bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of Respiratory Muscle Oxygen Consumption to Breathing Limitation and Cyspnea
Authors: Casan Pere , Villafranca Carlos C , Kearon Clive , Campbell Edward JM , Killian Kieran J
Published: March 2016

During exercise, the sustainable activity of large muscle groups is limited by oxygen delivery. The purpose of this study was to see whether the oxygen consumption of the respiratory muscles reaches a similar critical value under maximal resistive loading and hyperventilation. A secondary objective was to see whether dyspnea (estimated discomfort experienced with breathing using the Borg 0‐10 scale) and the oxygen consumption of the respiratory muscles are closely related across conditions. This would be expected if intramuscular sensory nerve fibres stimulated as a consequence of metabolic events contributed to this sensation. In six normal subjects the respiratory muscles were progressively activated by the addition of incremental inspiratory resistive loads to a maximum of 300 cm H20×s/L (SD=66.4), and incremental dead space to a maximum of 2638 mL (SD=452), associated with an increase in ventilation to 75.1 L/min (SD=29.79). Each increment was maintained for 5 mins to allow the measurement of oxygen uptake in a steady state. During resistive loading total oxygen consumption increased from 239 mL/min (SD=38.2) to 299 mL/min (SD=52.3) and dyspnea increased to "very severe" (Borg scale 7.5, SD=1.55). During dead space loading total oxygen consumption increased from 270 mL/min (SD=20.2) to 426 mL/min (SD=81.9) and dyspnea increased to "very severe" (7.1, SD=0.66). Oxygen cost of inspiratory muscle power was 25 mL/watt (95% confidence limits 16.7 to 34.3) with dead space loading and 91 mL/watt (95% confidence limits 54 to 128) with resistive loading. Oxygen consumption did not reach a critical common value in the two types of loading, 60 mL/min (SD 22.3) during maximal resistive loading and 156 mL/min (SD 82.4) during maximal dead space loading (P<0.05). Physiological factors limiting the respiratory muscles are not uniquely related to oxygen consumption and appear to be expressed through the activation of sensory structures, perceptually manifested as dyspnea.
Particulate Air Pollution and Health: Emerging Issues and Research Needs Related to the Development of Air Quality Standards
Authors: Hessel Patrick A , Goldsmith John R , Wichmann H-Erich , Wilson William E , Soskolne Colin L
Published: March 2016

The health effects of particulate air pollution were highlighted at the Eighth Annual Conference of the International Society for Environmental Epidemiology, held in Edmonton, Alberta in August 1996. Despite consistent evidence for adverse respiratory and cardiovascular health effects related to particulate air pollution, there are significant gaps in the knowledge of the mechanisms whereby particulate air pollution affects human health. Questions regarding the appropriate measure of dose for assessing exposures relevant to health outcomes and the methods used to analyze dose‐response data remain unanswered. Health effects have been demonstrated across the range of exposures that have been examined, and further research in low exposure settings is necessary to explore the lower end of the dose‐response curve. Although a significant body of literature has been generated, comprehensive risk assessments have not been undertaken. Examination of the chronic effects of particulate air pollution and identification of high risk populations are necessary. Although there are significant unanswered questions regarding the health effects of particulate air pollution, the available information suggests that particulate air pollution at levels consistent with current standards is associated with measurable health effects.
Exogenous Surfactant Therapy for Pediatric Patients with Acute Respiratory Distress Syndrome
Authors: Lewis James F , Dhillon Jasvinder S , Singh Ram N , Johnson Craig C , Frewen Timothy C
Published: March 2016

Exogenous surfactant administration is currently being tested in patients with the acute respiratory distress syndrome (ARDS). The results of the studies have varied because several factors may influence the host’s response to this therapy. This clinical pilot study was designed to evaluate the safety and efficacy of exogenous surfactant administration in pediatric patients with ARDS. Surfactant was administered to 13 patients with severe lung dysfunction, and eight of these patients experienced a significant improvement in oxygenation after the first dose of surfactant. In these patients the exogenous surfactant was administered within 48 h of the diagnosis of ARDS, whereas in the five patients who did not respond, surfactant was administered several days after the onset of ARDS. Responders also spent fewer days on a mechanical ventilator and less time in intensive care compared with nonresponders. Based on the results of this pilot study, a more appropriate multicentre clinical trial should be designed to evaluate this treatment strategy.
Acute Respiratory Distress Syndrome Associated with Tumour Lysis Syndrome in Leukemia
Authors: Bell Chaim M , Stewart Thomas E
Published: March 2016

Acute tumour lysis syndrome (ATLS) developed in two patients with acute myelogenous leukemia soon after they were treated with cytosine arabinoside. The patients also developed respiratory distress requiring intubation. Autopsy and clinical findings demonstrated the presence of acute respiratory distress syndrome (ARDS). An association appears to be present between ARDS and ATLS in this group of patients.
Cat Scratch Disease: The Story Continues
Authors: Opavsky Mary Anne
Published: March 2016

OBJECTIVE: To present a perspective on the current state of knowledge of cat scratch disease (CSD), including the evidence for Bartonella henselae as the etiological agent, epidemiological and clinical characteristics of the disease, available diagnostic tests and current therapeutic options.

DATA SOURCES: MEDLINE search of the literature published from 1966 to 1995 using ‘cat scratch disease’, ‘Bartonella henselae’, ‘Rochalimaea henselae’ as key words and bibliographies of selected papers.

