bluuebunny/crossref_metadata_2025 huggingface dataset:
Ethnic Variation in the Annual Rates of Adult Inflammatory Bowel Disease in Hospitalized Patients in Vancouver, British Columbia
Authors: Mangat Birinder K , Evaschesen Chad , Lee Tim , Yoshida Eric M , Salh Baljinder
Published: March 2016

BACKGROUND: There is currently little available information regarding the impact of ethnicity on the clinical features of inflammatory bowel disease (IBD). Migrating populations and changing demographics in Vancouver, British Columbia (BC) provide a unique opportunity to examine the role of ethnicity in the prevalence, expression and complications of IBD.

OBJECTIVES: To determine the demographics of IBD and its subtypes leading to hospitalization in the adult population of BC.

METHODS: A one‐year retrospective study was performed for all patients who presented acutely with IBD to Vancouver General Hospital from January 1, 2006 to December 31, 2006. Data regarding sex, age, ethnicity, IBD type and extent of disease, complications and management strategies were collected. Clinical data were confirmed by pathology and radiology reports.

RESULTS: There were 186 cases of IBD comprising Crohn’s disease (CD) 56%, ulcerative colitis (UC) 43% and indeterminate colitis (1%) 1%. The annual rate of IBD cases warranting hospitalization in Caucasians was 12.9 per 100,000 persons (7.9 per 100,000 persons for CD and 5.0 per 100,000 persons for UC). This was in contrast to the annual rate of IBD in South Asians at 7.7 per 100,000 persons (1.0 per 100,000 persons for CD and 6.8 per 100,000 persons for UC) and in Pacific Asians at 2.1 per 100,000 persons (1.3 per 100,000 persons for CD, 0.8 per 100,000 persons for UC). The male to female ratio was higher in South Asians and Pacific Asians than in Caucasians. The extent of disease was significantly different across racial groups, as was the rate of complications.

CONCLUSIONS: These early results suggest that there are ethnic disparities in the annual rates of IBD warranting hospitalization in the adult population of BC. There was a significantly higher rate of CD in the Caucasian population than in South Asian and Pacific Asian populations. The South Asian population had a higher rate of UC, with an increased rate of complications and male predominance. Interestingly, the rate of CD and UC was lowest in the Pacific Asian population. These racial differences – which were statistically significant – suggest a role for ethnodiversity and environmental changes in the prevalence of IBD in Vancouver.
Testing for Gluten-Related Disorders in Clinical Practice: The Role of Serology in Managing the Spectrum of Gluten Sensitivity
Authors: Armstrong David , Don-Wauchope Andrew C , Verdu Elena F
Published: March 2016

Immunoglobulin A tissue transglutaminase is the single most efficient serological test for the diagnosis of celiac disease. It is well known that immunoglobulin A tissue transglutaminase levels correlate with the degree of intestinal damage, and that values can fluctuate in patients over time. Serological testing can be used to identify symptomatic individuals that need a confirmatory biopsy, to screen at-risk populations or to monitor diet compliance in patients previously diagnosed with celiac disease. Thus, interpretation of serological testing requires consideration of the full clinical scenario. Antigliadin tests are no longer recommended for the diagnosis of classical celiac disease. However, our understanding of the pathogenesis and spectrum of gluten sensitivity has improved, and gluten-sensitive irritable bowel syndrome patients are increasingly being recognized. Studies are needed to determine the clinical utility of antigliadin serology in the diagnosis of gluten sensitivity.
How Well IsHelicobacter pyloriTreated in Usual Practice?
Authors: Yogeswaran Kumaresan , Chen Grant , Cohen Lawrence , Cooper Mary Anne , Yong Elaine , Hsieh Eugene , Rowsell Corwyn , Saibil Fred , Tinmouth Jill
Published: March 2016

BACKGROUND:Helicobacter pyloriis a WHO class I carcinogen also associated with nonmalignant gastrointestinal diseases. Effective treatment exists, and all persons infected withH pylorishould receive treatment. However, data regarding the rates of treatment prescription in clinical practice are lacking.

OBJECTIVE: To determine the rates ofH pyloritreatment in usual practice.

METHODS: Patients with histological evidence ofH pyloriinfection between January 1, 2007, and December 31, 2007, at Sunnybrook Health Sciences Centre (Toronto, Ontario) were identified. Charts were reviewed to determine the rates ofH pyloritreatment and confirmation of eradication, when indicated. Questionnaires were subsequently sent to endoscopists of patients identified as not having received treatment to determine the reasons for lack of treatment.

RESULTS: A total of 102 patients wereH pyloripositive and were appropriate candidates for treatment, of whom 58 (57%) were male and 78 (76%) were outpatients, with 92 (90%) receiving eradication therapy. When indicated, 15 of 22 (68%) patients received confirmation of eradication, 13 of 18 (72%) patients underwent repeat endoscopy and 86% received complete therapy. Outpatients were more likely to receive eradication therapy (OR 10.3 [95% CI 2.6 to 40.4]; P=0.001) and complete therapy (OR 13.2 [95% CI 3.8 to 45.7]; P=0.0001) compared with inpatients. Having a follow-up appointment resulted in higher treatment rates (OR 12.0 [95% CI 3.0 to 47.5]; P=0.001).

