies were obtained at 10 cm intervals. For biopsies at each interval, two quadrants were obtained using the double biopsy technique and the other two quadrants were obtained individually. Two pathologists blinded to the biopsy technique examined each biopsy for technical and diagnostic qualities. The primary outcome was the histological adequacy in the evaluation of dysplasia.

RESULTS: A total of 468 biopsies were obtained. A higher proportion of double-biopsy specimens were inadequate for dysplasia assessment compared with single-biopsy specimens (OR=2.78, 95% CI 1.37 to 5.59; P=0.005). In the double biopsy technique group, 14 samples were deemed inadequate due to actual tissue specimen loss, compared with eight samples in the single biopsy technique. However, when analysis was repeated using only the retrieved specimens, the double biopsy technique continued to be at higher risk of obtaining inadequate specimens (OR=14.5, 95% CI 2.1 to 98.7; P=0.006).

CONCLUSIONS: The results of the present study suggest that the double biopsy technique is vulnerable to specimen loss and reduced histological quality, and the adoption of this technique as an equivalent method for tissue sampling may be premature.
Granuloma-Positive Crohn’s Disease
Authors: Freeman Hugh J
Published: March 2016

BACKGROUND: The epithelioid granuloma is a characteristic histological feature of Crohn’s disease. In some pathological classification schemes, the criteria for a definite, probable or possible diagnosis have been listed, with the epithelioid granuloma indicating definite Crohn’s disease.

METHODS: In the present evaluation, 247 prospectively evaluated Crohn’s disease patients (24.3%), from a consecutively accumulated population database of 1015 patients, were found to have an epithelioid granuloma. The recently devised Montreal classification for Crohn’s disease was then applied to this granuloma-positive cohort of Crohn’s disease patients to define age at diagnosis for men and women, disease site and disease behaviour.

RESULTS: The investigation showed that patients with Crohn’s disease and granulomas were most often diagnosed early in the course of their disease, particularly women. Their disease was often extensive, with ileocolonic and upper gastrointestinal tract involvement. Finally, disease behaviour was most often complex, especially with penetrating disease complications.

CONCLUSION: Using homogeneous (ie, ‘reagent-grade’) patient cohorts defined by a recently devised classification method for Crohn’s disease, the study demonstrated that an epithelioid granuloma may represent a histopathological marker for an early biological event in the etiopathogenesis of Crohn’s disease, and this may have predictive significance with respect to the location and clinical behaviour of Crohn’s disease.
Resource Use Study in COPD (RUSIC): A prospective Study to Quantify the Effects of COPD Exacerbations on Health Care Resource Use Among COPD Patients
Authors: FitzGerald J Mark , Haddon Jennifer M , Bradley-Kennedy Carole , Kuramoto Lisa , Ford Gordon T , The RUSIC Study Group
Published: March 2016

BACKGROUND: There is increasing interest in health care resource use (HRU) in Canada, particularly in resources associated with acute exacerbations of chronic obstructive pulmonary disease (COPD).

OBJECTIVE: To identify HRU due to exacerbations of COPD.

METHODS: A 52‐week, multicentre, prospective, observational study of HRU due to exacerbations in patients with moderate to severe COPD was performed. Patients were recruited from primary care physicians and respirologists in urban and rural centres in Canada.

RESULTS: In total, 524 subjects (59% men) completed the study. Their mean age was 68.2±9.4 years, with a forced expiratory volume in 1 s of 1.01±0.4 L. Patients had significant comorbidities. There were 691 acute exacerbations of COPD, which occurred in 53% of patients: 119 patients (23%) experienced one acute exacerbation, 70 patients (13%) had two acute exacerbations and 89 patients (17%) had three or more acute exacerbations. Seventy‐five patients were admitted to hospital, with an average length of stay of 13.2 days. Fourteen of the patients spent time in an intensive care unit (average length of stay 5.6 days). Factors associated with acute exacerbations of COPD included lower forced expiratory volume in 1 s (P<0.001), high number of respiratory medications prescribed (P=0.037), regular use of oral corticosteroids (OCSs) (P=0.008) and presence of depression (P<0.001). Of the 75 patients hospitalized, only 53 received OCSs, four received referral for rehabilitation and 15 were referred for home care.

CONCLUSIONS: The present study showed a high prevalence of COPD exacerbations, which likely impacted on HRU. There was evidence of a lack of appropriate management of exacerbations, especially with respect to use of OCSs, and referral for pulmonary rehabilitation and home care.
Hospitalization-Based Major Comorbidity of Inflammatory Bowel Disease in Canada
Authors: Bernstein Charles N , Nabalamba Alice
Published: March 2016

OBJECTIVE: To define the patterns of hospitalization for known major comorbidities associated with inflammatory bowel disease (IBD) in Canada.

