bluuebunny/crossref_metadata_2025 huggingface dataset:
Nitric Oxide and Prostaglandins Potentiate the Liver Regeneration Cascade
Authors: Smith Jodi M Schoen , Lautt W Wayne
Published: March 2016

The liver has the remarkable ability to regenerate following damage or surgical resection. Although this feature of the liver has been studied for over 100 years, the trigger of the liver regeneration cascade remains controversial. Recent experimental evidence supports the hypothesis that nitric oxide (NO) and prostaglandins (PGs), released secondary to an increase in the blood flow-to-liver mass ratio following two-thirds partial hepatectomy (PHx), work synergistically to trigger liver regeneration. To extend this research, the hypothesis that NO and PGs are potential therapeutic targets to potentiate the liver regeneration cascade is tested. The NO donor s-nitroso-n-acetylpenicillamine, the phosphodiesterase V antagonist zaprinast (ZAP) and PGI2each potentiatedc-fosmessenger RNA expression, an index of initiation of the liver regeneration cascade, following PHx. Also, the triple combination of s-nitroso-n-acetylpenicillamine, ZAP and PGI2potentiatedc-fosmessenger RNA expression. These results support the hypothesis that NO and PGs can potentiate initiation of the regeneration cascade. An additional index of liver weight restoration 48 h after PHx was also used to test the hypothesis, because this index encompasses the entire liver regeneration cascade. ZAP and 6-keto-PGF1α, a stable metabolite of PGI2, and the combination of ZAP and 6-keto-PGF1α, each potentiated liver weight restoration 48 h after PHx. These results also provide support for the hypothesis that NO and PGs are possible therapeutic targets to potentiate liver regeneration following surgical resection.
Desperate Therapies and the Amazing Race for Antimicrobial Alternatives
Authors: Joffe A Mark
Published: March 2016

Infectious diseases remain a leading cause of death worldwide. Despite this fact, as well as the increasing recognition that microbial resistance is emerging as a serious threat to human health, antimicrobial research and development are declining. The current situation has evolved through a complex interaction of scientific, economic and regulatory forces. New approaches are needed. If therapies are unavailable or failing, we have only two options: we can prevent infections or we can develop new strategies to deal with them.
Comparison of Nasal Cannulas and the OxyArm in Patients Requiring Chronic Domiciliary Oxygen Therapy
Authors: Paul James , Otvos Ted
Published: March 2016

OBJECTIVES: The present study was designed to compare the performance of a new oxygen delivery device, the OxyArm (OA) (Southmedic Inc, Canada), with a standard nasal cannula (NC) (Salter‐Style 1600, Salter Labs, USA) for both oxygen delivery and patient preference in patients on long‐term oxygen therapy (LTOT).

DESIGN AND SETTING: Randomized crossover study conducted in an outpatient setting.

PATIENTS AND METHODS: Twenty‐five clinically stable LTOT patients were randomly assigned to an oxygen device (NC or OA) sequence. The baseline saturation level was determined, and patients were then treated at oxygen flow rates of 2 L/min, 3 L/min, 4 L/min, 5 L/min, 6 L/min and 7 L/min for 10 min each while at rest. Patients were then crossed over to the second device and the procedure was repeated. Oximetry values were then obtained following a 5 min walk test using the same device sequence. Lastly, the patients were sent home for a four‐week home OA trial, after which, they filled out a questionnaire.

RESULTS: This sample of patients was primarily elderly ex‐smokers with severe chronic obstructive pulmonary disease on oxygen therapy for the majority of the day. The primary findings were that the OA and NC were equally effective in delivering oxygen to patients and maintaining their oxygen saturation at both rest (P=0.82) and during a 5 min walk test (P=0.83). A patient’s personal experience and comfort were identified as the most important factors in deciding on an oxygen device. Most patients felt that the OA was most suited for oxygen therapy while at rest.

CONCLUSIONS: The OA proved to be similar to the NC in delivering oxygen and maintaining saturation in patients on LTOT. The OA is one of the few alternatives to using NCs for these patients and, with its current design, appears to be most suited for resting conditions.
Planning for the Pandemic
Authors: Embree Joanne
Published: March 2016

Over the past year, many of us have become involved in the development of strategic plans for the hospitals, health authorities and clinical practices in which we work in case an influenza pandemic occurs in the very near future. Planning for this on the front lines is difficult, due in large part to the uncertainties involved. How will the pandemic evolve? Is the current H5N1 strain of bird flu going to be ′the′ one? How closely will the pandemic resemble that of 1918? Will it have the same transmission characteristics as the yearly endemic influenza strains or will it be so different that our routine infection prevention precautions for influenza will be ineffective? Will there be a useful vaccine that is widely available and safe? That the current death rate associated with H5N1 strain infections in humans is approximately 60% is quite frightening; an influenza pandemic with such a high death rate is almost incomprehensible. Therefore, it is a relief to hear that the upper estimates are at a much lower rate of approximately 5% in most suggested epidemiological models. Will the use of oseltamivir really work to prevent infection, illness, morbidity or death? If so, will there be sufficient supplies available in Canada? How are we supposed to make plans so that our medical system, which is already quite stressed, will be functional under the extreme conditions that are anticipated? One major difficulty is that we do not actually know how soon, if at all, the pandemic will occur. Specific, highly detailed plans made today may not be applicable in the future. As a result, most contingency plans are being made for a generic situation based on the general assumption that some percentage of the workforce will be absent from work for some specified period of time. In general, the plans tend to be impersonal because they concentrate on essential functions that need to be undertaken in an institution and assume that, with training, all personnel can cross‐cover these services to accommodate for those times when the employees who routinely perform those tasks are absent.
The Life, Achievements and Legacy of a Great Canadian Investigator: Professor Boris Petrovich Babkin (1877–1950)
Authors: Beck Ivan T
Published: March 2016

The present paper reviews the life and achievements of Professor Boris Petrovich Babkin (MD DSc LLD). History is only worth writing about if it teaches us about the future; therefore, this historical review concludes by describing what today’s and future gastrointestinal physiologists could learn from Dr Babkin’s life.