CONCLUSION: During the time period studied, adequate rates ofH pyloritreatment were achieved in outpatients and patients who had formal follow-up at Sunnybrook Health Sciences Centre. However, some aspects of care remain suboptimal including treatment of inpatients and care following treatment. Additional studies are required to identify strategies to improve the care of patients infected withH pylori.
Inflammatory Pseudotumour of the Lung
Authors: Kaitoukov Youri , Rakovich George , Trahan Sylvain , Grégoire Jocelyn
Published: March 2016

Inflammatory pseudotumours of the lung are extremely rare. Their pathogenesis is controversial, their diagnosis is often difficult and their clinical behaviour may be unpredictable – ranging from benign to locally invasive, to metastatic in spite of an apparently ‘benign’ histology. A patient who presented with multiple recurrent lesions in the contralateral lung almost two years after the resection of a large primary tumour of the left upper lobe is reported.
Long‐Term Survival in Idiopathic Pulmonary Arterial Hypertension Associated with Massive Pulmonary Artery Dilation
Authors: Petrovic Vanja , Ryerson Christopher J , Levy Robert D
Published: March 2016

The present report describes two patients with long‐term survival after being diagnosed with idiopathic pulmonary arterial hypertension more than 20 years earlier. Both patients were treated with calcium channel blockers for several years and are currently maintained on bosentan, an oral endothelin receptor antagonist. Severe dilation of the main pulmonary arteries is present in both patients and may be related to long‐term survival with idiopathic pulmonary arterial hypertension.
Efficacy and Safety of Adalimumab in Canadian Patients with Moderate to Severe Crohn’s Disease: Results of the Adalimumab in Canadian SubjeCts with ModErate to Severe Crohn’s DiseaSe (ACCESS) Trial
Authors: Panaccione Remo , Loftus Edward V , Binion David , McHugh Kevin , Alam Shamsul , Chen Naijun , Guérette Benoît , Mulani Parvez , Chao Jingdong
Published: March 2016

OBJECTIVE: To evaluate open-label adalimumab therapy for clinical effectiveness, fistula healing, patient-reported outcomes and safety in Canadian patients with moderate to severe Crohn’s disease (CD) who were either naive to or previously exposed to antitumour necrosis factor (anti-TNF) therapy.

METHODS: Patients with moderate to severe CD (CD activity index [CDAI] score of greater than 220, or Harvey-Bradshaw index [HBI] of 7 or greater) were eligible. Patients received open-label adalimumab as induction (160 mg and 80 mg subcutaneously [sc]) at weeks 0 and 2, respectively and maintenance (40 mg sc every other week) therapy. At or after eight weeks, patients with flare or nonresponse could have their dosage increased to 40 mg sc weekly. Patients were followed for a minimum of six months or until adalimumab was commercially available in Canada.

RESULTS: Of the 304 patients enrolled, 160 were infliximab experienced, while 144 were anti-TNF naive. HBI remission (HBI score of 4 or lower) at week 24 was achieved by 53% of anti-TNF-naive and 36% of infliximab-experienced patients (P<0.01; P<0.001 for both groups for all visits versus baseline). Fistula healing rates at week 12 were 48% for anti-TNF-naive patients, and 26% for infliximab-experienced patients. At week 24, fistula healing rates were significantly greater for the anti-TNF-naive group (60% versus 28%; P<0.01). Improvements in quality of life and work productivity were sustained from week 4 to week 24 for all patients. Serious infections occurred in 2% of patients.

CONCLUSIONS: Adalimumab therapy induced and sustained steroid-free remission in both infliximab-experienced and anti-TNF-naive patients with moderate to severe CD. Clinically meaningful rates of fistula healing were also observed. Improvements in patient-reported outcomes were sustained throughout the 24-week study period.
Effects of Reactive Oxygen Species on Mitochondrial Content and Integrity of Human Anastomotic Colorectal Dehiscence: A Preliminary DNA Study
Authors: Potenza Lucia , Calcabrini Cinzia , De Bellis Roberta , Guescini Michele , Mancini Umberto , Cucchiarini Luigi , Nappo Gennaro , Alloni Rossana , Coppola Roberto , Dugo Laura , Dachà Marina
Published: March 2016

BACKGROUND: Anastomotic dehiscence is one of the most severe complications of colorectal surgery. Gaining insight into the molecular mechanisms responsible for the development of anastomotic dehiscence following colorectal surgery is important for the reduction of postoperative complications.

OBJECTIVE: Based on the close relationship between surgical stress and oxidative stress, the present study aimed to determine whether a correlation exists between increased levels of reactive oxygen species and colorectal anastomotic dehiscence.

METHODS: Patients who underwent surgical resection for colorectal cancer were divided into three groups: patients with anastomotic dehiscence (group 1); patients without dehiscence who underwent neoadjuvant radiochemotherapy (group 2); and patients without anastomotic dehiscence who did not undergo neoadjuvant radiochemotherapy (group 3). Quantitative polymerase chain reaction and real-time polymerase chain reaction assays were performed to measure nuclear DNA and mitochondrial DNA (mtDNA) content, and possible oxidative damage to nonmalignant colon and rectal tissues adjacent to the anastomoses.

RESULTS: mtDNA content was reduced in the colon tissue of patients in groups 1 and 2. Rectal mtDNA was found to be more damaged than colonic mtDNAs in all groups. The 4977 bp common deletion was observed in the mtDNA of tissues from both the colon and rectum of all patients.

