bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of a Candida Antigen Detection Method (Cand‐Tec): Experience from a University Teaching Hospital
Authors: Anderson Todd J , Bryant Heather E , Church Deirdre L
Published: March 2016

The usefulness of a rapid latex agglutination method for the detection of Candida antigen (Cand‐Tec; Ramco Laboratories. Texas) was retrospectively assessed in a university teaching hospital over a one year period. Patients were enrolled when the managing physician requested Cand‐Tec testing for confirmation of possible invasive candidal infection. The majority of patients were critically ill; 56% were in the intensive care unit, and 30% subsequently died. Analyses were available from 79 patients and 125 samples. Thirty‐three patients were diagnosed as having either definite invasive candidiasis or a high probability of infection based upon clinical, microbiological and tissue criteria. The sensitivity and specificity of Candida antigen detection was determined for doubling titres ≥1:4 to ≥1:16. If a titre of ≥1:4 was used as the diagnostic cut‐off level for definite candidal infection, overall sensitivity and specificity were 77% and 69%, respectively, while the positive predictive value was 48%, and the negative predictive value 89%. When patients with a high probability of invasive candidal infection were included in analyses for a cut‐off titre of ≥1:4, overall sensitivity and specificity were 70% and 69%, respectively, while the positive predictive value was 68%, and the negative predictive value 71%. The usefulness of the Cand‐Tec test was not improved further for any subgroup of patients (including those in the intensive care unit), nor by following serial titres in individual patients. In this experience, the Cand‐Tec test did not add enough information to include definitively or exclude invasive candidiasis in this high risk general patient population.
Subinhibitory Antimicrobial Concentrations: A Review of In Vitro and In Vivo Data
Authors: Zhanel George G , Hoban Daryl J , Harding Godfrey KM
Published: March 2016

Antimicrobial activity is not an ‘all or none’ effect. An increase in the rate and extent of antimicrobial action is usually observed over a wide range of antimicrobial concentrations. Subinhibitory antimicrobial concentrations are well known to produce significant antibacterial effects, and various antimicrobials at subinhibitory concentrations have been reported to inhibit the rate of bacterial growth. Bacterial virulence may be increased or decreased by subinhibitory antimicrobial concentrations by changes in the ability of bacteria to adhere to epithelial cells or by alterations in bacterial susceptibility to host immune defences. Animal studies performed in rats, hamsters and rabbits demonstrate decreased bacterial adherence, reduced infectivity and increased survival of animals treated with subinhibitory antimicrobial concentrations compared to untreated controls. The major future role of investigation of subinhibitory antimicrobial concentrations will be to define more fully, at a molecular level, how antimicrobials exert their antibacterial effects.
The Effect of Age and Occupation on the Seroprevalence of Helicobacter pylori Infection
Authors: Perez-Perez GI , Marrie T , Inouye H , Shimoyama T , Marshall G , Meiklejohn G , Blaser MJ
Published: March 2016

Serological studies in developed and developing countries using enzyme‐linked immunosorbent assays have validated this technique as a rapid, noninvasive method for the diagnosis of Helicobacter pylori infections. The prevalence of serum antibodies to H pylori was studied in 473 Canadian blood donors from Manitoba, 212 healthy Japanese. and 226 healthy Americans. As expected, the seroprevalence rose progressively with age in the three populations and reached its peak (greater than 55%) in subjects 60 years of age and older. The seroprevalence did not decrease in elderly persons (60 to 99 years), indicating a persistent immune response. More detailed analysis was perfom1ed on the Canadian population. Age‐adjusted prevalence rates in men and women were similar.
Among young adults (15 to 29 years). farmers had a significantly higher seroprevalence rate than white‐collar or blue‐collar workers. but in older persons occupational rates were similar. A multiple linear
regression analysis of the data confirmed that age and occupation in young adults were both significantly associated with seroprevalence of H pylori infections.
Seroprevalence of Antibodies against Human Herpesvirus 6 in the Quebec City Area
Authors: Deschênes Louise , Joly Jean R , Couillard Michel , Richer Gilles
Published: March 2016

Seroprevalence of antibodies against human herpesvirus 6 was determined in a sample of 303 randomly selected individuals from the Quebec City area. The influence of different variables on antibody litres was also evaluated. Human herpesvirus 6 was grown in the HSB‐2 cell line, and antibody litres were measured by indirect immunofluorescence. Serum samples were collected from 177 females and 126 males ranging in age from two months to 88 years. Ninety‐nine per cent (300 of 303) of this population had an antibody titre of at least 1:10, whereas 75% had a titre of at least 1:80. Women had a higher geometric mean litre than men (P=0.06). This difference between sexes varied according to age and became statistically significant in subjects older than 20 years of age (P=0.04). It was found that this difference was attributable to higher antibody litres in women in the 15 to 40 year age group who had previously had children.
Thrombotic Thrombocytopenic Purpura Associated with the Acquired Immune Deficiency Syndrome
Authors: Kumar Anand , Wang Jean , Sutton David , Bow Eric J
Published: March 2016

A bisexual male presented with acute thrombotic thrombocytopenic purpura (TTP) in association with established acquired immune deficiency syndrome. The patient had classic clinical and laboratory findings of TTP and responded well to plasmapheresis therapy. Previously reported cases of TTP in association with human immunodeficiency virus (HIV) infection are briefly reviewed. Basic concepts in the pathogenesis of TTP are examined in reference to HIV infection.
Bacteremic Pneumonia Caused by Penicillin‐Resistant Pneumococci: Case Report and Review with a Canadian Perspective
Authors: Burdge David R , Woo Vincent C , Ritchie Patricia MA
Published: March 2016

