bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergence of Penicillin‐Resistant Streptococcus Pneumoniae in Southern Ontario, 1993–94
Authors: Simor Andrew E , Rachlis Anita , Louie Lisa , Goodfellow Janet , Louie Marie
Published: March 2016

Objective: To determine the prevalence of resistance of Streptococcus pneumoniae to penicillin and other antimicrobial agents in metropolitan Toronto.

Design: Consecutive pneumococcal isolates from different patients were obtained from two private community‐based laboratories and from patients assessed in the emergency department of a tertiary‐care teaching hospital in Toronto, Ontario between June and December 1993, and between March and October 1994. In vitro susceptibility testing was done by broth microdilution in accordance with National Committee for Clinical Laboratory Standards guidelines.

Results: Twenty (7.3±3.1%) of 274 pneumococcal isolates were resistant to penicillin; six (30%) isolates had high‐level resistance (minimal inhibitory concentration [mic] 2.0 μg/mL or greater); and 14 isolates had intermediate resistance (mic 0.1 to 1.0 μg/mL). Penicillin‐resistant strains were also frequently resistant to tetracycline (55%), cotrimoxazole (50%), erythromycin (40%) and cefuroxime (35%). Resistant strains comprised several serotypes: 19F (six isolates), 9V (three), 23F (three), and one each of 6A, 6B, 14, and 19A; four isolates were nontypeable.

Conclusions: There has been a recent emergence of penicillin‐resistant S pneumoniae in southern Ontario. National and regional surveillance is warranted to determine the extent of the problem elsewhere in Canada.
The Lung Health Study
Authors: Manfreda J , Anthonisen NR , The Lung Health Study Research Group
Published: March 2016

OBJECTIVE: To determine whether smoking intervention and use of an inhaled bronchodilator can slow the rate of decline in forced expiratory volume in 1 s (FEV1) in smokers with mild obstructive pulmonary disease.

DESIGN: Randomized clinical trial: participants randomized to one of three groups: smoking intervention plus inhaled bronchodilator (Atrovent; ipratropium bromide) (SIA): smoking intervention plus placebo (SIP); or no intervention (usual care, UC).

SETTING: Ten centres in the United States and Canada.

PARTICIPANTS: A total of 5887 smokers, aged 35 to 60 years, with FEV1 55 to 90% predicted and FEV1/forced vital capacity (FVC) less than 70%.

INTERVENTIONS: Smoking intervention: intensive program combining behaviour modification and use or nicotine gum, with a subsequent maintenance program to prevent relapse. Bronchodilator: ipratropium bromide, two puffs three times daily from a metered dose inhaler.

MAIN OUTCOME MEASURES: Change in FEV1 over a five‐year period.

RESULTS: Sustained smoking cessation was achieved in 22% of both intervention groups (SIA, SIP), compared with 5% in UC. Both SIA and SIP groups showed significantly smaller declines in postbronchodilator FEV1 over the five years of the study ‐ 184 mL and 209 mL, respectively. compared with 267 mL in UC. This difference was accounted for by an increase in FEV1 in the SIA (+39 mL) and SIP (+11 mL) groups in the first year of the study, compared with a decline in UC (‐34 mL). Those who achieved sustained smoking cessation experienced the greatest benefit, evident for the five years of study. There was a small noncumulative benefit associated with use of the active bronchodilator, which disappeared after the bronchodilator was discontinued.

CONCLUSIONS: An effective smoking intervention program significantly reduced decline in FEV1 in smokers with mild airways obstruction. Use of an inhaled anticholinergic bronchodilator did not influence the long term decline of FEV1.
Pulmonary Alveolar Proteinosis in an AIDS Patient without Concurrent Pulmonary Infection
Authors: Liu Allen T , Miedzinski Lil J , Vallieres Eric , Rayner David C , Lien Dale C
Published: March 2016

Patients with acquired immunodeficiency syndrome (AIDS) are potentially at increased risk for developing secondary pulmonary alveolar proteinosis because of underlying immunosuppression and frequent opportunistic lung infections. This condition. however, has been diagnosed uncommonly in these patients and, with the exception of one previously reported case. only in the presence of concurrent pulmonary infection. The case of a 35‐year‐old male with AIDS who was found on open lung biopsy to have pulmonary alveolar proteinosis without evidence of associated lung infection is presented.
Skeletal Cryptococcosis: Case Report and Review of the Literature
Authors: Wood Lori , Miedzinski Lil
Published: March 2016

A case of isolated cryptococcal skull infection is presented in a patient with unexplained CD4 lymphopenia and chronic hepatitis B. All cases of this disease reported in the English literature from 1956 to the present are reviewed. The literature suggests that skeletal cryptococcosis is manifested in only 5% to 10% of recognized cases of disseminated cryptococcosis and that isolated skeletal disease without evidence of other tissue involvement is even less common. When isolated bony disease does occur it tends to occur in immunocompromised hosts, particularly those with defects of cell mediated immunity. Any bony site can be involved, most commonly the vertebrae, with the presentation often being a soft tissue swelling and pain in the affected area. Systemic constitutional symptoms occur in a minority of patients. Radiographic investigations are nonspecific and the gold standard of diagnosis remains culture isolation from bone tissue. The most commonly employed therapy for isolated bone disease is amphotericin alone or combined with surgical debridement. The new azoles may have a role in future therapy.
Investigation of Patients with Apparently Inoperable Lung Cancer
Authors: Karmy-Jones Riyad , Vallieres Eric , Lewis Joseph W , Dundas George
Published: March 2016