Dr Babkin was born in Russia in 1877. He graduated with an MD degree from the Military Medical Academy in St Petersburg, Russia, in 1904. Not being attracted to clinical practice, and after some hesitation concerning whether he would continue in history or basic science of medicine, he entered the laboratory of Professor Ivan Petrovich Pavlov. Although he maintained an interest in history, in Pavlov’s exciting environment he became fully committed to physiology of the gastrointestinal system. He advanced quickly in Russia and was Professor of Physiology at the University of Odessa. In 1922, he was critical of the Bolshevik revolution, and after a short imprisonment, he was ordered to leave Russia. He was invited with his family by Professor EH Starling (the discoverer of secretin) to his department at University College, London, England. Two years later, he was offered a professorship in Canada at Dalhousie University, Halifax, Nova Scotia. After contributing there for four years, he joined McGill University, Montreal, Quebec, in 1928 as Research Professor. He remained there for the rest of his career. Between 1940 and 1941, he chaired the Department, and following retirement, he remained as Research Professor. At the invitation of the world-famous neurosurgeon, Wilder Penfield, Dr Babkin continued as Research Fellow in the Department of Neurosurgery until his death in 1950 at age 73.

His major achievements were related to establishing the concept of brain-gut-brain interaction and the influence of this on motility, as well as on interface of multiple different cells, nerves and hormones on secretory function. He had a major role in the rediscovery of gastrin. He established a famous school of gastrointestinal physiologists at McGill University. He supported his trainees and helped them establish their careers. He received many honors: a DSc in London, England, and an LLD from Dalhousie University. Most importantly, he was the recipient of the Friedenwald Medal of the American Gastroenterological Association for lifelong contributions to the field. Dr Babkin taught us his philosophical aspect of approaching physiology, his devotion to his disciples and his overall kindness. Most importantly, he has proven that one can achieve international recognition by publishing mainly in Canadian journals. He is an example to follow.
13C Urea Breath Test forHelicobacter pylori: Evaluation of 10-minute Breath Collection
Authors: Mauro Marina , Radovic Vladimir , Wolfe Melanie , Kamath Markad , Bercik Premsyl , Armstrong David
Published: March 2016

AIM: To determine whether a shortened13C urea breath test (13C UBT) (breath collection time of 10 min) is as reliable as the standard assay (30 min).

METHODS: Two hundred ninety-seven patients (mean ± SD: 53±16 years, 57% female) completed a13C UBT. Breath samples were obtained at baseline and at 5 min intervals up to 30 min. Sixty-seven patients also underwent endoscopic biopsy. Cluster analysis was performed on the13C UBT data to determine the optimal cut-off point at each time interval. Sensitivity and specificity of the13C UBT at all intervals compared with histology and culture and against the standard 30 min interval were determined.

RESULTS: The calculated optimal cut-off points for each time interval (T), expressed as delta over baseline (δ‰), were 3.29 δ‰ at T5, 3.15 δ‰ at T10, 3.42 δ‰ at T15, 3.17 δ‰ at T20, 2.99 δ‰ at T25and 2.82 δ ‰ at T30. Except at T5, the risk of false-positive and false-negative test results at each time interval was lower than 2.3% using these cut-off points. When replacing the cut-off points with 3.0 δ‰, the risk of error was still lower than 2.3%. The test at T10showed 98.6% sensitivity and 98.6% specificity compared with T30. T10and T30showed 100% sensitivity and 96% specificity compared with histology and culture.

CONCLUSIONS: The13C UBT is an accurate, noninvasive test, even when the breath sample interval is reduced to 10 min. The present study confirms the validity of a cut-off point of 3.0 δ‰ for the 10 min and 30 min13C UBT.
Public Reporting: Illumination or Shadows?
Authors: Nicolle LE
Published: March 2016

The infection control communities in Britain and the United States (US) are experiencing an extraordinary conceptual shift with legislated mandatory reporting of hospital infections. In Britain, this shift began in 2001 with methicillin‐resistant Staphylococcus aureus (MRSA) bacteremia episodes (1), which are reported to the National Health Service and are publically available on a Health Protection Agency Web site. In the US, the impetus for public reporting of infection rates has come from consumer groups (2). These organizations have bypassed health care organizations and public health and other practitioners, and have addressed their demands to state legislatures. At least eight states have now passed and several more are considering legislation to mandate reporting. The process has been rancorous and, at least initially, vigorously opposed by health care organizations and infection control practitioners.
Surgical Management of Acute Necrotizing Lung Infections
Authors: Reimel Beth Ann , Krishnadasen Baiya , Cuschieri Joseph , Klein Matthew B , Gross Joel , Karmy-Jones Riyad
Published: March 2016

BACKGROUND: Surgical resection for acute necrotizing lung infections is not widely accepted due to unclear indications and high risk.