METHODS: The data source was the Statistics Canada Health Person Oriented Information hospital database (1994/1995 to 2003/2004). The number of stays for a diagnosis of Crohn’s disease or ulcerative colitis by theInternational Classification of Diseases, ninth edition, codes 555 or 556, or theInternational Classification of Diseases, 10th edition, Canadian Enhancement, codes K50 or K51, was extracted. Age- and sex-specific and age-adjusted rates of hospitalization for selected IBD-related comorbidities were assessed.

RESULTS: Rates of Hodgkin’s disease and non-Hodgkin’s lymphoma were low in the hospitalized IBD population. Rates for colon cancer, rectal cancer, pulmonary emboli and deep venous thromboembolism were generally higher among IBD patients younger than 50 years of age compared with the non-IBD hospitalized population.

CONCLUSIONS: IBD was associated with life-threatening comorbidities such as venous thromboembolic disease and colon cancer among persons younger than 50 years of age to a greater extent than the general hospitalized population. Recent secular trends in rates of non-Hodgkin’s lymphomas will need to be followed to determine whether the whole population, including IBD patients who receive immunomodulating therapies, are at increased risk.
Complete Disappearance of Lung Abnormalities on High‐Resolution Computed Tomography: A Case of Histiocytosis X
Authors: Negrin-Dastis Sergio , Butenda Dominique , Dorzee Jacques , Fastrez Jacques , d’Odémont Jean-Paul
Published: March 2016

A case of pulmonary Langerhans cell histiocytosis, proved by both lung high‐resolution computed tomography and lung biopsy, is described. Following smoking cessation, lung nodules and cysts gradually disappeared on serial computed tomography scans, with complete clearance of the lesions after 12 months. The role of tobacco smoking is discussed, in detail, against the background of the literature.
Oral Manifestations of Gastrointestinal Diseases
Authors: Daley Tom D , Armstrong Jerrold E
Published: March 2016

The present paper offers a detailed review of the oral manifestations of various gastrointestional diseases or conditions, with suggestions on how they may be relevant to the practice of gastroenterology. The review includes Crohn’s disease, ulcerative colitis, Gardner syndrome, Peutz-Jeghers syndrome, malabsorption conditions related to hematopoiesis, gastrointestinal malignancy metastatic to the jaws, jaundice and gastric reflux diseases.
The Paradox of Adult Asthma Control: “Who’s in Control Anyway?”
Authors: Hodder Rick
Published: March 2016

Surveys of Canadian patients with asthma and their physicians consistently report satisfaction with asthma management; however, when objective indicators are used, these same surveys also observe very poor levels of asthma control. The reasons for this apparent discrepancy, with an emphasis on the factors influencing adherence to therapy, are explored in the present review. Clues to the identification of patients at risk of dying from asthma and an approach to difficult asthma are discussed.
Necrotizing Pneumonia Complicated by Early and Late Pneumatoceles
Authors: Al-Saleh Suhail , Grasemann Hartmut , Cox Peter
Published: March 2016

Community‐acquired pneumonia generally has a benign course when treated, but can be complicated by pleural effusion, empyema, lung abscesses, necrotizing pneumonia or pneumatoceles. Pneumatoceles can cause cardiorespiratory compromise requiring urgent intervention. A child with a severe necrotizing pneumonia, as well as a large early pneumatocele complicating mechanical ventilation, is presented. While pneumonectomy resulted in transient improvement, the course was further complicated by multiple late occurring pneumatoceles that ultimately led to the patient’s death.
Practice Patterns in the Management of Chronic Obstructive Pulmonary Disease in Primary Practice: The Cage Study
Authors: Bourbeau Jean , Sebaldt Rolf J , Day Anna , Bouchard Jacques , Kaplan Alan , Hernandez Paul , Rouleau Michel , Petrie Annie , Foster Gary , Thabane Lehana , Haddon Jennifer , Scalera Alissa
Published: March 2016

BACKGROUND: The information on usual care for patients with chronic obstructive pulmonary disease (COPD) in primary care is limited in Canada.

OBJECTIVE: To evaluate primary care practice in patients with COPD in Quebec and Ontario compared with recommended care.

METHODS: The COPD Care Gap Evaluation (CAGE) was a prospective, cross‐sectional study. Physicians’ self‐reported data of enrolled COPD patients were compared with the recommended care for the level of disease severity (using the Canadian Thoracic Society classification by symptoms) and stability, derived from Canadian Thoracic Society COPD guidelines. Pharmacological treatment, spirometric confirmation of diagnosis and nonpharmacological management, including smoking cessation counselling, influenza immunization and referral for pulmonary rehabilitation, were assessed.