Over a three‐year period, 30 patients were referred to a multidisciplinary lung cancer group for palliative radiotherapy of presumed unresectable bronchogenic cancer on the basis of radiological findings. Further investigation, including surgical staging, demonstrated that 10 were candidates for surgical resection. Nine patients are alive and free of disease at a median follow‐up of 25.8 months. These results demonstrate that chest x‐ray and computed tomography of the chest may not be specific enough to rule out the possibility of surgical cure.
Migraine Variability: An Underrecognized Impediment to Effective Treatment
Authors: Edmeads John , Grenville Andrew , Aubé Michel
Published: March 2016

OBJECTIVE: To determine whether individuals in a population‐based sample of migraine sufferers experience attacks that vary in intensity and in degree of disability, and to correlate any variability with age, sex, attack frequency and physician‐consulting behaviour.
DESIGN: Telephone interviews of randomly selected, population‐based sample.
PARTICIPANTS: Men and women, aged 15 years and older, with headaches conforming to modified International Headache Society diagnostic criteria for migraine.
METHODS: Sample selected by modified random digit dialling method, with call‐backs. A total of 20,565 calls identified 341 migraine sufferers who were interviewed by trained interviewers from a survey research organization using a computer‐assisted system.
DATA ANALYSIS: Descriptive, with differences between proportions of groups tested by c2.
RESULTS: Eighty‐nine per cent of all migraine suffers had experienced two or three levels of severity in their migraine attacks as assessed by debilitation.
CONCLUSIONS: Most migraine sufferers experience frequent variation in attack severity, a finding that has implications for the prescribing of appropriate treatment.
Candida albicans Epididymo‐Orchitis and Fungemia in a Patient with Chronic Myelogenous Leukemia
Authors: Pimentel Mark , Nicolle Lindsay E , Qureshi Salman
Published: March 2016

The fourth reported case of candidal epididymo‐orchitis in the literature and the first reported case successfully cured with only low dose amphotericin B is described. A 75‐year‐old male with chronic myelogenous leukemia presented with acute testicular and epididymal swelling and pain. Subsequent investigations suggested the diagnosis of epididymo‐orchitis due to Candida albicans. This was successfully treated with intravenous amphotericin B (total dose of 500 mg). Based on the three previous case reports and the current case several characteristic features that increased the suspicion of this entity were identified. These features include an immunocompromised state, candiduria, specific epididymal ultrasonographic appearance, as well as typical clinical features of epididymo‐orchitis.
Diagnosis of Primary Hyperventilation Syndrome by Polysomnography: A Report of Two Cases
Authors: Sheth Tarang N , Kesten Steven
Published: March 2016

Two cases of primary hyperventilation syndrome misdiagnosed as asthma are reported. Polysomnography was used to diagnose the syndrome and to confirm the psychogenic etiology of the patients′ symptoms.
Surveillance of Occupational Lung Diseases in Canada
Authors: Dimich-Ward Helen , Contreras Gustavo R , Rousseau Roxanne , Chan-Yeung Moira
Published: March 2016

Surveillance programs for occupational lung diseases are reviewed, with reference to a two‐year pilot study that was undertaken in the province of British Columbia. Members of the British Columbia Thoracic Society were invited to participate by reporting any new cases of occupational lung disease in each two‐month period. Participating physicians responded well during the first year of the pilot study, but longer term commitment was difficult to maintain. It is recommend that physicians be educated, starting in medical school, about the recognition and diagnosis of occupational diseases and the importance of surveillance of chronic diseases. The authors encourage, at least on a trial basis, a nationally based surveillance program of occupational lung diseases.
Streptococcus suis Meningitis: First Case Reported in Quebec
Authors: Michaud Sophie , Duperval Raymond , Higgins Robert
Published: March 2016

Very few Streptococcus suis infections in humans have been reported in Canada, although the condition is frequent in pigs. Meningitis, often accompanied by severe hearing loss, is the most common clinical manifestation. The disease is an occupational illness affecting persons in contact with pigs and may be underdiagnosed because of misidentification of the responsible bacterium. Since Quebec is the leading province for swine production in Canada, physicians and microbiologists should be aware of this infection, especially when a streptococcal meningitis is diagnosed in swine workers. The first case of S suis type 2 meningitis reported in Quebec is described.
Inclusion of Peak Expiratory Flow for Selection of the ′Best′ Forced Vital Capacity Manoeuvre
Authors: Di Pede Francesco , Pistelli Francesco , Viegi Giovanni , Paoletti Paolo , Celi Alessandro , Carrozzi Laura , Vellutini Mariella , Pistelli Giuseppe , Giuntini Carlo
Published: March 2016

OBJECTIVE: To assess four different criteria for selecting the ′best′ forced vital capacity (FVC) manoeuvre to be used for clinical diagnostic purposes.

DESIGN: Criterion standard.

SETTING: General population survey performed in 1980‐82.

PATIENTS: One thousand, two hundred and eighty‐three subjects (age range eight to 64 years) were first stratified into five mutually exclusive groups according to the following criteria: simultaneous largest FVC, forced expiratory volume in 1 s (FEV1) and peak expiratory flow (PEF) (group 1; n=481); isolated largest FVC (group 2; n=223); isolated largest FEV1 (group 3; n=144); isolated largest PEF (group 4; n=299); and overlapping criteria (group 5; n=136).