OBJECTIVE: To review results of resection in the setting of acute necrotizing lung infections.

METHODS: A retrospective review of patients who underwent parenchymal resection between January 1, 2000, and January 1, 2006, for management of necrotizing pneumonia or lung gangrene.

RESULTS: Thirty-five patients underwent resection for lung necrosis. At the time of consultation, all patients presented with pulmonary sepsis, and also had the following: empyema (n=17), hemoptysis (n=5), air leak (n=7), septic shock requiring pressors (n=8) and inability to oxygenate adequately (n=7). Twenty-four patients were ventilated pre-operatively. Eleven patients had frank lobar gangrene, and the other patients had combinations of necrotizing pneumonia and abscesses. In 10 patients, preresection procedures were performed, including percutaneous drainage of an abscess (n=4), thoracoscopic decortication (n=4) and open decortication (n=2). Procedures included pneumonectomy (n=4), lobectomy (n=18), segmentectomy (n=2), wedge resection (n=4) and debridement (n=7). There were three (8.5%) postoperative deaths – two due to multiple organ failure and one due to anoxic brain injury. All patients not ventilated preoperatively were weaned from ventilatory support within three days. Of those ventilated preoperatively, three died, while four remained chronically ventilator dependent.

CONCLUSIONS: Surgical resection for necrotizing lung infections is a reasonable option in patients with persistent sepsis who are failing medical therapy. Ventilated patients have a worse prognosis but can still be candidates for resection. Patients who are hemodynamically unstable appear to have better outcomes if they can be stabilized before resection.
An Unusual Pulmonary Condition Presenting following Trauma
Authors: Turkington John RA , McAteer Eamon , Convery Rory P
Published: March 2016

An 18-year-old man presented to the emergency department following an assault. He complained of left-sided pleuritic chest pain and difficulty breathing. Clinical examination revealed reduced air entry and coarse crepitations at the left lung base. A chest x-ray showed a large opacity at the left lung base that contained multiple cystic areas with air-fluid levels. Due to the history of trauma, a provisional diagnosis of a ruptured hemidiaphragm with small bowel herniation was made. Further imaging, including ultrasound, spiral computed tomography and magnetic resonance angiography, showed an aberrant vessel supplying the opacity and drainage into the pulmonary venous system. A diagnosis of a bronchopulmonary sequestration (intralobar type) was made. The differential diagnosis of the radiographic appearance is also discussed.
Suppression of Pain by Exposure of Acupuncture Points to Polarized Light
Authors: Limansky Yuri P , Tamarova Zinaida A , Gulyar Sergiy A
Published: March 2016

BACKGROUND: According to clinical studies, the stimulation of acupuncture points (APs) by a variety of methods (eg, needles, pressure, etc) is an effective method for the treatment of many pain syndromes. However, no experimental proof exists showing that the exposure of APs to low‐intensity incoherent polarized (P) light evokes an analgesic affect.

OBJECTIVES: The authors’ previous work, using mice, shows that the exposure of APs to low‐intensity microwaves effectively decreases pain. The purpose of the present study was to determine whether exposure of APs to low‐intensity incoherent P light evokes a statistically significant reduction in pain.

METHODS: The effects of P light on behavioural responses to acute and tonic pain were tested in mice. The threshold of vocalization during electrical stimulation of the foot (acute pain) was measured before and after exposure of AP E‐36 to P light. The duration of licking the formalin‐injected foot (tonic pain) was investigated in control mice and mice exposed to P light on APs E‐36, V‐56 and V‐60 or on skin that did not contain analgesic APs.

RESULTS: Exposure of APs to P light evoked a statistically significant increase in pain threshold by 34.2% to 59.1%, and shortened the licking time by 32.3% to 50% in mice. The most effective AP was E‐36 in both the painful foot and the normal foot. After 2 min, 6 min and 10 min of P light exposure, analgesia was 7.6%, 30.9% and 50%, respectively. The exposure to P light on skin that did not contain analgesic APs did not evoke significant effect.

CONCLUSIONS: The results show the efficacy of pain suppression by exposure of antinociceptive APs to P light.
Community‐Acquired Antibiotic Resistance in Urinary Isolates from Adult Women in Canada
Authors: McIsaac Warren J , Mazzulli Tony , Permaul Joanne , Moineddin Rahim , Low Donald E
Published: March 2016

BACKGROUND: There are currently limited data regarding the prevalence of antimicrobial‐resistant organisms causing community‐acquired urinary tract infections among adult women in Canada. Trimethoprim‐sulfamethoxazole (TMP‐SMX) is the recommended first‐line empirical antibiotic treatment, unless resistance of Escherichia coli to TMP‐SMX exceeds 20%.

OBJECTIVE: To assess current levels of TMP‐SMX‐resistant E coli in community‐acquired cases of urinary tract infection in adult women.

METHOD: Assessment of urine culture reports obtained from 21 laboratories across Canada, submitted by family physicians for women aged 16 years and older.