DISCUSSION: Patients in groups 1 and 2 were more similar to one another than to group 3, probably due to higher levels of reactive oxygen species in the mitochondria; the greater damage found in the rectum suggests that dehiscence originates primarily from the rectal area.

CONCLUSIONS: The present study of mtDNA analyses of normal human colon and rectal tissues from patients with colorectal cancer is among the first of its kind.
Joining Forces: Collaborating Internationally to Deliver High‐Quality, Online Postgraduate Education in Pain Management
Authors: Devonshire Elizabeth , Siddall Philip J
Published: March 2016

The effective management of pain is a complex and costly global issue, requiring a range of innovative educational strategies to enable culturally appropriate and high‐quality health care provision. In response to this issue, the Pain Management Research Institute at the University of Sydney (Sydney, Australia) has established several strategic alliances with other overseas universities to deliver online postgraduate education in pain management. The present article discusses the rationale for joining forces, and the approach adopted in creating and maintaining these alliances. It also provides insights into the benefits, challenges and opportunities associated with collaborative educational initiatives of this nature, from institutional, academic and student perspectives.
A Survey of Sedation Practices for Colonoscopy in Canada
Authors: Porostocky Peter , Chiba Naoki , Colacino Palma , Sadowski Dan , Singh Harminder
Published: March 2016

BACKGROUND: There are limited data regarding the use of sedation for colonoscopy and concomitant monitoring practices in different countries.

METHODS: A survey was mailed to 445 clinician members of the Canadian Association of Gastroenterology and 80 members of the Canadian Society of Colon and Rectal Surgeons in May and June 2009.

RESULTS: Sixty-five per cent of Canadian Association of Gastroenterology members and 69% of Canadian Society of Colon and Rectal Surgeons members responded with the full survey. Most endoscopists reported using sedation for more than 90% of colonoscopies. The most common sedation regimen was a combination of midazolam and fentanyl. Propofol, either alone or with another drug, was used in 12% of cases. A higher proportion (94%) of adult gastroenterologists who routinely used propofol were highly satisfied compared with those using other sedative agents (45%; P<0.001). Fifty per cent of adult gastroenterologists and 29% of surgeons who were not currently using propofol expressed interest in starting to use it for routine colonoscopies. Only a single nurse was present in the endoscopy room during colonoscopy performed by two-thirds of the endoscopists.

CONCLUSIONS: Results of the present survey suggest that gastroenterologists in Canada use sedation for colonoscopy in more than 90% of their patients. There was higher satisfaction among gastroenterologists who used propofol routinely for all colonoscopies. Most endoscopy rooms were staffed by a single nurse, which may limit further increases in the use of propofol. Further studies are needed to determine optimal staffing of endoscopy units with and without the use of propofol. Sedation practices of general surgery endoscopists need to be evaluated.
Coinfection withCryptococcus GattiiandMycobacterium Tuberculosisin an Otherwise Healthy 18-Year-Old Woman
Authors: Van Tongeren Lindsay , Shaipanich Tawimas , Fleetham John A
Published: March 2016

A case ofCryptococcus gattii(pulmonary and central nervous system) andMycobacterium tuberculosis(pulmonary) coinfection in an otherwise healthy young woman is reported. The patient presented with a two-month history of dry cough. She had an unremarkable medical history. Both tuberculosis and cryptococcosis were diagnosed following bronchoscopy, and a subsequent lumbar puncture revealedC gattiiin the cerebrospinal fluid. There is evidence that bothM tuberculosisandC gattiimay have suppressive effects on the host immune system. This suggests a mechanism by which an otherwise healthy individual developed these two infections.
Gastrostomy Tube Insertion in Children: The Edmonton Experience
Authors: Ackroyd Ryan , Saincher Meghana , Cheng Simon , El-Matary Wael
Published: March 2016

BACKGROUND: Although gastrostomy tube insertion – whether endoscopic or open – is generally safe, procedure-related complications have been reported.

OBJECTIVE: To compare gastrostomy tube insertion-related complications between percutaneous endoscopic gastrostomy and open gastrostomy at a single pediatric centre.

METHODS: The charts of children (younger than 17 years of age at the time of tube insertion) who underwent endoscopic or open gastrostomy tube insertion from January 2005 to December 2007 at the Stollery Children’s Hospital (Edmonton, Alberta) were examined.

RESULTS: A total of 298 children underwent gastrostomy tube insertion over a period of three years. After excluding patients with incomplete charts, 160 children (91 boys, mean [± SD] age 3.18±4.73 years) were included. Eighty-five children (mean age 4.50±5.40 years) had their gastrostomy tube inserted endoscopically, while the remaining 75 (mean age 1.68±3.27 years; P<0.001) underwent an open procedure. The overall rate of major complications was 10.2% for the endoscopic technique and 8.6% for the open technique (P=0.1). Major infections were higher in the endoscopic technique group, while persistent gastrocutaneous fistulas after tube removal were more common in the open technique group.