INTERVENTION: Subjects performed spirometry following American Thoracic Society (ATS) protocol and filled out a standardized respiratory questionnaire.

MAIN OUTCOME MEASURES: Spirograms were analyzed by examining the frequency of spirometry abnormalities with regard to the presence of respiratory symptoms, first within mutually exclusive groups of subjects and then within the whole sample. The hypothesis of the role of PEF in ′best test′ selection was formulated after data collection.

MAIN RESULTS: When the isolated largest PEF criterion was used, the following data were obtained: the highest prevalence of spirometric abnormalities for each FVC parameter in each mutually exclusive group; the highest predictive value for mean and instantaneous expiratory flows in separating symptomatic from asymptomatic subjects; and finally, using the whole sample, higher levels of sensitivity and similar specificity to other criteria for all test parameters (all over 90%, except for PEF).

CONCLUSIONS: While maintaining the current ATS criteria of acceptability and variability for FVC trials, it is proposed that the curve that better reflects maximal expiratory effort, ie, that with the largest PEF, be recorded and analyzed for spirometric variables.
Subcutaneous Dirofilariasis in Nova Scotia
Authors: Haldane David JM , Johnston B Lynn , Walsh Noreen MG
Published: March 2016

A case of dirofilariasis in a 78‐year‐old woman from Nova Scotia is described along with the histological findings and the basis of identification of the parasite. The patient developed a subcutaneous nodule, which was excised. Dirofilaria ursi and ursi‐like nematodes are a rare cause of subcutaneous nodules. This is the first time dirofilariasis has been diagnosed in an adult in Atlantic Canada.
The SISAP: A New Screening Instrument for Identifying Potential Opioid Abusers in the Management of Chronic Nonmalignant Pain Within General Medical Practice
Authors: Coambs Robert B , Jarry Josée L , Santhiapillai Anusha C , Abrahamsohn Rixi V , Atance Cristina M
Published: March 2016

BACKGROUND: Many physicians are overly cautious about prescribing opioids for chronic pain because of fears of iatrogenic addiction. However, in patients with chronic pain, addiction to opioid analgesics is exceedingly rare when there is no prior history of alcohol or drug abuse.
OBJECTIVE: To validate an instrument that separates possible opioid abusers from those who are at low risk.
DESIGN/METHODS: The Screening Instrument for Substance Abuse Potential (SISAP) was designed to identify individuals with a possible substance abuse history quickly and accurately. It is based on the National Alcohol and Drug Use Survey (n=9915). Using the first half of the sample (n=4967), two previously validated alcohol use items were combined with three illicit drug use items. These five questions identified those with a history of alcohol and/or illicit drug use.
RESULTS: Using the second half of the sample (n=4948), the validation procedure showed that the five combined items correctly classified 91% of substance abusers and had a low rate of false negatives.
DISCUSSION: The SISAP is brief and resistant to misrepresentation or falsification. The SISAP is expected to improve pain management by facilitating focus on the appropriate use of opioid analgesics and therapeutic outcomes in the majority of patients who are not at risk of opioid abuse, while carefully monitoring those who may be at greater risk.
Opioid Therapy for Chronic Nonmalignant Pain
Authors: Portenoy Russell K
Published: March 2016

Long term administration of an opioid drug for chronic nonmalignant pain continues to be controversial, but is no longer uniformly rejected by pain specialists. This is true despite concerns that the regulatory agencies that oversee physician prescribing of opioid drugs continue to stigmatize the practice. The changing clinical perspective has been driven, in part, by widespread acknowledgement of the remarkably favourable outcomes achieved during opioid treatment of cancer pain. These outcomes contrast starkly with popular teaching about chronic opioid therapy and affirm the potential for prolonged efficacy, tolerable side effects, enhanced function associated with improved comfort and minimal risk of aberrant drug‐related behaviours consistent with addiction. A large anecdotal experience in populations with nonmalignant pain suggests that these patients are more heterogeneous and that opioid therapy will greatly benefit some and will contribute to negative outcomes for others. The few controlled clinical trials that have been performed support the safety and efficacy of opioid therapy, but have been too limited to ensure generalization to the clinical setting. A critical review of the medical literature pertaining to chronic pain, opioid pharmacology and addiction medicine can clarify misconceptions about opioid therapy and provide a foundation for patient selection and drug administration. The available data support the view that opioids are no panacea for chronic pain, but should be considered in carefully selected patients using clinically derived guidelines that stress a structured approach and ongoing monitoring of efficacy, adverse effects, functional outcomes and the occurrence of aberrant drug‐related behaviours.
Antibody Response in Seropositive Multiple Sclerosis Patients Vaccinated with Attenuated Live Varicella Zoster Virus
Authors: Ross RT , Dawood MR , Cheang Mary , Nicolle Lindsay E
Published: March 2016

OBJECTIVE: To determine the safety and effectiveness of live attenuated varicella zoster virus (VZV) vaccine (OKA/Merck) on 50 patients with chronic progressive multiple sclerosis (MS), based on the hypothesis that VZV might be the antigen or antigen mimic of MS plus the fact that repeated high antigen doses have produced ‘antigen paralysis’ in experimental allergic encephalomyelitis mice.