RESULTS: In 2199 adult women with a positive urine culture, 1079 (49.1%) of pathogens isolated were resistant to at least one antibiotic and 660 (30.0%) were multidrug‐resistant (resistant to two or more antibiotics). TMP‐SMX resistance was seen in 245 of 1613 (15.2%) E coli isolates (95% CI 13.5 to 17.0). This proportion was higher in women 50 years of age and older (155 of 863 isolates [18.0%]; P=0.001), in British Columbia (70 of 342 isolates [20.5%]) and in Ontario (62 of 370 isolates [16.8%]) when compared with eastern provinces (65 of 572 isolates [11.4%]; P=0.001). Fluoroquinolone‐resistant E coli occurred in 107 of 1557 (6.9%) isolates (95% CI 5.7 to 8.2), with the highest level found in British Columbia (54 of 341 isolates [15.8%]; P=0.001).

CONCLUSION: TMP‐SMX continues to be appropriate as first‐line empirical treatment of acute cystitis in adult women in Canada, as resistance remains below 20%. However, TMP‐SMX resistance is higher in older women and in some provinces. The level of fluoroquinolone‐resistant E coli is highest in British Columbia.
Estimated Numbers of Community Cases of Illness Due to Salmonella, Campylobacter and Verotoxigenic Escherichia Coli: Pathogen‐Specific Community Rates
Authors: Thomas M Kate , Majowicz Shannon E , Sockett Paul N , Fazil Aamir , Pollari Frank , Doré Kathryn , Flint James A , Edge Victoria L
Published: March 2016

OBJECTIVE: To estimate the annual number of cases of illness due to verotoxigenic Escherichia coli (VTEC), Salmonella and Campylobacter in the Canadian population, using data from the National Notifiable Disease registry (NND), estimates of under‐reporting derived from several National Studies on Acute Gastrointestinal Illness, and the literature.

METHODS: For each of the three pathogens (VTEC, Salmonella and Campylobacter), data were used to estimate the percentage of cases reported at each step in the surveillance system. The number of reported cases in the NND for each pathogen was then divided by these percentages. In cases where the pathogen‐specific estimates were unavailable, data on acute gastrointestinal illness were used, accounting for differences between those with bloody and nonbloody diarrhea.

RESULTS: For every case of VTEC, Salmonella and Campylobacter infection reported in the NND, there were an estimated 10 to 47, 13 to 37, and 23 to 49 cases annually in the Canadian population, respectively.

CONCLUSIONS: The authors estimate that a significant number of infections due to VTEC, Salmonella and Campylobacter occur each year in Canada, highlighting the fact that these enteric pathogens still pose a significant health burden. Recognizing the significant amount of under‐reporting is essential to designing appropriate interventions and assessing the impact of these pathogens in the population.
Acute Pancreatitis and Upper Gastrointestinal Bleeding as Presenting Symptoms of a Duodenal Brunner’s Gland Hamartoma
Authors: Stermer Edy , Elias Nizar , Keren Dean , Rainis Tova , Goldstein Omer , Lavy Alexandra
Published: March 2016

Brunner’s gland hamartomas are rare, benign small bowel tumours. There were fewer than 150 cases reported in the English literature until the end of the last century. These hamartomas may be discovered incidentally during an upper gastrointestinal tract endoscopy. Otherwise, they may be diagnosed in patients presenting with acute upper gastrointestinal bleeding, anemia or symptoms of intestinal obstruction. The case of a young woman admitted for acute upper gastrointestinal bleeding along with acute pancreatitis is presented. The investigation revealed a giant Brunner’s gland hamartoma in the second part of the duodenum. After total endoscopic resection of the tumour, the patient has remained completely asymptomatic for a follow-up period of seven months.
A Survey of the Pain Experienced by Males and Females with Fabry Disease
Authors: Gibas Andrea L , Klatt Regan , Johnson Jack , Clarke Joe TR , Katz Joel
Published: March 2016

BACKGROUND: The clinical onset of Fabry disease, a rare, X‐linked, multisystemic disorder, is marked by neuropathic pain. Males suffer extensively from this disease. Females, as genetic ‘carriers’, have traditionally been viewed as either asymptomatic or mildly afflicted with this disease.

OBJECTIVES: To describe Fabry‐related pain and compare experiences between the sexes. Patients’ perceptions of physician pain assessments were also examined.

METHODS: A disease‐specific questionnaire was accessible on‐line (www.fabry.org) and mailed to 552 members of a Fabry disease support group.

RESULTS: The response rate was 14.3% for the support group‐based mail questionnaire. Females (58.0%) were significantly older (mean ± SD 45.9±13.5 years) than males (mean ± SD 40.0±12.1; t [86]=−2.11, P<0.05). Females were diagnosed with Fabry disease later (31.1±14.0 years) than males (24.2±11.9 years; t [86]=−2.43, P<0.05). Females (mean score for pain disability rating 3.0±1.4) suffered more extensive disability from migraine pain (mean score 2.2±1.3; F [1, 74]=45.0, P<0.005), and, unlike males, did not exhibit a decline in pain intensity with disease duration. Satisfaction with physician pain assessments was moderate.