RESULTS: Participating physicians (n=161; 44 in Quebec, 117 in Ontario) recruited 1090 patients (320 in Quebec, 770 in Ontario). The mean (± SD) age of the patients was 69.9±10.4 years; 60% were male and 40% were currently smoking. Pharmacological treatment that matched guideline recommendations was identified in 34% of patients. Discrepancies between reported and recommended treatment stemmed from nonprescription of long‐acting bronchodilators (LABDs) for patients with moderate (27%) and severe (21%) COPD, nonprescription of two long‐acting beta agonists (a beta2‐agonist and an anticholinergic) for patients with severe COPD (51%), and prescription of inhaled corticosteroids (63%) and LABDs (47%) for patients with mild COPD for which the treatment is not recommended. Spirometric confirmation of diagnosis, as recommended by the guidelines, was reported in 56% of patients. For non‐pharmacological management, smoking cessation counselling (95%) and influenza immunization (80%) were near optimal. Referral for pulmonary rehabilitation (9%) was not common. Differences between provinces were seen mainly in the prescription of short‐acting bronchodilators (89% in Quebec, 76% in Ontario) and LABDs (60% in Quebec, 80% in Ontario).

CONCLUSIONS: Substantial gaps between recommended and current care exist in the management of COPD patients in primary care practice. Undertreatment of patients with severe COPD has potential clinical implications, including loss of autonomy and hospitalization.
A Pilot Study to Compare Tobramycin 80 mg Injectable Preparation wth 300 mg Solution for Inhalation in Cystic Fibrosis Patients
Authors: Nikolaizik Wilfried H , Vietzke Delia , Ratjen Felix
Published: March 2016

BACKGROUND: Inhaled tobramycin has been shown to improve lung function in cystic fibrosis (CF) patients chronically infected with Pseudomonas aeruginosa. However, to date no comparative data are available for different dose regimens used in clinical practice.

OBJECTIVES: To compare the clinical efficacy of the two most commonly used treatment regimens of inhaled tobramycin in patients with CF.

METHODS: In an open crossover study of CF patients, subjects were randomly allocated to receive either 80 mg tobramycin twice‐daily continuous treatment or 300 mg tobramycin twice daily in cycles of 28 days on and 28 days off treatment. After three months, patients were switched to the alternative treatment regimen.

RESULTS: A total of 32 patients with a mean (± SD) age of 18.5±8.6 years were included in the study. Compared with the treatment period using colistin, forced expiratory volume in 1 s decreased by −2.1±13.8% in the 80 mg tobramycin group and increased by +2.3±13.0% in the 300 mg group. Similar changes were observed in forced vital capacity (−2.5±12.9% in the 80 mg tobramycin group versus +2.5±9.6% in the 300 mg tobramycin group). Variability in responses was large but the differences were not statistically significant. Personal preference indicated that the majority of patients preferred the high‐dose cycle compared with the lower dose continuous inhalation, but this was not linked to objective data on efficacy.

CONCLUSIONS: The present trial fails to provide convincing evidence for superiority in efficacy of either of the two treatment regimens of inhaled tobramycin in CF patients.
Quality of Bronchial Biopsies for Morphology Study and Cell Sampling: A Comparison of Asthmatic and Healthy Subjects
Authors: Labonté Isabelle , Laviolette Michel , Olivenstein Ron , Chakir Jamila , Boulet Louis-Philippe , Hamid Qutayba
Published: March 2016

BACKGROUND: Bronchial biopsies are widely used for histopathological, primary cell culture and genetic studies, but very few reports have evaluated their quality.

OBJECTIVES AND METHODS: The present project evaluated the quality (using a scoring system) and the general morphology of a pool of six bronchial biopsy specimens taken from three different sampling sites (the lobar, segmental and subsegmental carinae) in 27 subjects (13 asthmatic subjects and 14 healthy controls). The present study also assessed quantitative measurements of structural changes related to asthma.

RESULTS: In total, 94.4% of the biopsy attempts had enough tissue to be processed. From these, 61.7% were scored with a good to excellent quality, while 76.5% presented smooth muscle bundles and 40.5% had an intact epithelium wall. The data also confirmed the structural changes observed in asthma, such as increased apparent thickening of the basement membrane, reduced amounts of smooth muscle for healthy controls and decreased percentage of intact epithelium for asthmatic subjects.

CONCLUSION: A pool of six bronchial biopsy specimens can provide tissue of excellent quality in both asthmatic and healthy subjects and, consequently, a valuable sample for morphological analysis of mucosal structures.