DESIGN: Fifty patients were randomly selected without controls. They were assessed clinically at entry and on four other occasions over 14 months. Enhanced cranial magnetic resonance imaging (MRI) was performed at entry and at six and 12 months post entry. All were vaccinated after initial assessment and again six weeks later.

SETTING: All clinical and laboratory assessments were performed at the Health Sciences Centre, Winnipeg, in the out‐patient department. All MRI examinations were performed at the St Boniface General Hospital, Winnipeg, Manitoba. Both are tertiary care hospitals.

POPULATION STUDIED: Fifty randomly selected patients with chronic progressive MS, age 18 to 60 years, and a disability status scale of 2.0 or greater were included. Forty‐five patients completed the study.

INTERVENTIONS: Two vaccinations with attenuated live VZV six weeks apart.

RESULTS: All patients were VZV seropositive at entry and all showed an increased antibody level following vaccination. No one was harmed by the vaccine. There may have been some changes in the MS of 15 patients.

CONCLUSIONS: It may be reasonable and safe to challenge the process of MS using large doses of the immunogenic proteins of the VZV to induce ‘immune paralysis’.
Importance of Q Fever in Community Acquired Pneumonia
Authors: Goyette Monique , Bouchard Jean , Poirier André , Morrier Eric , Artsob Harvey , Corbeil Francois
Published: March 2016

Coxiella burnetii appears to be endemic in animals in the Mauricie region of Quebec, and causes some human cases of Q fever annually. Unlike in other rural areas, patients in this study experienced few respiratory symptoms. To determine whether C burnetii pneumonia is underdiagnosed, adults admitted to hospital for community acquired pneumonia were included in a one‐year serological study. Significant immunofluorescent antibody (IFA) titres in four of 118 patients with pneumonia (fewer than 4%) were studied. Clinical presentation, standard laboratory tests and epidemiological data did not allow identification of these cases; however, Q fever increased during the warm months. There were no detectable complement fixing (CF) antibodies in these four cases. C burnetii causes few cases of pneumonia in Mauricie. IFA seems to be a more sensitive test than CF.
Association of Human Lymphocyte Antigens with Obstructive Airways Disease after Bone Marrow Transplantation
Authors: Spaner David , Lipton Jeffrey , Chan Charles K
Published: March 2016

BACKGROUND: Obstructive airways disease (OAD) is a known complication of allogeneic bone marrow transplantation. The etiology of OAD is unknown but is probably multifactorial. The identification of a significant human lymphocyte antigen (HLA) association with the development of OAD might offer some insight into its pathogenesis and serve as a marker to identify prospectively patients at risk for developing OAD.

OBJECTIVE: The major histocompatibility antigen (MHC) associations of OAD post‐allogeneic bone marrow transplantation were studied to determine whether particular subsets of patients are more susceptible to this syndrome.

POPULATION: Twenty‐one of 244 consecutive patients with allogeneic transplants performed between 1980 and 1987 were identified as developing OAD after having had normal pulmonary function tests before transplant. Thirty‐nine controls were selected on the basis of normal pulmonary function tests pre‐ and post‐transplant and comparable follow‐up periods.

METHODS: The study was a retrospective case‐control study. Gene frequencies of the HLA‐A and ‐B types in the patients and controls were compared and a relative risk of OAD with a given HLA allele was calculated.

RESULTS: There was a significant correlation of the development of OAD with the presence of the MHC antigen, HLA‐B12 (44,45).

CONCLUSIONS: These data support the idea that patients who express the HLA‐B12 (44,45) antigen are at higher risk for the development of OAD post bone marrow transplantation. However, the findings are based on retrospective analysis and accordingly should be considered tentative until followed by larger and preferably prospective studies to confirm the findings.
Implementing the Three‐Equation Method of Measuring Single Breath Carbon Monoxide Diffusing Capacity
Authors: Graham Brian L , Mink Joseph T , Cotton David J
Published: March 2016

Conventional methods of measuring the single breath diffusing capacity of the lung for carbon monoxide (DLcoSB) are based on the Krogh equation, which is valid only during breath holding. Rigid standardization is used to approximate a pure breath hold manoeuvre, but variations in performing the manoeuvre cause errors in the measurement of DLcoSB. The authors previously described a method of measuring DLcoSB using separate equations describing carbon monoxide uptake during each phase of the manoeuvre: inhalation, breath holding and exhalation. The method is manoeuvre‐independent, uses all of the exhaled alveolar gas to improve estimates of mean DLcoSB and lung volume, and is more accurate and precise than conventional methods. A slow, submaximal, more physiological single breath manoeuvre can be used to measure DLcoSB in patients who cannot achieve the flow rates and breath hold times necessary for the standardized manoeuvre. The method was initially implemented using prototype equipment but commercial systems are now available that are capable of implementing this method. The authors describe how to implement the method and discuss considerations to be made in its use.
Low Prevalence of Gastrointestinal Colonization with Antimicrobial‐Resistant Bacteria in High Risk Units in a Canadian Tertiary Care Centre
Authors: Embil John M , Kabani Amin , Zhanel George , Nicolle Lindsay E
Published: March 2016

OBJECTIVE: To determine the prevalence of antimicrobial‐resistant bacteria among patients receiving care in high risk units in a Canadian tertiary care centre.