CONCLUSION: Although the rate of major complications was similar between the endoscopic and open tube insertion groups, major infections were more common among children who underwent endoscopic gastrostomy. The decision for gastrostomy tube insertion was primarily based on clinical background.
Collagenous Sprue
Authors: Freeman Hugh James
Published: March 2016

Collagenous sprue is a small bowel mucosal lesion that has been historically associated with persistent diarrhea, progressive weight loss and severe malabsorption causing multiple nutrient deficiencies. A severe to variably severe mucosal lesion with distinct subepithelial collagen deposits occurs. Celiac disease has been intimately linked to collagenous sprue and, similar to celiac disease, small bowel ulceration, perforation and lymphoma may complicate the clinical course of collagenous sprue. In collagenous sprue, concomitant collagen deposits may also occur in gastric or colonic mucosal sites (or both), indicating that this unusual mucosal process may be very heterogeneous and far more extensive in the intestinal tract than previously appreciated. Moreover, reports of diagnosis during infancy suggest that the natural history of the disorder could be more prolonged than is currently appreciated. Finally, the collagen deposits, per se, may be due to different causes and, in some, even represent a novel paraneoplastic histopathological marker. Future studies are needed to more precisely define molecular and genetic biomarkers that identify homogeneous groups and permit the development of improved treatment strategies for this increasingly recognized disorder.
Impact of Candida Species on Clinical Outcomes in Patients with Suspected Ventilator‐Associated Pneumonia
Authors: Delisle Marie-Soleil , Williamson David R , Albert Martin , Perreault Marc M , Jiang Xuran , Day Andrew G , Heyland Daren K
Published: March 2016

BACKGROUND: The significance of Candida species in respiratory tract (RT) secretions in critically ill patients is unclear.

METHODS: A retrospective analysis of the Canadian ventilator‐associated pneumonia (VAP) trial was conducted. Only patients with suspected VAP whose initial cultures failed to grow any known pathogens were included. Using two fundamentally different statistical techniques that adjusted for important confounding variables, the clinical outcomes of patients with Candida species recovered from RT cultures were compared with patients whose RT cultures were not positive for Candida species.

RESULTS: RT cultures yielded no identifiable bacterial pathogens in 274 patients; 68 patients had Candida species in the RT alone, while 206 patients did not have Candida species recovered from any site. The unadjusted OR of hospital mortality for patients with Candida species was 2.9 (95% CI 1.6 to 5.2; P<0.001). The hazard ratio of time to hospital discharge was 0.54 (95% CI 0.38 to 0.77; P=0.001). Logistic regression analysis demonstrated that age, Acute Physiology score and Chronic Health Evaluation (APACHE) II score, primary diagnosis of respiratory failure, two or more comorbidities and Candida species were independently associated with increased hospital mortality. Similar trends were observed with time to hospital discharge. The association between Candida species and increased mortality remained after controlling for potential confounders using both propensity score stratification and multivariable modelling approaches.

CONCLUSIONS: Patients with suspected VAP, in whom no bacterial pathogen was identified and in whom Candida species were isolated from RT cultures, exhibited a greater burden of illness compared with similar patients without Candida. Whether Candida species colonization of RT secretions is a marker of disease severity or actually contributes to poorer clinical outcomes remains unclear.
Electronic Gaming as Pain Distraction
Authors: Jameson Eleanor , Trevena Judy , Swain Nic
Published: March 2016

The current study investigated whether active distraction reduces participants’ experience of pain more than passive distraction during a cold pressor task. In the first experiment, 60 participants were asked to submerge their hand in cold (2°C) water for as long as they could tolerate. They did this with no distraction, and then with active (electronic gaming system) and passive (television) distraction, in randomly assigned order. Tolerance time, pain intensity ratings and task absorption ratings were measured for each condition. A second experiment attempted to control for participants’ expectations about the effects of distraction on pain. Forty participants underwent the same experimental procedure, but were given verbal suggestions about the effects of distraction by the experimenter before each distraction condition. Participants in both experiments had a significantly higher pain tolerance and reported less pain with the active distraction compared with passive or no distraction. Participants reported being more absorbed, and were significantly more willing to do the task again when they had the active distraction compared with both passive distraction and no distraction. They also had more enjoyment, less anxiety and greater reduction in pain with active distraction than with passive distraction. There was no effect of suggestion. These experiments offer further support for the use of electronic games as a method of pain control.
The Prevalence of Chronic Pain in Canada
Authors: Schopflocher Donald , Taenzer Paul , Jovey Roman
Published: March 2016

Published population estimates of the prevalence of chronic pain have been highly variable due, in part, to differences in definitions and study methodologies. Designing health care delivery models that address chronic pain and reduce its impact, however, require accurate, up‐to‐date prevalence data. This article first reviews studies that examined the prevalence of chronic pain both internationally and in Canada. The ensuing sections describe a telephone‐based survey of a well‐defined population of adults using a detailed and sequential definition of chronic pain, and well‐validated and reliable data collection tools for establishing the prevalence of chronic pain in Canada.

BACKGROUND: While chronic pain appears to be relatively common, published population prevalence estimates have been highly variable, partly due to differences in the definition of chronic pain and in survey methodologies.

OBJECTIVES: To estimate the prevalence of chronic pain in Canada using clear case definitions and a validated survey instrument.

METHODS: A telephone survey was administered to a representative sample of adults from across Canada using the same screening questionnaire that had been used in a recent large, multicountry study conducted in Europe.

RESULTS: The prevalence of chronic pain prevalence for adults older than 18 years of age was 18.9%. This was comparable with the overall mean reported using identical survey questions and criteria for chronic pain used in the European study. Chronic pain prevalence was greater in older adults, and females had a higher prevalence at older ages compared with males. Approximately one‐half of those with chronic pain reported suffering for more than 10 years. Approximately one‐third of those reporting chronic pain rated the intensity in the very severe range. The lower back was the most common site of chronic pain, and arthritis was the most frequently named cause.