DATA EXTRACTION: Selected studies reporting data on etiology, epidemiology, clinical characteristics, diagnosis and therapy of CSD were evaluated.

DATA SYNTHESIS AND CONCLUSIONS: Evidence accumulated to date supports B henselae as the etiological agent of CSD. The most significant risk factors for CSD are being licked on the face, scratched or bitten by a kitten and owning a kitten with fleas. Available serological tests can confirm classic CSD and identify B henselae as the cause of more atypical presentations, such as fever of unknown origin, granulomatous hepatitis, encephalitis and osteomyelitis. Symptomatic management is appropriate for isolated lymphadenopathy caused by CSD in healthy individuals; however, antibiotic therapy may be indicated for patients with more severe manifestations of the disease and immunocompromised hosts. Further study of CSD, in particular the epidemiology and therapy, is warranted. A better understanding of the pathogenesis of B henselae infection will have important implications in both immunocompetent and immunocompromised individuals.
Transmissibility and Infection Control Implications of Burkolderia cepacia in Cystic Fibrosis
Authors: Fung Scott K , Dick H , Devlin H , Tullis E
Published: March 2016

OBJECTIVE: To describe the microbiology and potential virulence factors of Burkholderia cepacia; to discuss the studies that have investigated its mode of transmission among cystic fibrosis patients; and to identify the major risk factors associated with acquisition of this pathogen inside and outside of the hospital environment.

DATA SOURCES: MEDLINE search of the literature published between 1986 and 1997 using the key words/subject words Pseudomonas cepacia, Burkholderia cepacia, cystic fibrosis, infection control and transmissibility, and the bibliography of selected papers.

DATA EXTRACTION: Selected studies examining epidemiology, microbiology, virulence factors and mode of transmission of B cepacia in cystic fibrosis.

DATA SYNTHESIS AND CONCLUSIONS: B cepacia is a multidrug‐resistant Gram‐negative bacillus that has recently been recognized as a major respiratory pathogen in patients with cystic fibrosis. Colonization by this organism can lead to rapid pulmonary deterioration and premature death. Recent studies based on genomic subtyping techniques have suggested that it can be transmitted from person to person. Close social contact and hospitalization have been identified as risk factors for cross‐infection. With the implementation of strict infection control policies such as segregation according to colonization status, the rate of new colonization has substantially decreased in most cystic fibrosis treatment centres.
History of Pain Research and Management in Canada
Authors: Merskey Harold
Published: March 2016

Scattered accounts of the treatment of pain by aboriginal Canadians are found in the journals of the early explorers and missionaries. French and English settlers brought with them the remedies of their home countries. The growth of medicine through the 18th and 19th centuries, particularly in Europe, was mirrored in the practice and treatment methods of Canadians and Americans. In the 19th century, while Americans learned about causalgia and the pain of wounds, Canadian insurrections were much less devastating than the United States Civil War. By the end of that century, a Canadian professor working in the United States, Sir William Osler, was responsible for a standard textbook of medicine with a variety of treatments for painful illnesses. Yet pain did not figure in the index of that book. The modern period in pain research and management can probably be dated to the 20 years before the founding of the International Association for the Study of Pain. Pride of place belongs to The management of pain by John Bonica, published in Philadelphia in 1953 and based upon his work in Tacoma and Seattle. Ideas about pain were evolving in Canada in the 1950s with Donald Hebb, Professor of Psychology at McGill University in Montreal, corresponding with the leading American neurophysiologist, George H Bishop. Hebb′s pupil Ronald Melzack engaged in studies of early experiences in relation to pain and, joining with Patrick Wall at Massachusetts Institute of Technology, published the 1965 paper in Science that revolutionized thinking. Partly because of this early start with prominent figures and partly because of its social system in the organization of medicine, Canada became a centre for a number of aspects of pain research and management, ranging from pain clinics in Halifax, Kingston and Saskatoon ‐ which were among the earliest to advance treatment of pain ‐ to studying the effects of implanted electrodes for neurosurgery. Work in Toronto by Moldofsky and Smythe was probably responsible for turning ideas about fibromyalgia from the quaint concept of ′psychogenic rheumatism′ into the more fruitful avenue of empirical exploration of brain function, muscle tender points and clinical definition of disease. Tasker and others in Toronto made important advances in the neurophysiology of nociception by the thalamus and cingulate regions. Their work continues while a variety of basic and clinical studies are advancing knowledge of fundamental mechanisms, including work by Henry and by Sawynok on purines; by Salter and by Coderre on spinal cord mechanisms and plasticity; by Katz on postoperative pain; by several workers on children′s pain; and by Bushnell and others in Montreal on cerebral imaging. Such contributions reflect work done in a country that would not want to claim that its efforts are unique, but would hope to be seen as maintaining some of the best standards in the developed world.
Human Immunodeficiency Virus Infection in Pregnancy
Authors: Arikan Yasemin , Burdge David R
Published: March 2016