DESIGN: Prevalence study over a four‐month period in 1995 with rectal swab or freshly passed stool specimen collected from each patient included in study. Standardized record data extraction for selected patient variables was used.

SETTING: Units at high risk for antimicrobial‐resistant organisms at the Health Sciences Centre, Winnipeg, including neonatal (NICU), pediatric (PICU), surgical (SICU) and medical intensive care units (MICU), central dialysis unit (CDU), and the in‐patient oncology ward (ONC).

PATIENTS: One hundred and fifty‐seven patients admitted to the high risk care units for at least 72 h were screened. Ward distribution was NICU 13 (8.3%), PICU nine (5.7%), SICU 24 (15.3%), MICU 19 (12.1%), CDU 62 (39.5%) and ONC 30 (19.1%). Fifty‐one of 157 (32.5%) patients had urinary drainage devices, 108 (68.8%) had invasive vascular devices, and 57 (36.3%) had had a surgical procedure within the month before specimen collection. In the month before sampling, 114 (72.6%) had received antimicrobial therapy, including 21 (13.3%) who had received vancomycin, and 81 (51.5%) were receiving antimicrobials, seven (10.8%) vancomycin, on the day of sampling.

RESULTS: Antimicrobial susceptibilities were performed on 371 bacterial isolates. There were no vancomycin‐resistant enterococci or methicillin‐resistant Staphylococcus aureus. Eleven (10.8%) enterococci were resistant to ampicillin, none of which were β‐lactamase producers, 19 (18.6%) and five (4.9%) demonstrated high level resistance to gentamicin and streptomycin, respectively. One (0.7%) Escherichia coli was resistant to ciprofloxacin and another to gentamicin. Six (20.7%) Enterobacter cloacae samples were resistant to cefotaxime. One (2.4%) Klebsiella species was resistant to ciprofloxacin and another to cefotaxime. Two (16.6%) Citrobacter species were resistant to cefotaxime. One of 11 (9%) Pseudomonas aeruginosa isolates was resistant to ceftazidime; none were resistant to piperacillin, aminoglycosides, ciprofloxacin or imipenem.

CONCLUSIONS: The prevalence of antimicrobial‐resistant organisms colonizing the gastrointestinal tract in patients in these high risk units is low. The reasons for this low prevalence of antimicrobial resistance require further exploration.
Human and Canine Blastomycosis: A Common Source Infection
Authors: Morgan Matthew W , Salit Irving E
Published: March 2016

In fall 1993 a man and a dog developed blastomycosis after visiting an island off Bayfield Inlet, Georgian Bay, located near Parry Sound, Ontario. The man recovered but the dog died of blastomycosis. It was hypothesized that the common source of exposure was the island since the permanent residences of the two cases were in different cities. One further case of human infection, based on positive serology, and four additional cases of probable canine blastomycosis were identified. All cases had travelled to Bayfield Inlet during summer and early fall 1993. To the authors’ knowledge this is the first Canadian report of a common source of infection of human and canine blastomycosis. This report also provides evidence for a new endemic area of blastomycosis infection.
A Multidisciplinary Hospital‐based Antimicrobial Use Program: Impact on Hospital Pharmacy Expenditures and Drug Use
Authors: Salama Suzette , Rotstein Coleman , Mandell Lionel
Published: March 2016

The authors’ hospital embarked on a three‐component, multidisciplinary, hospital‐based antimicrobial use program to cut costs and reduce inappropriate antimicrobial use. Initially, antimicrobial use patterns and costs were monitored for 12 months. For the next two years, an antimicrobial use program was implemented consisting of three strategies: automatic therapeutic interchanges; antimicrobial restriction policies; and parenteral to oral conversion. The program resulted in a reduction in the antimicrobial portion of the total pharmacy drug budget from 41.6% to 28.2%. Simultaneously, the average cost per dose per patient day dropped from $11.88 in 1991 to $10.16 in 1994. Overall, mean monthly acquisition cost savings rose from $6,810 in 1992 to $27,590 in 1994. This study demonstrates that a multidisciplinary antimicrobial use program in a Canadian hospital can effect dramatic cost savings and serve as a quality assurance activity of physician antimicrobial prescribing behaviour.
Socioeconomic Status and Childhood Atopy
Authors: Demissie Kitaw , Ernst Pierre , Becklake Margaret R
Published: March 2016

BACKGROUND: Variation in the prevalence of allergic disorders among socioeconomic groups could be due either to differences in the type of allergens encountered or to actual differences in susceptibility to sensitization to any particular antigen.

OBJECTIVE: To examine the relationship of skin test positivity to inhaled aeroallergens and socioeconomic status (SES).

METHODS: A total of 989 Montreal elementary school children were studied. A short questionnaire was completed by parents, and the children performed spirometry before and after a free‐running exercise challenge. A subsample of 309 children underwent allergy skin prick tests to common inhaled aeroallergens. SES was established using parental occupation.

RESULTS: Higher social class was associated with an increased likelihood of having positive skin tests to cat and trees, while there was a trend towards an inverse relationship between SES and skin test sensitivity to cockroach and moulds. Reported history of asthma, hay fever or eczema were unrelated to SES.