CONCLUSIONS: A consensus is developing that there is a high prevalence of chronic pain within adult populations living in industrialized nations. Recent studies have formulated survey questions carefully and have used large samples. Unfortunately, a substantial proportion of Canadian adults continue to live with chronic pain that is longstanding and severe.
An 11-Year-Old Male Patient with Refractory Asthma and Heartburn
Authors: Al-Abdoulsalam Tareq , Anselmo Mark A
Published: March 2016

Achalasia is characterized by obstruction of the distal esophagus and subsequent dilation of the proximal esophagus, and is considered to be a rare disorder in children. Patients commonly present with gastrointestinal (GI) symptoms such as dysphagia; however, pulmonary symptoms may also occur. Rare pulmonary symptoms due to achalasia are dyspnea and wheeze due to tracheal compression. The authors describe an 11-year-old boy who was referred to a pediatric respiratory clinic for asthma that was not responsive to inhaled medications. The child presented with a one-year history of dyspnea on exertion, cough and wheeze. He also complained of chronic dyspepsia. The presence of GI symptoms, in addition to abnormalities on chest radiograph and spirometry, suggested the presence of achalasia. The diagnosis was confirmed and the patient subsequently underwent surgical myotomy that relieved his GI and pulmonary symptoms, and normalized spirometry. The present article is an illustrative case report to remind pediatricians to consider other diagnoses when a patient does not respond to asthma medications.
Persistent Sputum Cellularity and Neutrophils May Predict Bronchiectasis
Authors: Drost Nicole , D’silva Liesel , Rebello Ryan , Efthimiadis Ann , Hargreave Frederick E , Nair Parameswaran
Published: March 2016

BACKGROUND: Quantitative cell counts in sputum provide an accurate assessment of the type and severity of bronchitis.

OBJECTIVE: To examine whether sputum cell counts could identify bronchiectasis in patients with recurrent bronchitis.

METHODS: A retrospective survey of a clinical database (January 2004 to January 2005) of quantitative cell counts from sputum selected from expectorate in patients with obstructive airways diseases was used to identify predictors of bronchiectasis using ROC curves. This was prospectively evaluated (February 2005 to April 2008) using high-resolution computed tomography scans of thorax that were independently scored by a radiologist who was blinded to the clinical details.

RESULTS: The retrospective survey identified 41 patients with bronchiectasis among 490 patients with airway diseases. Total cell count of 60×106/g or greater of the selected sputum with predominant neutrophils on two occasions had a sensitivity of 86.7%, a specificity of 87.5%, and positive and negative predictive values of 93% and 78%, respectively, to identify bronchiectasis. In the prospective study, 10 of 14 (71%) patients who met these criteria were identified to have bronchiectasis. Both total cell count and the percentage of neutrophils correlated with radiographic bronchiectasis severity.

CONCLUSIONS: Persistent or recurrent intense sputum cellularity with neutrophilia is suggestive of bronchiectasis.
Effect of Adalimumab on Work Productivity and Indirect Costs in Moderate to Severe Crohn’s Disease: A Meta-Analysis
Authors: Binion David G , Louis Edouard , Oldenburg Bas , Mulani Parvez , Bensimon Arielle G , Yang Mei , Chao Jingdong
Published: March 2016

OBJECTIVE: To assess the effect of adalimumab on work productivity and indirect costs in patients with Crohn’s disease (CD) using a meta-analysis of clinical trials.

METHODS: Study-level results were pooled from all clinical trials of adalimumab for moderate to severe CD in which work productivity outcomes were evaluated. Work Productivity and Activity Impairment Questionnaire outcomes (absenteeism, presenteeism and total work productivity impairment [TWPI]) were extracted from adalimumab trials. Meta-analyses were used to estimate pooled averages and 95% CIs of one-year accumulated reductions in work productivity impairment with adalimumab. Pooled averages were multiplied by the 2008 United States national average annual salary ($44,101) to estimate per-patient indirect cost savings during the year following adalimumab initiation.

RESULTS: The four included trials (ACCESS, CARE, CHOICE and EXTEND) represented a total of 1202 employed adalimumab-treated patients at baseline. Each study followed patients for a minimum of 20 weeks. Pooled estimates (95% CIs) of one-year accumulated work productivity improvements were as follows: −9% (−10% to −7%) for absenteeism; −22% (−26% to −18%) for presenteeism; and −25% (−30% to −20%) for TWPI. Reductions in absenteeism and TWPI translated into per-patient indirect cost savings (95% CI) of $3,856 ($3,183 to $4,529) and $10,964 ($8,833 to $13,096), respectively.

CONCLUSION: Adalimumab provided clinically meaningful improvements in work productivity among patients with moderate to severe CD, which may translate into substantial indirect cost savings from an employer’s perspective.
Identification of a Persistent Primitive Trigeminal Artery Following the Transposition Technique for Trigeminal Neuralgia: A Case Report
Authors: Kato Naoki , Tanaka Toshihide , Sakamoto Hiroki , Arai Takao , Hasegawa Yuzuru , Abe Toshiaki
Published: March 2016

Trigeminal neuralgia is lancinating pain of a few seconds duration triggered by minor sensory stimuli such as speaking, chewing or even a breeze on the face. Vascular compression of the trigeminal nerve at the root entry zone and other vessels has been implicated in its cause. Despite the initial success of medical treatment in some cases, however, many patients become refractory over time and eventually require surgical intervention. This report describes a case involving a 62‐year‐old woman who presented with right orbital pain provoked by, among others, exercise and cold. Medication proved to be ineffective and, after magnetic resonance imaging, microvascular decompression and surgical observation, the diagnosis became clearer. The case highlights the importance of preoperative imaging and careful intraoperative findings to determine whether variant arteries are responsible for trigeminal neuralgia.