The incidence and prevalence of human immunodeficiency virus (HIV) infection in women of child‐bearing age continue to increase both internationally and in Canada. The care of HIV‐infected pregnant women is complex, and multiple issues must be addressed, including the current and future health of the woman, minimization of the risk of maternal‐infant HIV transmission, and maintenance of the well‐being of the fetus and neonate. Vertical transmission of HIV can occur in utero, intrapartum and postpartum, but current evidence suggests that the majority of transmission occurs toward end of term, or during labour and delivery. Several maternal and obstetrical factors influence transmission rates, which can be reduced by optimal medical and obstetrical care. Zidovudine therapy has been demonstrated to reduce maternal‐infant transmission significantly, but several issues, including the short and long term safety of antiretrovirals and the optimal use of combination antiretroviral therapy in pregnancy, remain to be defined. It is essential that health care workers providing care to these women fully understand the natural history of HIV disease in pregnancy, the factors that affect vertical transmission and the management issues during pregnancy. Close collaboration among a multidisciplinary team of knowledgeable health professionals and, most importantly, the woman herself can improve both maternal and infant outcomes.
Recurrent Thoracic Duplication Cyst with Associated Mediastinal Gas
Authors: Al-Sadoon Hammad , Wiseman Nathan , Chernick Victor
Published: March 2016

Mediastinal cysts are not uncommon in the pediatric age group. Presentation varies from an abnormality found on routine chest radiograph to severe respiratory distress and even respiratory failure. Presentation depends on the age of the patient, the location of the lesion, the extent and the size of the mass, and what structures are involved. The case of a six‐year‐old boy who presented with recurrence of a mediastinal mass associated with gas two years after surgical removal of an infected esophageal duplication cyst is described. No connection between the cyst and the esophagus to explain the presence of gas was documented. This appears to be the first reported case of esophageal duplication cyst associated with mediastinal gas.
Invasive Fungal Infections in Canada from 1992 to 1994
Authors: Nicolle LE , Rotstein C , Bourgault AM , St-Germain G , Garber G , the Canadian Infectious Diseases Society Invasive Fungal Reg
Published: March 2016

PURPOSE: To describe the frequency, characteristics and impact of invasive fungal infection in Canada.

METHODS: Nominal case reporting with standardized data collection from selected sites across Canada. Cases were found primarily through laboratory review with supplementation by record review and clinical surveillance at some sites.

RESULTS: The frequency of invasive fungal infection varied from 3.54 to 6.64/100,000 population per year. Candida species were responsible for 66% of all reports; 80% of candidal infections were bloodstream isolates. Crytococcus neoformans, Aspergillus species and Histoplasma capsulatum each accounted for 5% to 10% of cases, and all other organisms less than 5% each. Human immunodeficiency virus infection was an important comorbidity for cryptococcus and histoplasma infections, and was associated with increased mortality for only histoplasma infections. Geographical variation of histoplasma, blastomyces and coccidioidomyces infection was confirmed. Case fatality was high for all invasive fungal infections, except coccidioidomycosis, blastomycosis and sporotrichosis.

CONCLUSIONS: Candida species infections are the major pathogens in invasive fungal infections in Canada; all other species occur relatively infrequently. The potential for therapeutic intervention to limit mortality requires further assessment.
Predictors of Onset of Wheezing in Grain Elevator Workers
Authors: Pahwa Punam , Senthilselvan Ambikaipakan , McDuffie Helen H , Dosman James A
Published: March 2016

A longitudinal study of Canadian grain elevator workers over a 12‐year period was conducted. Data on respiratory symptoms and pulmonary function tests were collected once every three years as part of the Grain Dust Medical Surveillance Program started by Labour Canada in 1978; each three‐year interval was called a ′cycle′. Of workers who had two or more observations, 1848 subjects (67.2%) were free of respiratory symptoms (wheeze, dyspnea, cough or sputum) at the baseline (cycle II). Predictors of first episode of wheezing were examined in these symptoms‐free grain workers. Baseline mean age ± SD of the grain workers was 34.0±11.4 years and mean duration of work in the industry was 9.9±8.7 years. Of the 1848 symptoms‐free grain workers at cycle II, 203 (11.0%) subsequently reported wheezing during the study. Cox′s proportional hazards model for analysis of survival data was used to determine significant predictors of first episode of wheezing. Significant predictors for first episode of wheezing were current smoking (relative risk [RR] 2.33; 95% CI 1.63 to 3.33; P<0.0001) and baseline forced expiratory volume in 1 s to forced vital capacity ratio [RR 0.02; 95% CI 0.003 to 0.20; P<0.0001). Baseline pulmonary function measurements and smoking habits appear to be important predictors of future development of asthma‐like symptoms in grain elevator workers.
Minithoracoscopy for Pleural Effusions
Authors: Malthaner RA , Inculet RI
Published: March 2016

The current management of pleural disease often requires direct visualization and biopsy of the pleural space using thoracoscopy. A diagnostic and therapeutic approach to pleural disease is described that uses a new 2 mm rigid thorascope. The technique allows complete visualization, biopsy and drainage of the pleural space with rapid recovery and minimal pain.
Classification of Chronic Pain at a Multidisciplinary Pain Rehabilitation Clinic
Authors: Lidbeck Jan , Hautkamp Gertie IM , Ceder Ritva A , Näslund Urban LO
Published: March 2016

OBJECTIVE: To make a detailed diagnostic analysis of patients with chronic pain syndromes, including classification according to the International Association for the Study of Pain (IASP).

DESIGN: Descriptive study of consecutive referrals during a two‐year period.

SETTING: A multidisciplinary out‐patient pain clinic focused on occupational rehabilitation.

SUBJECTS: A total of 309 chronic pain patients.