CONCLUSIONS: Contrary to the traditional view of females as carriers, females with Fabry disease experienced intense disease‐related pain; pain produced comparable distress and impairment in both sexes. The diagnostic delay and absence of a decline in pain symptoms over time in females suggest additional disease burden. Females may be triply disadvantaged in the health care system due to disease rarity, devalued carrier status and sex.
Pneumococcal Conjugate Vaccination in Canadian Infants and Children Younger than Five Years of Age: Recommendations and Expected Benefits
Authors: Mcclure Carol A , Ford Michael W , Wilson Jeff B , Aramini Jeff J
Published: March 2016

INTRODUCTION: Streptococcus pneumoniae infection may result in invasive pneumococcal disease (IPD), such as bacteremia, meningitis and bacteremic pneumonia, or in non‐IPD, such as pneumonia, sinusitis and otitis media. In June 2001, a heptavalent pneumococcal conjugate vaccine (PCV7) (Prevnar, Wyeth Pharmaceuticals, Canada) was approved for use in children in Canada. The objective of the present paper is to review S pneumoniae‐induced disease incidence and vaccine recommendations in Canadian infants and children younger than five years of age. Particular attention is given to the expected benefits of vaccination in Canada based on postmarketing data and economic modelling.

METHODS: Searches were performed on PubMed and Web of Science databases and specific Canadian journals using the key words ′pneumococc*′, ′vaccine′, ′conjugate′, ′infant′ and ′Canadian′.

RESULTS AND DISCUSSION: PCV7 appears to be safe and effective against IPD and non‐IPD in children younger than five years of age and, more importantly, in children younger than two years of age (who are at highest risk for IPD). An examination of postmarketing data showed a reduction in incidence of pneumococcal disease in age groups that were vaccinated and in older age groups, indicating the likelihood of herd protection. Concurrently, there was a reduction in the occurrence of antimicrobial‐resistant isolates.

CONCLUSIONS: The results from the present review suggest that PCV7 is currently benefiting Canadian children and society by lowering S pneumoniae‐associated disease. Additional gains from herd protection and further reductions in antimicrobial resistance will be achieved as more Canadian children younger than five years of age are routinely vaccinated with PCV7.
Serum Creatinine in Patients with Advanced Liver Disease Is of Limited Value for Identification of Moderate Renal Dysfunction: Are the Equations for Estimating Renal Function Better?
Authors: MacAulay Jillian , Thompson Kara , Kiberd Bryce A , Barnes David C , Peltekian Kevork M
Published: March 2016

BACKGROUND: The Cockcroft-Gault formula (CGF) is used to estimate the glomerular filtration rate (GFR) based on serum creatinine (Cr) levels, age and sex. A new formula developed by the Modification of Diet in Renal Disease (MDRD) Study Group, based on the patient’s Cr levels, age, sex, race and serum urea nitrogen and serum albumin levels, has shown to be more accurate. However, the best formula to identify patients with advanced liver disease (ALD) and moderate renal dysfunction (GFR 60 mL/min/1.73 m2or less) is not known. The aim of the present study was to compare calculations of GFR, using published formulas (excluding those requiring urine collections) with standard radionuclide measurement of GFR in patients with ALD.

METHODS: Fifty-seven consecutive subjects (40% women) with a mean age of 50 years (range 16 to 67 years) underwent 99m-technetium-diethylenetriamine pentaacetic acid (99mTc-DTPA) (single injection) radionuclide measurement of GFR. To calculate GFR, three formulas were used: the reciprocal of Cr multiplied by 100 (100/Cr), the CGF and the MDRD formulas. Pearson’s correlation coefficient (r) and Bland-Altman analyses of agreement were used to analyze the association between99mTc-DTPA clearance and the three equations for GFR.

RESULTS: The mean99mTc-DTPA clearance was 83 mL/min/1.73 m2(range 28 mL/min/1.73 m2to 173 mL/min/1.73 m2). Mean calculated GFRs by 100/Cr, the CGF and the MDRD formula were 106 mL/min/1.73 m2, 98 mL/min/1.73 m2and 86 mL/min/1.73 m2, respectively. Regression analysis showed good correlation between radionuclide GFR and calculated GFR with r(100/Cr)=0.74, r(CGF)=0.80, r(MDRD)=0.87, all at P≤0.0001. The MDRD formula provided the least bias. The Bland-Altman plot showed best agreement between GFR calculated by the MDRD formula and99mTc-DTPA clearance, with only 3 mL/min/1.73 m2overestimation. There was higher variability between radionuclide GFR and calculated GFR by the CGF and by 100/Cr. Although there was no difference in precision, GFR calculated by the MDRD formula had the best overall accuracy. The sensitivity and specificity for detection of moderate renal dysfunction by the MDRD formulas were 73% and 87%, respectively.

CONCLUSIONS: Among the Cr-based GFR formulas, the MDRD formula showed a larger proportion of agreement with radionuclide GFR in patients with ALD. In clinical practice, the MDRD is the best formula for detection of moderate renal dysfunction among those with ALD.
The Value of Thoracic Computed Tomography Scans in Clinical Diagnosis: A Prospective Study
Authors: Turner Mark O , Mayo John R , Müller Nestor L , Schulzer Michael , FitzGerald J Mark
Published: March 2016

BACKGROUND: Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross‐sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.

OBJECTIVE: To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.

DESIGN: A before and after survey of physicians who had ordered thoracic CT scans.

SETTING: Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.

SUBJECTS: Physicians who had ordered CT scans.

INTERVENTION: Physicians completed a standard questionnaire before and after the CT scan result was available.

MEASUREMENTS: Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.

RESULTS: Four hundred fifty‐four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High‐priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).