A patient who presented with trigeminal neuralgia associated with a persistent primitive trigeminal artery (PPTA) is presented. A 62‐year‐old woman suffering from right orbital pain was admitted to the hospital. Medical treatment for three months was ineffective, and her neuralgia had deteriorated and gradually spread in the maxillary division. Magnetic resonance imaging demonstrated the flow void signal attached to the right trigeminal nerve. Thus, microvascular decompression was performed. The superior cerebellar artery was the responsible artery, and it was transposed to decompress the trigeminal nerve. After this manoeuvre, an artery was identified running parallel to the trigeminal nerve toward Meckel’s cave. The artery, which turned out to be a PPTA, communicated with the basilar artery. The PPTA was carefully observed, and it was found not to be the artery causing the neuralgia because it did not compress the nerve at surgical observation. No additional procedure between the PPTA and the trigeminal nerve was performed. The patient’s symptom improved dramatically following surgery, and her postoperative course was uneventful. Postoperative three‐dimensional computed tomography showed the PPTA. The findings in the present case suggest that transposition of the responsible artery effectively decompresses the root entry zone and assists in determining whether the PPTA is affecting the trigeminal nerve.
Daptomycin‐Nonsusceptible, Vancomycin‐Intermediate, Methicillin‐Resistant Staphylococcus aureus Endocarditis
Authors: Yu Ryan , Dale Suzanne E , Yamamura Deborah , Stankus Vida , Lee Christine
Published: March 2016

Due to the emergence of Staphylococcus aureus with reduced vancomycin susceptibility, newer antibiotics, including daptomycin, have been used to treat methicillin‐resistant S aureus infections. Daptomycin is a cyclic lipopeptide that is approved to treat S aureus bacteremia and right‐sided endocarditis, and reports of S aureus with reduced susceptibility to daptomycin are infrequent. To our knowledge, the present report describes the first Canadian case of daptomycin‐nonsusceptible, vancomycin‐intermediate S aureus infection.
Reactive Airways Dysfunction Syndrome from Acute Inhalation of Dishwasher Detergent Powder
Authors: Hannu Timo J , Riihimäki Vesa E , Piirilä Päivi L
Published: March 2016

Reactive airway dysfunction syndrome, a type of occupational asthma without a latency period, is induced by irritating vapour, fumes or smoke. The present report is the first to describe a case of reactive airway dysfunction syndrome caused by acute exposure to dishwater detergent containing sodium metasilicate and sodium dichloroisocyanurate. The diagnosis was based on exposure data, clinical symptoms and signs, as well as respiratory function tests. A 43‐year‐old nonatopic male apprentice cook developed respiratory symptoms immediately after exposure to a cloud of detergent powder that was made airborne by vigorous shaking of the package. In spirometry, combined obstructive and restrictive ventilatory impairment developed, and the histamine challenge test revealed bronchial hyper‐responsiveness. Even routine handling of a strongly caustic detergent, such as filling a dishwasher container, is not entirely risk free and should be performed with caution.
Parasitic Disease Screening among HIV Patients from Endemic Countries in a Toronto Clinic
Authors: Costiniuk Cecilia T , Cooper Curtis L , Doucette Steve , Kovacs Colin M
Published: March 2016

BACKGROUND: Many North American‐based HIV patients originate from parasitic disease‐endemic regions. Strongyloidiasis, schistosomiasis and filariasis are important due to their wide distribution and potential for severe morbidity.

OBJECTIVES: To determine the prevalence, as determined by serological screening, of strongyloidiasis, schistosomiasis and filariasis among patients in an HIV‐focused, primary care practice in Toronto, Ontario. A secondary objective was to determine factors associated with positive serological screens.

METHODS: A retrospective review of electronic patient records was conducted. Results of serological screens for parasites and relevant laboratory data were collected.

RESULTS: Ninety‐seven patients were identified. The patients’ mean CD4+ count was 0.45×109/L, median viral load was undetectable and 68% were on highly active antiretroviral therapy (HAART). Most originated from Africa (37%) and South America (35%). Of the 97 patients, 10.4% and 8.3% had positive or equivocal screening results for strongyloidiasis, respectively, 7.4% and 4.2% had positive or equivocal screening results for schistosomiasis and 5.5% and 6.8% had positive or equivocal screens for filariasis. Persons with positive parasitic serologies were more often female (28% versus 9%, P=0.03), younger in age (36 versus 43 years of age, P<0.01), had been in Canada for a shorter duration (5 versus 12 years, P<0.0001) and had a higher viral load (10,990 copies/mL versus <50 copies/mL, P <0.001). All patients were asymptomatic. Eosinophilia was not associated with positive screening results.