METHODS: After a standardized multimodal physical and psychological examination, the chronic pain syndrome of each patient was assigned one or more clinical diagnoses; assigned to an etiological pain category (nociceptive pain, non‐nociceptive including idiopathic pain, and psychological pain); and coded diagnostically according to IASP taxonomy.

RESULTS: In all, 397 clinical diagnoses were made (ie, a mean of 1.3 diagnoses per patient). A large majority (87%) received a diagnosis of myalgia. Myofascial pain (trigger point syndrome) was diagnosed in two‐thirds of the patients and was the most frequent clinical pain syndrome. A total of 51.8% of the pain syndromes were categorized as nociceptive, 43.0% as idiopathic and less than 1% as pain of psychological origin. Classification using the IASP system yielded a very high proportion of nociceptive, musculoskeletal pain syndromes of high intensity, with widespread pain and/or pain located in the neck/shoulder/arm region, and of dysfunctional etiology.

CONCLUSIONS: Musculoskeletal pain was very common in this series, and myofascial pain syndromes were the most frequent specific pain disorders. However, myofascial pain had generally gone unrecognized by the referring physician. In contrast to findings of other studies, the incidence of low back pain and of primary psychological pain was low. Comparison of the results with those of Swedish epidemiological surveys showed the frequencies of the diagnoses in this series to be representative of chronic pain syndromes in the Swedish general population.
Hantavirus Pulmonary Syndrome: Report of the First Canadian Paediatric Case
Authors: Lee Bonita E , Joffe Ari R , Vaudry Wendy
Published: March 2016

Hantavirus pulmonary syndrome (HPS) was first recognized as a severe respiratory illness transmitted through rodent excreta in the southwestern United States in 1993. As of November 1997, 175 cases have been reported in the United States. The mortality rate of this disease has been reported to be as high as 52% in the United States, and the majority of the cases (94%) involved adults. Twenty‐one cases have been recognized in Canada. This paper describes the first Canadian paediatric case and discusses some of the clinical features of this disease.
Comparison of Budesonide Turbuhaler with Budesonide Aqua in the Treatment of Seasonal Allergic Rhinitis
Authors: Yang William H , Dolovich Jerry , Drouin Michel A , Keith Paul , Haddon Jennifer , Jennings Barbara , the Rhinocort Study Group
Published: March 2016

OBJECTIVE: To compare the effect of budesonide Turbuhaler 400 µg/day with budesonide aqua 256 µg/day in the treatment of seasonal allergic rhinitis (SAR). Secondarily to ascertain patients′ preferences for the two nasal devices and to assess quality of life.

DESIGN: Randomized, multicentre, double‐blind, double‐ dummy, parallel groups study.

SETTING: Private practices and hospital clinics in Ontario, Quebec and Manitoba.

POPULATION: Two hundred and eighty‐four out‐patients with SAR, who were symptomatic during the ragweed season, volunteered for enrolment (243 randomized).

RESULTS: Mean daily nasal symptom scores were significantly reduced with treatment. There were no statistically significant changes from baseline for eye symptoms. Most patients (more than 80%) achieved substantial control of their symptoms with budesonide. The most common nasal and non‐nasal adverse events for both groups were epistaxis and headache. Turbuhaler was easier to use and more convenient to carry, had less of an unpleasant taste, and caused less nasal irritation than the aqua spray. More than twice as many patients preferred Turbuhaler to the aqua spray (69% versus 31%). Improvement in quality of life from baseline to clinic visits was statistically significant in both groups.

CONCLUSION: Once daily use of 256 mg of budesonide aqua and 400 mg of budesonide Turbuhaler are equally safe and efficacious in the treatment of SAR. Patients preferred the budesonide powder formulation delivered via Turbuhaler two to one over the aqua formulation.
Calcium Handling in Airway Smooth Muscle: Mechanisms and Therapeutic Implications
Authors: Janssen Luke J
Published: March 2016

Calcium plays a central role in the activation of many cellular processes, including the most relevant end‐point in airway smooth muscle physiology: contraction. For this reason, the cytosolic concentration of calcium is tightly controlled by an elaborate array of mechanisms. The latter include multiple entry pathways from the extracellular space, a pump on the membrane that extrudes calcium out of the cell, an internal pump that sequesters calcium into an intracellular pool and at least two types of release sites from which sequestered calcium can be released back into the cytosol; all of these mechanisms are tightly regulated by second messenger‐signalling pathways. Understanding of the relationship between calcium handling and contraction ("excitation‐contraction coupling") has progressed from a mechanism in which activation of voltage‐dependent calcium channels plays a central role (as in skeletal muscle) to a mechanism in which a small localized signalling event triggers a massive release of internal calcium (as in cardiac muscle) to a more complicated model in which the internal calcium pool divides the cytosol into two physiologically distinct spaces where the cytosolic concentration of calcium is regulated independently (as in vascular smooth muscle). The changes that may occur in calcium‐handling pathways in asthma and the opportunities for novel approaches to the treatment of asthma are also discussed.
Implementation and Evaluation of a Preprinted Perioperative Antimicrobial Prophylaxis Order Form in a Teaching Hospital
Authors: Au Paul , Salama Suzette , Rotstein Coleman
Published: March 2016

OBJECTIVE: To determine the effect of a preprinted perioperative antimicrobial prophylaxis order form on the appropriateness, standardization and cost of surgical prophylaxis.