CONCLUSIONS: The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.
Chronic Urticaria: A Cutaneous Manifestation of Celiac Disease
Authors: Haussmann Jessica , Sekar Arni
Published: March 2016

Celiac disease, or gluten-sensitive enteropathy, is an immune-mediated disease of the small bowel that results in malabsorption. It classically presents with gastrointestinal symptoms including chronic diarrhea, weight loss, abdominal bloating and anorexia. It is becoming more frequently identified in asymptomatic patients with a diagnosis of deficiencies related to malabsorption of iron, folic acid, vitamin B12and vitamin D. It is increasingly identified as a cause for early or refractory osteoporosis. Occasionally, celiac disease presents with cutaneous manifestations alone. Dermatitis herpetiformis is a well-recognized cutaneous manifestation of celiac disease. Other cutaneous manifestations include alopecia, angular stomatitis and aphthous ulcerations. Described here is a case of a 24-year-old woman who presented with intermittent urticaria and gastrointestinal complaints. She was found to have celiac disease on small-bowel biopsy. Both her gastrointestinal symptoms and urticaria resolved when she was put on a gluten-free diet, suggesting that her urticaria was a cutaneous manifestation of celiac disease.
Infrared Therapy for Chronic Low Back Pain: A Randomized, Controlled Trial
Authors: Gale George D , Rothbart Peter J , Li Ye
Published: March 2016

OBJECTIVE: The objective of the present study was to assess the degree of pain relief obtained by applying infrared (IR) energy to the low back in patients with chronic, intractable low back pain.

METHODS: Forty patients with chronic low back pain of over six years’ duration were recruited from patients attending the Rothbart Pain Management Clinic, North York, Ontario. They came from the patient lists of three physicians at the clinic, and were randomly assigned to IR therapy or placebo treatment. One patient dropped out of the placebo group; as a result, 21 patients received IR therapy and 18 recieved placebo therapy. The IR therapy was provided by two small, portable units in a sturdy waistband powered by small, rechargeable batteries made by MSCT Infrared Wraps Inc (Canada). These units met safety standards for Food and Drug Administration portability, and are registered with the Food and Drug Administration as a therapeutic device. The unit converted electricity to IR energy at 800 nm to 1200 nm wavelength. The treated group received IR therapy. The placebo group had identical units, but the power was not connected to the circuit‐board within the IR pad. Patients attended seven weekly sessions. One baseline and six weekly sets of values were recorded. The principle measure of outcome was pain rated on the numerical rating scale (NRS). The pain was assessed overall, then rotating and bending in different directions.

RESULTS: The mean NRS scores in the treatment group fell from 6.9 of 10 to 3 of 10 at the end of the study. The mean NRS in the placebo group fell from 7.4 of 10 to 6 of 10.

CONCLUSION: The IR therapy unit used was demonstrated to be effective in reducing chronic low back pain, and no adverse effects were observed.
Commonly Used Preparations for Colonoscopy: Efficacy, Tolerability and Safety – A Canadian Association of Gastroenterology Position Paper
Authors: Barkun Alan , Chiba Naoki , Enns Robert , Marcon Margaret , Natsheh Susan , Pham Co , Sadowski Dan , Vanner Stephen
Published: March 2016

INTRODUCTION: The increased demand for colonoscopy, coupled with the introduction of new bowel cleansing preparations and recent caution advisories in Canada, has prompted a review of bowel preparations by the Canadian Association of Gastroenterology.

METHODS: The present review was conducted by the Clinical Affairs group of committees including the endoscopy, hepatobiliary/transplant, liaison, pediatrics, practice affairs and regional representation committees, along with the assistance of Canadian experts in the field. An effort was made to systematically assess randomized prospective trials evaluating commonly used bowel cleansing preparations in Canada.

RESULTS: Polyethylene glycol (PEG)-; sodium phosphate (NaP)-; magnesium citrate (Mg-citrate)-; and sodium picosulphate, citric acid and magnesium oxide (PSMC)-containing preparations were reviewed. Regimens of PEG 2 L with bisacodyl (10 mg to 20 mg) or Mg-citrate (296 mL) are as effective as standard PEG 4 L regimens, but are better tolerated. NaP preparations appear more effective and better tolerated than standard PEG solutions. PSMC has good efficacy and tolerability but head-to-head trials with NaP solutions remain few, and conclusions equivocal. Adequate hydration during preparation and up to the time of colonoscopy is critical in minimizing side effects and improving bowel cleansing in patients receiving NaP and PSMC preparations. All preparations may cause adverse events, including rare, serious outcomes. NaP should not be used in patients with cardiac or renal dysfunction (PEG solution is preferable in these patients), bowel obstruction or ascites, and caution should be exercised when used in patients with pre-existing electrolyte disturbances, those taking medications that may affect electrolyte levels and elderly or debilitated patients. Health Canada’s recommended NaP dosing for most patients is two 45 mL doses 24 h apart. However, both safety and efficacy data on this dosing schedule are lacking. Many members of the Canadian Association of Gastroenterology expert panel administer both doses within 24 h, as studied in clinical trials, after careful one-on-one discussion of risks and benefits in carefully selected patients. Safety data on PSMC and combination preparations in North America are limited and clinicians are encouraged to keep abreast of developments in this area.