CONCLUSIONS: Using symptoms and eosinophilia to identify parasitic infection was not reliable. Screening for strongyloidiasis and schistosomiasis among patients with HIV from parasite‐endemic countries is simple and benign, and may prevent future complications. The clinical benefits of screening for filariasis require further elucidation, but this practice appears to be the least warranted.
Gluten-Free Diet Does Not Appear to Induce Endoscopic Remission of Eosinophilic Esophagitis in Children with Coexistent Celiac Disease
Authors: Abraham Joseph R , Persad Rabin , Turner Justine M , Huynh Hien Q
Published: March 2016

BACKGROUND: Celiac disease and eosinophilic esophagitis are usually considered to be separate gastrointestinal diseases; however, it appears that they may coexist more often than would be expected. It is unknown whether eosinophilic esophagitis in patients with celiac disease responds to a gluten-free diet.

OBJEVTIVES: To examine the clinical, endoscopic and histological features of children with both conditions to evaluate whether eosinophilic esophagitis responds to a gluten-free diet.

METHODS: From January 1, 2009, to June 30, 2011, the medical records of children <18 years of age diagnosed with eosinophilic esophagitis and/or celiac disease were reviewed. Patients with clinical, endoscopic and histological diagnoses of both diseases were identified and included. These findings were analyzed, as were laboratory results, treatment and follow-up.

RESULTS: During the study period, there were 206 celiac disease patients, 86 eosinophilic esophagitis patients and nine (4.4% of total celiac) patients with both diagnoses. Gluten-free diet was the primary treatment for both conditions in seven of nine (78%) cases. In six of these seven (86%) patients, no endoscopic or histological improvement of eosinophilic esophagitis was observed, while in one patient, histological remission of esophageal eosinophilia occurred while on a gluten-free diet.

CONCLUSION: The prevalence of eosinophilic esophagitis in patients with celiac disease was 4.4%, confirming a higher than expected prevalence of eosinophilic esophagitis compared with the general population. In patients with celiac disease, a gluten-free diet did not appear to induce remission of coexistent endoscopic and histological features of eosinophilic esophagitis.
Alagille Syndrome and Wilson Disease in Siblings: A Diagnostic Conundrum
Authors: Amson Meghan , Lamoureux Esther , Hilzenrat Nir , Tischkowitz Marc
Published: March 2016

The authors describe two siblings, each with a different, rare genetic condition that affects liver function. The index case, the 18-year-old asymptomatic brother of a young man recently diagnosed with Wilson disease, presented for Wilson disease screening and was also found to have abnormal liver function suggestive of cholestasis. However, ceruloplasmin level, 24 h urine copper concentration and liver synthetic function were normal. Further hepatic investigations and genetic mutation analysis were performed, ultimately leading to a diagnosis of Alagille syndrome. He was treated with ursodiol, which resulted in normalization of his liver function tests. Subsequently, he was found to be a carrier for a mutation in the Wilson disease gene,ATP7B. In the present report, the potential implications of being a heterozygote for Wilson disease in the context of Alagille syndrome are discussed. Also stressed is that care must be exercised by the clinician when diagnosing family members who may present with two different disorders closely mimicking one another.
Qualitative Study of Physician Perspectives on Classifying Screening and Nonscreening Colonoscopy using Administrative Health Data: Adding Practice Does Not Make Perfect
Authors: Sewitch Maida J , Hilsden Robert , Joseph Lawrence , Rabeneck Linda , Paszat Lawrence , Bitton Alain , Cooper Mary Anne
Published: March 2016

BACKGROUND: Previously developed screening colonoscopy algorithms based on diagnostic and endoscopy procedural variables have not been sufficiently accurate for use in epidemiological and health services research.

OBJECTIVE: To increase understanding of the administrative health database variables that could help to discern screening and nonscreening colonoscopy.

METHODS: A qualitative study using physician focus groups was conducted in Montreal (Quebec), Calgary (Alberta) and Toronto (Ontario). Specialty-specific focus group sessions were held among family physicians and gastroenterologists – the physicians responsible for referring patients to and performing screening colonoscopy, respectively. Interview guides were developed to better understand physician clinical and billing practices. Discussions were audiotaped, transcribed verbatim and analyzed using the constant comparative approach.

RESULTS: Forty family physicians and seven gastroenterologists participated in five focus group sessions. Patient variables included demographics (age) and medical history (colorectal cancer risk factors/symptoms, medication for colorectal cancer risk factors/symptoms, gastrointestinal disorders, severe disease). Clinical practice variables included timing of the colonoscopy (evenings, weekends, holidays, during hospitalization; same-day endoscopist consultation and colonoscopy), use of services (hospitalization, annual examination, transfer from other facility) and procedure use patterns (large bowel or other medical/surgical procedure before and subsequent to colonoscopy). However, wide variability in clinical and billing practices will likely preclude the development of a reasonably accurate screening colonoscopy algorithm. Physicians suggested adding a screening colonoscopy code to the administrative health data.

CONCLUSIONS: Failure to acknowledge the limitations of the provincial administrative health databases to identify screening colonoscopy may lead to incorrect conclusions and the establishment of inappropriate health care policies.
Serious Events in Older Ontario Residents Receiving Bowel Preparations for Outpatient Colonoscopy with Various Comorbidity Profiles: A Descriptive, Population-Based Study
Authors: Ho Joanne M , Gruneir Andrea , Fischer Hadas D , Fu Longdi , Lipscombe Lorraine L , Bell Chaim M , Cavalcanti Rodrigo B , Anderson Geoffrey M , Rochon Paula A
Published: March 2016

BACKGROUND: Polyethylene glycol-based bowel preparations (PEGBPs) and sodium picosulfate (NaPS) are commonly used for bowel cleansing before colonoscopy. Little is known about adverse events associated with these preparations, particularly in older patients or patients with medical comorbidities.