CONCLUSIONS: The results of this study suggest differences in levels of exposure to different allergens by social class. From the public health point of view, community‐based allergen avoidance measures need to be adapted to social class.
New Concepts in the Diagnosis and Pathogenesis of Trichomonas vaginalis
Authors: Bhatt Renuka , Abraham Mary , Petrin Dino , Garber Gary E
Published: March 2016

Trichomonas vaginalis infection is the most commonly encountered sexually transmitted disease. There is a need for more accurate and rapid laboratory diagnostic methods, leading to better control and treatment strategies. Various virulence factors such as adherence, contact‐independent factors, hemolysis and acquisition of host macromolecules have been shown to play a role in the pathogenesis of this infection. Detection of the factors that are only present in the pathogenic isolates of trichomonads will lead to a better understanding of the epidemiology of this pathogen. Culture technique is highly specific compared with microscopic techniques, but it is time consuming. Immunological techniques lack proper correlation with clinical manifestations. The application of monoclonal antibodies, either singly or in a group that recognizes a common antigen, along with methods such as detection of common DNA fragment from clinical specimens, may have a promising future in the laboratory diagnosis of trichomoniasis.
Patient Controlled Analgesia Used to Assess the Efficacy and Potency of a New Opioid
Authors: Ginsberg Brian , Grichnik Katherine P , Muir Margaret , Damask Michael , Glass Peter S
Published: March 2016

Patient controlled analgesia (PCA) is widely used for the management of postoperative pain. PCA also permits a comparison to be made among analgesics in the clinical setting because it limits the variability introduced by third parties. Use of PCA to establish efficacy and potency data for an investigational drug, pentamorphone, compared with morphine is reported. Pentamorphone was found to be more efficacious than morphine in the first hour after surgery because significantly more patients were able to achieve a visual analogue scale of less than 30 mm with pentamorphone. Thereafter pentamorphone and morphine were found to be equally efficacious. Initially pentamorphone may be more potent than morphine based on the greater volume of morphine used in the first hour of therapy. However, a potency ratio could not be determined because this result was under conditions of unequal analgesia. The potency ratio determined at 24 h of therapy under equianalgesic conditions (252:1) is similar to previously reported potency data from laboratory studies (200:1). This study supports the use of PCA as a model to investigate and compare new drugs to establish their efficacy and potency.
A Contribution to the Understanding of Pain in Fibromyalgia Based on Cerebrospinal Fluid Investigations
Authors: Værøy Henning
Published: March 2016

Fibromyalgia is established in current practice as a condition with widespread pain and a number of specific tender points, as well as symptoms of limb stiffness, lack of refreshing sleep and depression. Musculoskeletal correlations with the syndrome have generally been disappointing. Chemical changes in the cerebrospinal fluid are of interest and seem to show significant relationships with fibromyalgia, both with respect to opioid peptides and substance P. The nature of these relationships and their possible linkage with neuronal plasticity at the spinal cord level are discussed. The influence of both peripheral sensitization and reduced presynaptic inhibitory feedback is considered in this connection.
Ventilator Circuits, Humidification and Ventilator‐Associated Pneumonia
Authors: Hess Dean
Published: March 2016

Technical issues in the care of mechanically ventilated patients include those related to the ventilator circuit, humidification and ventilator‐associated pneumonia. Principal issues related to ventilator circuits include leaks and compression volume. Circuit compression volume affects delivered tidal volume as well as measurements of auto‐positive end‐expiratory pressure and mixed expired PCO2. Resistance through the ventilator circuit contributes to patient‐ventilator dyssynchrony during assisted modes of mechanical ventilation. Adequate humidification of inspired gas is necessary to prevent heat and moisture loss. Common methods of humidification of inspired gas during mechanical ventilation include use of active heated humidifiers and passive artificial noses. Artificial noses are less effective than active humidifiers and are best suited to short term use. With active humidifiers, the circuit can be heated to avoid condensate formation. However, care must be exercised when heated circuits are used to avoid delivery of a low relative humidity and subsequent drying of secretions in the artificial airway. Although pneumonia is a complication of mechanical ventilation, these pneumonias are usually the result of aspiration of pharyngeal secretions and are seldom related to the ventilator circuit. Ventilator circuits do not need to be changed more frequently than weekly for infection control purposes, and the incidence of ventilator‐associated pneumonia may be greater with more frequent circuit changes.
Concentration‐Effect Relationship after Intravenous Hydromorphone Administration: Use of An Effect Compartment Model and System Analysis to Minimize Hysteresis of Effects
Authors: Westerling D , Hoglund P
Published: March 2016

OBJECTIVE: To investigate the concentration‐effect relationship of hydromorphone by using two different methods to minimize the hysteresis between concentration and effects.

DESIGN: Open study.

SUBJECTS: Twelve healthy volunteers.

MEASUREMENTS: The analgesic effect of hydromorphone, evaluated as pressure pain thresholds (PPTs), and nonanalgesic effects, miosis and reduction of saliva production, were related to the concentration of the opioid, analyzed by high performance liquid chromatography. Hysteresis between the concentration and the measured effects of hydromorphone was minimized by a link model and system analysis.

RESULTS: Parameter estimation was successful using both methods of hysteresis minimization. According to the link model, the mean concentration of hydromorphone at steady state (Css50) producing 50% of the Emax for reduction of saliva production was 6.7±3.0 nmol/L and the mean Emax, given as the fraction of baseline salivation, was ‐1.1±0.2. Mean Css50 for reduction of pupil size was 15±20 nmol/L, and mean Emax was ‐0.8±0.2. For analgesia, mean Css50 was 68±42 nmol/L and mean Emax was 1.8±2.2. Similar results were obtained by using system analysis.