CONCLUSIONS: All four preparations reviewed provided effective bowel cleansing for colonoscopy in the majority of patients, with varying tolerability. Adequate hydration is essential in patients receiving the preparations.
Probiotics to Prevent the Need for, and Augment the Use of, Antibiotics
Authors: Reid Gregor
Published: March 2016

Although humans and microbes are inseparable, our knowledge and understanding of the majority of microbes that help keep us alive and well is in desperate need of further investigation. Of the organisms that influence humans before birth and inhabit various niches from birth to old age, we know little about their identity, origin, metabolic properties, attributes and mechanisms of interactions with the host and surrounding microbes. The use of probiotics ("live microorganisms which when administered in adequate amounts confer a health benefit on the host") has re‐emerged as a means to restore and boost the beneficial microbes in our bodies. The timing of resurgent interest in this ancient field coincides with the need to augment or replace antibiotics whose side effects are unwelcome and whose efficacy is diminishing due to drug resistance. Evidence that probiotic strains can act as adjuncts to antibiotic therapy by reducing adverse effects, improving antibiotic function and enhancing mucosal immunity is mounting. It is to our discredit that basic research on microbial ecology has been stalled in Canada for the past 20 years. If supported, research into indigenous and probiotic microbes will form an important part of future research that sheds light on health, disease and a basic understanding of life itself. In some cases, probiotics will be the difference between a good quality of life and a bad one, or perhaps even life over death. Improvements in clinical studies, manufacturing and regulatory standards must coincide with this progress to ensure that physicians and consumers have reliable, proven products for safe and efficacious use.
Oral Corticosteroid Use and the Risk of Acute Myocardial Infarction in Chronic Obstructive Pulmonary Disease
Authors: Huiart Laetitia , Ernst Pierre , Ranouil Xavier , Suissa Samy
Published: March 2016

BACKGROUND: Given the limited efficacy of oral corticosteroids in treating chronic obstructive pulmonary disease (COPD), the possible cardiac side effects of oral corticosteroids are of particular concern in an elderly population. The impact of the use of oral corticosteroids on the risk of acute myocardial infarction (AMI) in a cohort of patients with COPD was studied.

METHODS: The Saskatchewan health services databases were used to form a population‐based cohort of 5648 patients aged 55 years or older who received a first treatment for COPD between 1990 and 1997. A nested case‐control analysis was conducted: 371 cases presenting with a first myocardial infarction were matched with 1864 controls according to the length of follow‐up, the date of cohort entry and age. Conditional logistic regression was used to adjust for sex, severity of COPD, systemic hypertension, diabetes and prior cardiovascular disease.

RESULTS: Only the current use of corticosteroids was associated with an increased risk of AMI (adjusted RR=2.01 [95% CI 1.13 to 3.58]), particularly when the current dose was larger than 25 mg/day of prednisone or the equivalent (adjusted RR=3.22 [95% CI 1.42 to 7.34]). This observed increase in risk rapidly returned to baseline after the cessation of the medication, suggesting that the use of such high doses reflected the treatment of acute exacerbations of the disease.

CONCLUSIONS: An association was found between the current use of oral corticosteroids and the occurrence of an AMI, suggesting that acute exacerbations of COPD are associated with an increased risk of acute coronary syndromes.
Prevalence of Work‐Related Respiratory Symptoms in Iranian Farmers
Authors: Hashemi N , Mirsadraee M , Shakeri MT , Varasteh AR
Published: March 2016

BACKGROUND: Animal exposure may be an important trigger for work‐related symptoms among farmers.

OBJECTIVE: To estimate the prevalence of work‐related respiratory symptoms (WRS) in sheep breeders and agricultural farmers and to determine work‐related risk factors.

METHODS: A family doctor used a questionnaire to interview a cohort of 173 farmers comprised of 127 sheep breeders and 46 agricultural farmers in the rural area of Rokh (northeast Iran). The questionnaire pertained to recurrent wheezing, cough, breathlessness or chronic phlegm while at work (these symptoms define WRS), flu‐like illness and physician‐diagnosed asthma.

RESULTS: There were 71 subjects (41%) with WRS: 10 of 46 agricultural farmers (21.7%) and 61 of 127 sheep breeders (48.0%). The proportions of sheep breeders with wheezing (16.5%), asthma (14%), cough (29%), breathlessness (31.5%) and flu‐like illness (38%) were higher than in agricultural farmers. A significant dose‐response relationship among the daily hours worked with animals, the number of animals and the prevalence of symptoms was established for sheep farmers. Sheep shearing and the use of pesticide were associated with an increased risk of wheezing and phlegm.

CONCLUSIONS: The results suggest that sheep farmers in general have higher rates of work‐related symptoms than agricultural farmers. The severity of work‐related symptoms will increase with an increase in frequency of animal contact; therefore, these results may underestimate the impact of this exposure.
Canadian Physicians’ Choices for Their Own Colon Cancer Screening
Authors: Raza Mamoon , Bernstein Charles N , Ilnyckyj Alexandra
Published: March 2016

INTRODUCTION: Compliance with colorectal cancer (CRC) screening in Canada is low. The aim of the present survey was to determine whether Canadian physicians older than 50 years were pursuing colon cancer screening. Specifically, physicians were asked to identify their modality of choice and identify their barriers to screening.

METHODS: Surveys were mailed to members, older than 50 years, of the Canadian Association of Gastroenterology, the Society of Obstetricians and Gynaecologists of Canada, the Canadian Society of Internal Medicine, the Canadian Psychiatric Association and the Canadian Association of Radiologists.