DESIGN: A pre‐ and postintervention prospective study with evaluation of drug acquisition costs in selected surgical procedures.

SETTING: A 420‐bed teaching hospital in the Hamilton‐Wentworth region.

PATIENTS: A three‐month survey of 901 consecutive patients followed by a two‐month trial period of 725 consecutive patients undergoing general surgery, orthopedic and urological procedures.

INTERVENTION: A perioperative antimicrobial prophylaxis order form was developed based on guidelines from the literature and input from physician and nursing staff. The form was introduced through educational inservices and put into operation.

MEASUREMENT: The measurement of antimicrobial perioperative prophylaxis appropriateness and drug acquisition costs were assessed pre‐ and postintroduction of the order form. Subsequently, prescriber compliance and satisfaction with the program were also evaluated.

RESULTS: Appropriateness of perioperative antimicrobial surgical prophylaxis was increased from 36% in the baseline period to 79% in the trial period (P<0.0001). A reduction of $440.71 ($23.20/procedure) in drug acquisition costs was observed for 19 matched hip and knee prosthetic surgical procedures between the baseline and trial periods. In addition, compliance with the perioperative order form rose steadily during the trial period. Physician prescribers reported that the form was used, and was appropriate and user‐friendly but that it did not influence their prescribing habits. Nurses responded that the form was helpful and improved the timing of prophylaxis.

CONCLUSIONS: The perioperative antimicrobial prophylaxis order form standardized antimicrobial administration time and resulted in an increase in appropriateness. A reduction in antimicrobial costs for surgical procedures was realized. This quality improvement project has enhanced the quality of patient care.
Transcutaneous Electrical Stimulation and Postoperative Total Knee Arthroplasty Pain
Authors: Mahomed Mohamed N , Maistrelli Gianni L , Mossanen Ayoob , Glazier Derek
Published: March 2016

OBJECTIVE: To determine the efficacy of the Synaptic 2000 in reducing total knee replacement postoperative pain in a prospective randomized controlled trial.

DESIGN: Patients were prospectively randomly assigned to two groups, one receiving seven days of transcutaneous electrical stimulation (TES) therapy in addition to standard postoperative care, and the other receiving standard postoperative care. Both groups received postoperative patient‐controlled analgesia and were switched to oral opiates.

SETTING: Patients were treated at a university teaching hospital for elective primary unilateral total knee replacement.

PATIENTS: All patients consented to enter the study. All had primary osteoarthritis. Fifteen patients were entered into each arm of the study, and all patients completed the study. The mean age of patients was 64 years for treatment and 71 years for controls.

OUTCOME MEASURES: Outcome measures were analgesic consumption, return of knee range of motion and score on a visual analogue pain scale.

RESULTS: No significant differences were noted in postoperative analgesic use, knee range of motion, length of stay or visual analogue pain scale score. Mean total analgesic use of morphine was 148 mg in the TES group and 108 mg in the control group. The TES group mean knee range of motion on postoperative day 7 was 75.3°; it was 73.6° in the control group. Group mean length of stay was 9.5 days in the TES group and 8.3 days in the control group.
Immunity to Diphtheria in a Sample of the Canadian Adult Population
Authors: Pelletier Louise , Duclos Philippe , Gill Peter , Deforest Adamedia
Published: March 2016

OBJECTIVE: To assess immunity to diphtheria in a sample of Canadian adults.

DESIGN: A seroprevalence study of a group of plasmapheresis donors was performed over a four‐month period in 1996. A convenience sample of 1619 sera was collected to obtain a good distribution by age groups and centres. The determination of diphtheria antitoxin concentrations was performed by neutralization of diphtheria toxin in cell culture.

SUBJECTS: A total of 1619 plasmapheresis donors from Halifax, Quebec City, London, Calgary and Edmonton were studied.

RESULTS: Of the 1619 sera, 20.3% tested showed susceptibility to diphtheria (antitoxin concentration less than 0.01 IU/mL). The proportion of susceptibles increased from 9.5% in subjects 30 to 39 years of age to 36.3% in those 60 years of age or more. The age group 20 to 29 years demonstrated a higher proportion of susceptibles (18.3%) than the next age group (30 to 39 years) in four of the five centres. Significant differences in antibody levels were also observed among the centres. There was no statistically significant difference between sexes.

CONCLUSIONS: Overall, detectable antibody and presumably immunity to diphtheria in the present sample of Canadian adults is relatively good. However, reason(s) for the relatively high proportion of susceptibles in those aged 20 to 29 years of age in certain centres, as well as why Canada has not experienced any diphtheria outbreaks in the past 20 years given these susceptibility levels, should be investigated further.
Anti-inflammatory effects of salmeterol compared with beclomethasone in eosinophilic mild exacerbations of asthma: A randomized, placebo controlled trial
Authors: Turner Mark O , Johnston Patrick R , Pizzichini Emilio , Pizzichini Marcia MM , Hussack Pat A , Hargreave Frederick E
Published: March 2016

BACKGROUND: Salmeterol is a potent long acting beta-agonist that is effective in relieving the symptoms and airflow limitation of asthma.

OBJECTIVE: To determine whether the effect of salmeterol on clinical parameters in a mild eosinophilic exacerbation of asthma was similar to that of beclomethasone dipropionate (BDP) and, thus, is due to an anti-inflammatory property.