OBJECTIVE: To characterize the incidence of serious events following outpatient colonoscopy in patients using PEGBPs or NaPS.

METHODS: The present population-based retrospective cohort study examined data from Ontario health care databases between April 1, 2005 and December 31, 2007, including patients ≥66 years of age who received either PEGBP or NaPS for an outpatient colonoscopy. Patients with cardiac or renal disease, long-term care residents or patients receiving concurrent diuretic therapy were identified as high risk for adverse events. The primary outcome was a serious event (SE) defined as a composite of nonelective hospitalization, emergency department visit or death within seven days of the colonoscopy.

RESULTS: Of the 50,660 outpatients ≥66 years of age who underwent a colonoscopy, SEs were observed in 675 (2.4%) and 543 (2.4%) patients in the PEGBP and NaPS groups, respectively. Among high-risk patients (n=30,168), SEs occurred in 481 (2.8%) and 367 (2.8%) of patients receiving PEGBP and NaPS, respectively.

CONCLUSIONS: The SE rate within seven days of outpatient colonoscopy was 24 per 1000 procedures, and among high-risk patients was 28 per 1000 procedures. The rates were similar for PEGBP and NaPS. Clinicians should be aware of the risks associated with colonoscopy in older patients with comorbidities.
The Bockus International Society of Gastroenterology: Historical Review
Authors: Chaun Hugh
Published: March 2016

The Bockus International Society of Gastroenterology was founded in 1958 in honour of Dr Henry L Bockus (1894–1982) by his former students, residents and fellows at the Graduate School of Medicine of the University of Pennsylvania, Philadelphia, USA. It was a celebrated tribute to Dr Bockus’ outstanding leadership in the development and teaching of clinical gastroenterology as a subspecialty, which was in its infancy in the post-World War II era. He established the first formal training course in clinical gastroenterology in America. His department of gastroenterology became the leading graduate school of clinical gastroenterology in the world, training many clinical gastroenterologists in America and from many regions around the world. For many years, Dr Bockus was the most prominent American in world gastroenterology. The Bockus Society holds biennial scientific congresses in different continents, thus continuing to foster Dr Bockus’ lifelong interest and vision to promote international medical friendship, and excellence in education and research collaboration.
Exacerbation of Pulmonary Fibrosis Following Single Lung Transplantation
Authors: Yang Dawei , Wilson Jennifer M , Bai Chunxue , Yee John , Wilcox Pearce G , Khalil Nasreen , Levy Robert D
Published: March 2016

Acute exacerbations of interstitial lung disease present as clinical deteriorations, with progressive hypoxemia and parenchymal consolidation not related to infection, heart failure or thromboembolic disease. Following single lung transplantation, patients receive maintenance immunosuppression, which could mitigate the development of acute exacerbations in the native lung. A 66‐year‐old man with fibrotic, nonspecific interstitial pneumonitis presented with fever, hypoxemia and parenchymal consolidation limited to the native lung four years after single lung transplantation. Investigations were negative for infection, heart failure and thromboembolic disease. The patient worsened over the course of one week despite broad‐spectrum antimicrobial therapy, but subsequently improved promptly with augmentation of prednisone dosed to 50 mg daily and addition of N‐acetylcysteine. Hence, the patient fulfilled the criteria for a diagnosis of an acute exacerbation of pulmonary fibrosis in his native lung. Clinicians should consider acute exacerbation of parenchymal lung disease of the native lung in the differential diagnosis of progressive respiratory deterioration following single lung transplantation for pulmonary fibrosis.
A Vignette‐Based Survey to Assess Clinical Decision Making Regarding Antibiotic Use and Hospitalization of Patients with Probable Aseptic Meningitis
Authors: Patriquin Glenn , Hatchette Jill , Forward Kevin
Published: March 2016

BACKGROUND: The many etiologies of meningitis influence disease severity – most viral causes are self‐limiting, while bacterial etiologies require antibiotics and hospitalization. Aided by laboratory findings, the physician judges whether to admit and empirically treat the patient (presuming a bacterial cause), or to treat supportively as if it were viral.

OBJECTIVE: To determine factors that lead infectious disease specialists to admit and treat in cases of suspected meningitis.

METHODS: A clinical vignette describing a typical case of viral meningitis in the emergency department was presented to clinicians. They were asked to indicate on a Likert scale the likelihood of administering empirical antibiotics and admitting the patient from the vignette and for eight subsequent scenarios (with varied case features). The process was repeated in the context of an inpatient following initial observation and/or treatment.

RESULTS: Participants were unlikely to admit or to administer antibiotics in the baseline scenario, but a low Glasgow Coma Score or a high cerebrospinal fluid (CSF) white blood cell count with a high neutrophil percentage led to empirical treatment and admission. These factors were less influential after a negative bacterial CSF culture. These same clinical variables led to maintaining treatment and hospitalization of the inpatient.

CONCLUSIONS: Most participants chose not to admit or treat the patient in the baseline vignette. Confusion and CSF white blood cell count (and neutrophil predominance) were the main influences in determining treatment and hospitalization. A large range of response scores was likely due to differing regional practices or to different levels of experience.