RESULTS: Of 2807 surveys, 46% were returned. Screening for CRC was reported by 53% of respondents. The Canadian Association of Radiologists members (61%) and the Canadian Association of Gastroenterology members (61%) were more likely to be screened than other specialties (P<0.01 and P<0.05, respectively). Members of the Society of Obstetricians and Gynaecologists of Canada (44%) were least likely to be screened (P<0.001). Men (P<0.001) and Ontario physicians (P<0.01) were more likely to be screened than women and Canadian physicians from other provinces, respectively. Colonoscopy (56%) was the most common screening modality used, followed by fecal occult blood testing (27%). Respondents who had not been screened cited a lack of personal time (47%) and insufficient data to warrant screening (14%).

DISCUSSION: More than one-half of all respondents were screened for CRC. Colonoscopy is the most common screening modality used. Lack of time is the most common reason cited for not participating in CRC screening.
Antimicrobial Resistance among Salmonella and Shigella Isolates in Five Canadian Provinces (1997 to 2000)
Authors: Martin Leah J , Flint James , Ravel André , Dutil Lucie , Doré Kathryn , Louie Marie , Jamieson Frances , Ratnam Sam
Published: March 2016

OBJECTIVE: To describe rates of antimicrobial resistance (AMR) among Salmonella and Shigella isolates reported in five Canadian provinces, focusing on clinically important antimicrobials.

METHODS: The authors retrospectively investigated AMR rates among 6219 Salmonella and 1673 Shigella isolates submitted to provincial public health laboratories in Alberta, Newfoundland and Labrador, Ontario, Prince Edward Island and Saskatchewan from 1997 to 2000; these isolates were estimated to represent 41% of Salmonella cases and 72% of Shigella cases reported by the study provinces.

RESULTS: Among Salmonella isolates, 27% (1704 of 6215) were resistant to ampicillin, 2.2% (135 of 6122) to trimethoprim/sulfamethoxazole, 1.5% (14 of 938) to nalidixic acid, 1.2% (one of 84) to lomafloxacin and 0.08% (five of 6163) to ciprofloxacin. Among Shigella isolates, 70% (1144 of 1643) were resistant to trimethoprim/sulfamethoxazole, 65% (1079 of 1672) to ampicillin, 3.1% (eight of 262) to nalidixic acid, 0.49% (eight of 1636) to ciprofloxacin, 0.14% (one of 700) to ceftriaxone and 0.08% (one of 1292) to ceftazidime.

CONCLUSIONS: Higher rates of resistance to clinically important antimicrobials (including ciprofloxacin) were observed among both Salmonella and Shigella isolates than has previously been reported. Current Canadian data on rates of AMR for these pathogens are required.
Pain Due to Multiple Sclerosis: Analysis of the Prevalence and Economic Burden in Canada
Authors: Piwko Charles , Desjardins Olivier B , Bereza Basil G , Machado Marcio , Jaszewski Barbara , Freedman Mark S , Einarson Thomas R , Iskedjian Michael
Published: March 2016

BACKGROUND: Multiple sclerosis (MS) is a neurological disease affecting approximately 50,000 Canadians. Although studies have described overall MS costs, none have focused specifically on MS‐related pain.

OBJECTIVES: To estimate the prevalence of MS‐related pain in Canada, the proportion of patients treated and responding to treatment for MS‐related pain, and the associated economic burden.

METHODS: Results were captured through physician and patient surveys. Patients were recruited through MS clinics and the MS Society. Patient‐reported outcomes and resource utilization over the previous six months were collected by telephone interview. Costs were measured in 2004 Canadian dollars. The economic burden was extrapolated to the population using national demographics and prevalence. Spearman’s ρ assessed the relationship between cost and pain severity.

RESULTS: Physicians estimated that 46% of their MS patients experienced MS‐related pain, and that 35% received treatment for pain. Pain was reported to be relieved somewhat in 29%±10% of their patients, adequately in 26%±19% and poorly in 27%±13%, while 17%±9% received no relief. Two hundred ninety‐seven participants completed the patient survey. Seventy‐one per cent (211 of 297 patients) experienced MS‐related pain. Eighty per cent of patients reported taking some type of medication to manage their pain, and of these, 82% reported some reduction in pain. The mean ± SD direct cost per patient of MS‐related pain was $2,528±5,695. The mean ± SD indirect cost per patient was $669±875. Total costs were positively correlated with levels of self‐reported pain (ρ=0.291, P<0.0001). The estimated six‐month burden of pain of MS patients in Canada was $79,444,888.

CONCLUSIONS: The prevalence of pain is high in MS patients. This condition may be underdiagnosed and undertreated, and results in a significant economic burden on society.
Hot Tub Lung Mimicking Classic Acute and Chronic Hypersensitivity Pneumonitis: Two Case Reports
Authors: Verma Geetika , Jamieson Frances , Chedore Pamela , Hwang David , Boerner Scott , Geddie William R , Chapman Kenneth R , Marras Theodore K
Published: March 2016

Pulmonary disease in otherwise healthy patients can occur by secondary exposure to nontuberculous mycobacteria from hot tubs. The pathology of hot tub lung may be related to an infection, a hypersensitivity reaction or both. Previous reports of hot tub lung have highlighted distinct pathological features that have distinguished this entity from classic hypersensitivity pneumonitis. Two cases of hot tub lung in Ontario, which presented at very different time points in their disease course, are reported; one patient presented more fulminantly with a clinical picture resembling subacute hypersensitivity pneumonitis, and the other presented with chronic disease. Both cases exhibited clinical, radiological and pathological findings closely mimicking classic subacute and chronic hypersensitivity pneumonitis.