PATIENTS AND METHODS: Thirty-four asthmatics with a persistent increase in symptoms for at least two weeks and an increase of sputum eosinophils of 4% or more were randomized in a double-blind fashion to one of three groups that received daily treatment with 100 µg salmeterol, 1 mg BDP or placebo in divided doses using identical pressurized inhalers. Patients were treated with study medications for three weeks, followed by one week of open label BDP (500 µg bid). Patients were seen at weekly intervals, and sputum and blood were obtained on each visit. The primary outcome measure was a change in sputum eosinophils, and secondary outcomes were changes in blood eosinophils, eosinophilic cationic protein (ECP) and clinical parameters. Three patients (one in each group) could not produce any sputum after randomization and were excluded from the analysis.

RESULTS: Twelve patients received salmeterol, 10 received BDP and nine received placebo. Salmeterol treatment had no effect on sputum eosinophils geometric mean, (from 35.5 [24.9] to 26.9% [25.8]), blood eosinophils (from 7.6 [4.8] to 7.2% [3.9]) or ECP (from 33.1 [18.1] to 27.8 [16.3] mg/L) but improved morning peak expiratory flow (PEF) and diurnal variation of PEF, and decreased the use of rescue medication more than placebo (P<0.05 for all comparisons). In contrast, BDP improved both inflammatory indexes (sputum eosinophils from 22.5 [17.9] to 5.7% [6.8], blood eosinophils from 9.0 [5.5] to 2.1% 1.0, and serum ECP from 36.5 [22.0] to 16.1 [10.1] mg/L) as well as clinical parameters.

CONCLUSIONS: These results show that salmeterol improves the symptoms and airway function of patients with asthma, but has no effect on eosinophilic airway infiltration. These findings support current asthma guidelines, which recommend the initial use of inhaled steroid to maximize clinical improvement. While salmeterol also produces clinical improvement, it does not suppress sputum eosinophilia. The analysis of induced or spontaneous sputum for inflammatory indexes may be a valuable clinical test to guide the use of inhaled steroid and/or a long acting beta-agonist.
Platelet Depletion and Severity of Streptococcal Endocarditis
Authors: Dall Lawrence , Miller Todd , Herndon Betty , Diez Ireneo , Dew Michelle
Published: March 2016

OBJECTIVE: To evaluate the importance of thrombocytopenia in streptococcal endocarditis using an animal model.

DESIGN: A model of human septic endocarditis was established in rats (polyethylene catheters across the aortic valve and administration of Streptococcus sanguis, 5×107 colony forming units [cfu] intravenous). Thrombocytopenia at four levels was produced by antiplatelet serum. Secondary methods of producing thrombocytopenia were also evaluated. At sacrifice (96 h after platelet depletion and 72 h after infection), vegetations were removed, weighed, diluted, plated and counted. Potential mechanisms of the dose‐response relationship between vegetation density and platelet count were evaluated.

SETTING: Controlled research laboratory experiments.

POPULATION STUDIED: Animal models of streptococcal endocarditis.

MAIN RESULTS: The bacterial density of the aortic valve vegetations significantly increased as the platelet count decreased (P=0.0007). In severely thrombocytopenic animals (two‐dose antiplatelet serum), data suggest increased vegetation embolism. Platelet depletion, which was minimal with chemical methods, was produced most effectively by antithrombocyte serum. Platelet surfaces in endocarditis were found to express elevated CD62p proteins (72.7% endocarditis, 34.7% control). Platelet protein fractions were evaluated in vitro by both streptocidal (P=0.19) and phagocytosis‐stimulating assays. Platelet presence in mature aortic valve vegetations averaged only about 2%.

CONCLUSIONS: In platelet depletion experiments using a rat model, a dose‐response relationship of peripheral circulating platelet depletion to aortic valve vegetation density was found. The mechanism relating thrombocytopenia to endocarditis severity remains unresolved.
The Nature and Prevalence of Pain in Dreams
Authors: Zadra Antonio L , Nielsen Tore A , Germain Anne , Lavigne Gilles , Donderi DC
Published: March 2016

BACKGROUND: Little is known about the frequency and nature of pain in dreams. Several authors have suggested that pain may be beyond the representational capability of dreaming.

OBJECTIVE: To obtain more detailed information on the nature and prevalence of pain in a larger sample of everyday dreams collected through home logs. To examine the context within which dreamed pain occurs and to assess participants′ retrospective recall of past experiences of pain in dreams.

METHOD: One hundred and eighty‐five participants completed a battery of questionnaires and recorded their dreams for two consecutive weeks.

RESULTS: Retrospective responses to the questionnaire indicate that close to 50% of individuals report having experienced pain in their dreams at least once. A total of 3045 dreams were reported in the home dream logs. Eighteen of these dreams contained unambiguous references to the subject experiencing pain.

DISCUSSION: Pain sensations in dreams are reported as being realistic, localized to a specific area of the body, typically resulting from violent encounters with other characters and often accompanied by intense affect. A model is proposed to explain how sensory experiences such as pain can be produced in the dream state.

CONCLUSION: Cognitive systems that contribute to the representation of pain imagery are sometimes functional during dreaming.
Serological Evidence of Increased Coccidioides immitis Infections in Western Canada in 1996
Authors: Prasad Errol , Diediw Patricia , Fernandes Donna , Hodge Lorreen , Ower Katherine , Rennie Robert
Published: March 2016

OBJECTIVE: To investigate the epidemiology of Coccidioides immitis infection in persons returning to western Canada from C immitis endemic zones in southwestern United States.