CONCLUSION: Hydromorphone demonstrated a high intrinsic activity, producing miosis and dryness of the mouth. The analgesic effect of hydromorphone at the dose used in this laboratory setting was transient but significant. The link model and system analysis were equally efficient at evaluating the relation between concentration, and analgesic and nonanalgesic effects of hydromorphone, and gave similar results. Both methods may be useful in the study of pharmacodynamics of opioids.
Salmeterol and Airway Response to Allergen
Authors: Cockcroft Donald W , Swystun Veronica A , Bhagat Rajesh , Kalra Sanjay
Published: March 2016

BACKGROUND: Regular treatment with inhaled salbutamol (seven to 14 days) increases airway responsiveness to allergen.

OBJECTIVE: To assess the effect of salmeterol 50 µg twice daily for six days on the early asthmatic response to allergen (PC15).

DESIGN: Double‐blind, randomized, crossover trial comparing salmeterol with placebo (twice daily over six days) with one week or more washout. Forced expiratory volume in 1 s (FEV1) and allergen PC15 were measured 36 h after each treatment was discontinued.

SETTING: Tertiary care out‐patient bronchoprovocation laboratory.

SUBJECTS: Fourteen atopic asthmatics well controlled with (n=5) or without (n=9) inhaled corticosteroids. Subjects did not use inhaled beta‐agonists for at least two weeks before and during the trial.

RESULTS: FEV1 was slightly but significantly lower 36 h after the last dose of salmeterol versus placebo (3.28±0.83 versus 3.40±0.88 L, P=0.032). Airway responsiveness to allergen increased by about half a doubling concentration (log10 PC15 2.71±0.61 versus 2.85±0.61, P=0.047).

CONCLUSION: A six‐day treatment course of salmeterol 50 μg twice daily resulted in a slight decline in FEV1 and a modest increase in airway response to allergen at 36 h.
Economic Benefits of a Routine Second Dose of Combined Measles, Mumps and Rubella Vaccine in Canada
Authors: Rivière Marc , Tretiak Roma , Levinton Carey , Fitzsimon Catherine , Leclerc Caroline
Published: March 2016

OBJECTIVE: To evaluate the potential economic benefits of a program for a second routine dose of combined measles, mumps and rubella (MMR) vaccine, administered to children in Canada.

DESIGN: Both published and unpublished data from the United States and Canada were incorporated into a linear model. This information was supplemented with opinions on probability and resource use from interviews with a Canadian panel of physicians and practitioners. The province of Quebec was used as a model for resource use and costs.

MATERIAL AND METHODS: Data were based on a vaccination program for Canadian children at 18 months, with an estimated annual birth cohort of 400,000. Further data were also collected for the lifetime costs of complications arising from these diseases or from vaccination, for both patients and family caregivers.

OUTCOME MEASURES: Outcomes were reviewed from the perspectives of a provincial ministry of health (direct medical costs) and of society (all direct and indirect medical and nonmedical costs).

RESULTS: It was estimated that a second dose of MMR vaccine administered at 18 months of age would prevent 9200 cases of measles, 6120 cases of mumps and 1960 cases of rubella, producing a savings of $6.34 for every dollar spent from the ministry of health perspective, and $3.25 from the societal perspective.

CONCLUSIONS: A routine second dose immunization with MMR vaccine would result in considerable cost savings in Canada.
Membrane Currents in Airway Smooth Muscle: Mechanisms and Therapeutic Implications
Authors: Janssen Luke J
Published: March 2016

Electrophysiological and pharmacological techniques were used to characterize the membrane conductance changes underlying spasmogen‐evoked depolarization in airway smooth muscle (ASM). Changes included a transient activation of chloride ion channels and prolonged suppression of potassium ion channels; both changes are triggered by release of internally sequestered calcium ion and in turn cause opening of voltage‐dependent calcium channels. The resultant influx of calcium ions contributes to contraction as well as to refilling of the internal calcium ion pool. Bronchodilators, on the other hand, act in part through activation of potassium channels, with consequent closure of calcium channels. The tools used to study ion channels in ASM are described, and the investigations of the roles of ion channels in ASM physiology (autacoid‐evoked depolarization and hyperpolarization) and pathophysiology (airway hyperresponsiveness) are summarized. Finally, how the relationship between ion channels and ASM function/dysfunction may relate to the treatment of asthma and related breathing disorders is discussed.
Coping and Self‐Medication in a Community Sample of Junior High School Students
Authors: Bedard Geneviève Bianca V , Reid Graham J , McGrath Patrick J , Chambers Christine T
Published: March 2016

OBJECTIVE: To examine differences between high and low catastrophizers in terms of pain, self‐medication, coping, age and sex.

DESIGN: Data were collected from 651 junior high students. Coping was assessed in response to pain in general. Pain (intensity and frequency) and self‐medication were assessed in response to five types of pain: headache, stomach, muscle and/or joint and/or back, ear and/or throat, and menstrual pains.