DESIGN: Review of C immitis serology requests from 1996.

METHODS: Data were based on review of enzyme immunoassay and immunodiffusion results from 1993 to 1996 inclusive. Detailed information on clinical presentation, treatment and outcome of disease process was obtained through questionnaires and interviews with physicians who submitted Coccidioides serology requests in 1996.

RESULTS: Positive serology for C immitis increased from 4.7% to 5.2% (between 1993 and 1995 inclusive) to 10.7% in 1996. Enzyme immunoassay for immunoglobulin G and/or immunoglobulin M or immunodiffusion was positive in 25 patients in 1996. The mean age of these patients was 62 years, and the predominant clinical presentation was pulmonary infiltrate with fever. All patients with positive serology were known to have travelled to central or southwestern Arizona or southern California.

CONCLUSIONS: Travel to a defined coccidioidomycosis endemic zone presents a risk for the older traveller. Serology for C immitis supported the clinical, histological and microbiological diagnoses in patients who had travelled to this defined endemic zone.
Diarrhea Recurrence in Patients with Clostridium difficile‐Associated Diarrhea: Role of Concurrent Antibiotics
Authors: Alfa MJ , Harding GKM , Ronald AR , Light RB , MacFarlane N , Olson N , DeGagne P , Kasdorf K , Simor A , MacDonald KS , Louie L
Published: March 2016

OBJECTIVE: To monitor prospectively patients with Clostridium difficile‐associated diarrhea (CAD) in a six hundred bed tertiary care hospital to determine which factors influenced the recurrence of the diarrhea.

DESIGN: A prospective, nonrandomized study. After an initial diagnosis of CAD, patients were interviewed, and each week stool samples and environmental samples were monitored for the presence of toxigenic C difficile for as long as the patients remained in hospital. The relationship of concurrent antibiotics, prolonged fecal excretion of organism or toxin, and environmental contamination was assessed.

PATIENTS: Over a two‐and‐a‐half year period, 75 consecutive patients with CAD were selected and those who gave their written informed consent were enrolled. A control group to evaluate environmental contamination consisted of 75 patients with diarrhea not associated with C difficile.

RESULTS: Of the 75 CAD patients, 11 (14.7%) had a recurrence of their diarrhea. Diarrhea recurrence was associated with an increased rate of prolonged excretion of toxigenic organism and/or C difficile toxin(s) (nine of 11 [81.8%] compared with nine of 64 [14.1%]; P≤0.0001; relative risk 14.25; 95% CI 3.383 to 60.023). The risk of diarrhea recurrence was not related to a specific antibiotic but to concurrent therapy. Treatment within 30 days of initial CAD‐specific treatment with an antibiotic other than metronidazole or vancomycin occurred significantly more frequently in patients with recurrence of diarrhea compared with those who did not have a recurrence (eight of 11 [72.7%] compared with 22 of 64 [34.4%], P=0.022; relative risk 4; 95% CI 1.153 to 13.881). The environmental contamination rate for toxigenic C difficile in week one in the rooms of patients with diarrhea not caused by C difficile was low (two of 75 [2.6%]) compared with week one data for patients with CAD (14 of 75 [18.7%], P=0.002; relative risk 1.922; 95% CI 1.479 to 2.498). The most frequent site contaminated was the bedpan sprayer (eight of 14 [57.1%]). Pulsed field gel electrophoresis analysis of stool and environmental toxigenic isolates indicated that there was not a single endemic strain of C difficile.

CONCLUSIONS: This study indicates that the recurrence of diarrhea may be related to concurrent ‘other’ antibiotics. Although data indicated that there was a correlation between diarrhea recurrence and prolonged fecal excretion of toxin, further studies are required to clarify the clinical significance.
No Increase in Frequency of Antifungal Resistance among Yeasts Isolated from Normally Sterile Sites in Patients at Foothills Hospital from 1993 to 1996
Authors: Gibb A Patrick , Thorson Cheryl , van den Elzen Harry
Published: March 2016

OBJECTIVE: To determine the prevalence of resistance to antifungal drugs among yeasts isolated from sterile sites from patients in one hospital and the relationship of resistance to antifungal use, and to assess whether resistance was increasing.

METHOD: Susceptibility testing performed by National Committee for Clinical Laboratory Standards (NCCLS) (Villanova, Pennsylvania) microdilution method and by E test. Antifungal use was determined by selected chart review and from pharmacy data.

SPECIMENS AND SETTING: Tertiary care adult hospital with neonatal intensive care.

POPULATION STUDIED: Distinct yeast isolates from sterile site specimens collected during the years 1993 to 1996.

RESULTS: A total of 132 yeast isolates were studied, of which 78 (59%) were Candida albicans. The proportion of C albicans remained steady over the four‐year period, and there was no trend to increased resistance among C albicans. The number of isolates of all species with fluconazole microdilution minimum inhibitory concentration (MIC) greater than 8 mg/L in each of the four years were one of 32 in 1996, three of 26 in 1994, six of 33 in 1995, and one of 41 in 1996. A single isolate had an itraconazole microdilution MIC greater than 0.5 mg/L in each year. Prior use of antifungal therapy was rare in this patient population.

CONCLUSIONS: The increase in resistance to antifungal drugs reported by some centres did not occur in this institution over the course of the study. This experience may reflect differences in infection control practices and in patterns of use of antifungal agents. The NCCLS method was found to be superior to the E test as a routine method for testing susceptibility of yeasts.
Host Defence to Pulmonary Mycosis
Authors: Mody Christopher H , Warren Peter W
Published: March 2016

OBJECTIVE: To provide a basic understanding of the mechanisms of host defense to pathogenic fungi. This will help physicians understand why some patients are predisposed to fungal infections and update basic scientists on how microbial immunology applies to fungal disease.

DATA SOURCES: English articles from 1966 to present were identified from a MEDLINE search.

STUDY SELECTION: Articles were identified by a MEDLINE search of ‘exp lung/’ or ‘exp lung diseases/’ and ‘exp fungi/’. The titles and abstracts were screened to identify articles that contained salient information pertaining to host defense of respiratory mycoses.

DATA EXTRACTION: Information was summarized from the articles pertaining to host defense of pulmonary mycosis that had been identified by the MEDLINE search.

DATA SYNTHESIS: Fungi represent a unique and highly diverse group of pathogenic organisms that have become an increasingly prevalent cause of life‐threatening illness. A worldwide increase in persons with immunodeficiency has been a major contributing factor to the increase in fungal disease. As a result, clinicians are faced with an expanding array of fungal infections that pose diagnostic and therapeutic challenges. The respiratory tract is the route of acquisition for many important fungal infections; thus, understanding the host defense in the lung is an essential component of understanding host defense to fungal disease. With this understanding, fungi may be divided on the basis of the predilection of certain mycosis for specific immune defects.

CONCLUSIONS: By separating fungi based on the host immune defects that predispose to disease, in conjunction with traditional divisions based on the geographic distribution of fungi, clinicians are able to focus their diagnostic efforts and to identify fungal pathogens better. In addition, an understanding of the normal host defense mechanisms that serve to control fungal infections is essential to the development of novel antifungal therapies.
The 1996 and 1997 National Survey of Physician Asthma Management Practices: Background and Study Methodology
Authors: Jin Robert L , Choi Bernard CK
Published: March 2016

OBJECTIVES: To collect national baseline information on asthma management practices by physicians, and to compare these practices with the recommendations of the Canadian Asthma Consensus Conference (‘the guidelines’).

DESIGN: Cross‐sectional survey of representative samples of physicians in Canada in late 1996 and early 1997.

POPULATION STUDIED: Five specialty types of physicians who manage asthma patients: respirology, pediatrics, internal medicine, allergy and clinical immunology, and general practice and family medicine. Stratified sampling by province and specialty was used to select physicians for the study. Weighting was used in the analysis to generalize the results to the national level for the five specialty groups of physicians.

METHOD: Mailed questionnaire, self‐administered by the respondent; three mailings of the questionnaires were used to increase the response rate.

MAIN RESULTS: The frequency with which each of the five specialty types chose specific asthma management choices was determined, using weighted percentages representative of the specialty groups on a national basis. ANOVA determined the statistically significant differences among the five specialties in choosing particular asthma management actions. Then, logistic regression was used to calculate the odds ratios showing an association between the characteristics of the physician respondents and specific asthma management choices that they made in the survey.

CONCLUSIONS: The data analysis demonstrated significant variations among physicians in asthma management practices, according to specialty type and other characteristics. The initial report was released in April 1998, and manuscripts for journal submissions are being prepared.
A Randomized Controlled Study of the Pain‐ and Tension‐Reducing Effects of 15 Min Workplace Massage Treatments Versus Seated Rest for Nurses in a Large Teaching Hospital
Authors: Katz Joel , Wowk Adarose , Culp Dianne , Wakeling Heather
Published: March 2016

OBJECTIVES: To evaluate whether a series of eight 15 min, on‐site massage treatments would be effective in reducing pain and tension in nursing staff at a large teaching hospital.

HYPOTHESES: On‐site massage treatment would result in reduced pain intensity and tension levels and increased relaxation compared with a control group receiving seated rest.

DESIGN: Randomized, controlled trial of eight sessions of Swedish massage therapy versus eight sessions of seated rest.

PARTICIPANTS: Thirty‐two hospital staff (29 registered nurses and three clerical staff) volunteers.

SETTING: Participants were recruited from a tertiary care centre.

OUTCOME MEASURES: Pulse rate (beats/min), pain measured using a 10 cm Visual Analogue Scale (VAS), tension (VAS), relaxation (yes/no) and the Profile of Mood States (POMS) were measured before and after each session.

RESULTS: The groups did not differ significantly on baseline demographic variables or in attendance rates. Post‐treatment VAS pain, VAS tension, and total POMS scores showed the same pattern of results: one‐way ANCOVAs revealed a significant effect of the covariate (mean pretreatment score averaged across sessions attended) and a significant main effect for groups indicating that post‐treatment pain, tension and POMS scores were significantly lower in the massage group than in he seated rest group (all P<0.001). A greater proportion of the massage group reported a sense of relaxation, and had pain and tension relief that persisted for up to a day or longer post massage (P<0.0009).

CONCLUSIONS: The provision of on‐site massage treatments for nursing staff at a large teaching hospital resulted in significant reductions in pain and tension levels and an increase in overall mood compared with a control group that received seated rest.