RESULTS: Catastrophizing groups were formed based on scores from the upper and lower thirds of a catastrophizing scale. The high catastrophizing group had higher levels of pain intensity and frequency for all five types of pain, and self‐medicated more for headache, and ear and/or throat pain, compared with the low catastrophizing group. High catastrophizers reported taking over‐the‐counter (OTC) medication more frequently than low catastrophizers. High catastrophizers used information seeking, problem solving, social support seeking, positive self‐statements and externalization more often than low catastrophizers. Low catastrophizers used behavioural and cognitive distraction more often than high catastrophizers. High catastrophizers perceived themselves to have more difficulty in dealing with pain and less control over their emotions when in pain than low catastrophizers. There were no significant differences between high and low catastrophizers in terms of controllability of pain. There was a higher percentage of catastrophizers in grade 9 than in grades 7 or 8 and a higher percentage of girls catastrophizing than boys.

CONCLUSIONS: More frequent use of coping strategies while experiencing greater pain intensity and frequency may reflect catastrophizers′ general inability to reduce pain. Greater use of OTC medications by catastrophizers is likely due to their experiences of more frequent and intense pain.
Herpes Simplex Esophagitis in Immunocompetent Hosts
Authors: Eymard Daniel , Martin Luc , Doummar Gilbert , Piché Jean
Published: March 2016

Over four months, three cases of biopsy‐proven herpes simplex esophagitis were seen at Centre hospitalier Pierre‐Boucher, Longueuil, in young adult males with no evidence of immunosuppression and negative serological testing for antibody against the human immunodeficiency virus. Clinical presentation consisted of odynophagia, fever and retrosternal chest pain. All patients rapidly improved with acyclovir therapy.
Lack of Evidence for Age Differences in Pain Beliefs
Authors: Gagliese Lucy , Melzack Ronald
Published: March 2016

OBJECTIVE: To assess, in two studies, whether there are any age differences in beliefs about the role of psychological, organic and ageing factors in the experience of chronic pain.

SUBJECTS: Healthy adults free from chronic pain ranging in age from 18 to 86 years (first study); adults with chronic pain due to arthritis, fibromyalgia or other rheumatological disorders ranging in age from 27 to 79 years (second study).

MATERIALS: In both studies, subjects completed the Pain Beliefs Questionnaire which was modified to measure beliefs about the relationship between pain and ageing. In addition, subjects completed various self‐assessments of health, pain intensity and depression. Those with chronic pain also completed the Arthritis Self‐Efficacy Scale.

RESULTS: There was no evidence of any age differences in beliefs about pain in either the pain‐free or chronic pain samples. There was some evidence that elderly patients may report less pain, but there were no age differences found on measures of depression or self‐efficacy.

CONCLUSIONS: The elderly were no more likely than younger persons to associate pain with the normal ageing process than with organic factors such as tissue damage, nor were they more likely to deny the importance of psychological factors to the pain experience.
Implications of Concepts of Consciousness for Understanding Pain Behaviour and the Definitiion of Pain
Authors: Craig Kenneth D
Published: March 2016

Judgements of the nature and severity of pain others may be experiencing are heavily influenced by an observer′s preconceptions about the nature of the experience. Our personal sense of conscious experience dictates a search for consciousness characterized by the state of awareness found in competent adults, including constructive memories and thoughts, images and feelings. People incapable of verbally articulating experiences akin to those reported by competent older children and adults are at risk of having other evidence of pain denied, minimized or ignored. Despite substantial behavioural evidence for pain in the neonate and infant, and findings indicating destructive immediate and long term consequences if pain is not controlled, pain in infants and children often continues to be discounted. An alternative perspective on infant consciousness of pain focusing upon sensory and emotional components is presented. The current prominent definition of pain supports the prejudice favouring adult conceptions of consciousness by emphasizing the importance of self‐report in assessing pain. Explanatory notes accompanying this definition also perpetrate the misguided belief that the experience of pain emerges as a product of early life experiences. The case for using nonverbal as well as verbal expression in the process of inferring states of pain is presented. As well, the proposition is supported that there should be explicit recognition that the experience of pain is an inherent quality of life present in all viable newborns, with the nature of the experience and its expression changing in the course of maturation and as a result of exposure to life experiences related to tissue injury.
Amino Acid Levelsin the Brain of Rats with Peripheral Nerve Constriction or Section
Authors: Bianchi Mauro , Ferrario Paolo , Clavenna Antonio , Biella Gabriele , Sotgiu Maria Luisa
Published: March 2016

BACKGROUND: Both excitatory and inhibitory amino acids modulate central neuronal activity following peripheral nerve tissue injury.

OBJECTIVE: To establish whether mononeuropathy induced by chronic constriction injury or by sectioning of the sciatic nerve affects neurotransmitter amino acid levels in the rat brain areas.

METHODS: Glutamine, glutamic acid, gamma‐aminobutyric acid (GABA) and aspartic acid in the hindbrain, midbrain and hypothalamus of rats were measured by high performance liquid chromatography 14 days after surgery.

RESULTS: After monolateral nerve ligation an increase in glutamine and a decrease in GABA levels in all brain areas were observed, with no side preference. The section of the sciatic nerve did not cause any modification in amino acid levels.

CONCLUSIONS: The results allow one to differentiate more clearly classic models of mononeuropathy from a biochemical point of view. Moreover, results indicate that continuous neuronal stimulation induced by nerve constriction is able to modify some amino acid pathways at a supraspinal level.