A Canadian adult with bacteremic pneumonia caused by a relatively penicillin‐resistant (minimal inhibitory concentration 0.25 μg/mL) Streptococcus pneumoniae is reported, and the published literature regarding penicillin‐resistant pneumococci in Canada reviewed. Although penicillin resistance has been reported infrequently to date, this case emphasizes the need for routine antimicrobial sensitivity testing of all pneumococci isolated from normally sterile sites, and for ongoing systematic surveillance for penicillin and other antibiotic resistance in Canada.
Legionella‐Associated Lung Abscess: Critical Pathogen or Minor Isolate?
Authors: Dow Gordon CK , Chow Anthony W
Published: March 2016

Two cases of lung abscess, in which Legionella species were identified in association with other bacterial isolates, are presented. In the first case, Legionella pneumophila and Klebsiella pneumoniae were identified in a 24‐year‐old post renal transplant patient with a right upper lobe pulmonary abscess. Healing did not occur until the institution of specific therapy directed against legionella. In the second case, Legionella micdadei and several other respiratory bacterial pathogens were identified in a 74‐year‐old woman with a lung abscess. The patient later died with multisystem failure despite adequate antimicrobial therapy. Prior cases of legionella‐associated lung abscess have occurred predominantly in corticosteroid‐treated patients. The role of coexisting bacterial isolates remains obscure.
Bacterial Infection Complicating Varicella Infection: A 10‐Year Review of Hospitalized Children
Authors: Milo-Manson Golda , Portwine Carol , Wang Elaine
Published: March 2016

An increased incidence of Streptococci pyogenes (group A streptococcus [GAS]) infections and rheumatic fever has been reported over the past decade. The present study was conducted to determine whether a similar increase in such infections was observed after varicella, an infection previously shown to be associated with a high incidence of streptococcal infections. The charts of all children admitted with chickenpox to the Hospital for Sick Children in Toronto, Ontario from January 1, 1980 to December 31, 1989 were reviewed. Immunocompromised children and those hospitalized for another reason who had an incidental diagnosis of chickenpox were excluded. Twenty‐five cases with bacterial infection complicating chickenpox were compared with 103 patients without secondary infection. No statistically significant differences were observed for age, gender, duration of illness prior to hospitalization or duration of hospitalization in the two groups. GAS was the most frequent isolate in the cases, followed by Staphylococcus aureus, Escherichia coli and Haemophilus influenzae. The types of infection were significantly different for GAS compared with other organisms, with a predominance of skin infections in the former group (χ2 analysis, P<0.05). No increase in the incidence of GAS infections was observed over time. This study confirms the importance of GAS infections in patients with varicella, but no increase was observed in hospitalized children during the 10‐year study period.
Pharmacokinetic Properties of Clarithromycin: A Comparison with Erythromycin and Azithromycin
Authors: LeBel Marc
Published: March 2016

Objective: To compare the pharmacokinetic properties of two new macrolide antibiotics, clarithromycin and azithromycin, with those of the prototype macrolide, erythromycin.

Data Sources: Primarily peer review journals were searched for papers describing the pharmacokinetics of these new macrolides.

Study Selection: Fifteen in vitro and clinical studies of clarithromycin and azithromycin and one clinical abstract on clarithromycin from the past four years were selected for review.

Data Extraction: Data relevant to the pharmacokinetic characteristics of clarithromycin, azithromycin and, to a lesser extent, erythromycin were selected for presentation in this comparison.

Data Synthesis: By reviewing the available studies, it was possible to construct pharmacokinetic profiles of the new compounds, and to compare them with each other and with erythromycin.

Conclusions: Both clarithromycin and azithromycin have been shown to have an antibacterial spectrum and pharmacokinetic profile superior to that of erythromycin. The differences between the new compounds, however, may not be that significant. Each is likely to become a first‐line therapeutic option in specific instances, which will become better delineated as clinical research on these new macrolides continues.
Prevalence of Antibody to Current Influenza Virus Strains in a 1992 Canadian Serosurvey and Crude Estimates of 1991–92 Season A/Beijing/353/89 Infections
Authors: Weber John M
Published: March 2016

Objectives: The annual influenza serosurvey was conducted to monitor influenza activity and gauge susceptibility to currently circulating and emerging influenza viruses.

Design: Six hundred and thirty sera from among specimens received for various tests were selected from all age groups and sent with age and geographic identifiers to the Laboratory Centre for Disease Control. Forty sera per province were selected during a one‐week period beginning May 31, 1992 except for the province of Alberta which submitted 80 specimens, and Ontario and Quebec which each submitted 160 sera during a four‐week period. Sera were tested for hemagglutination inhibiting (HI) antibodies against the 1992–93 vaccine strains and A/Taiwan/1/86 (H1N1).

Main Results: The percentage of sera from all ages having HI antibody to A/Beijing/353/89 (H3N2) at a titre of 1:40 or greater more than doubled from 22% in the 1991 sample to 53% in 1992. The percentage of sera in all ages having antibody titre at 1:40 or greater to H1N1 strains A/Texas/36/91 and A/Taiwan/1/86 was 55% and 57%, respectively, in 1992, up from 45% with antibody titre 1:40 or greater to A/Taiwan/1/86 in 1991. Twenty‐seven per cent of sera had antibody titre 1:40 or greater to B/Panama/45/90 compared with 19% in 1991.

Conclusion: The relative increase in the percentage of sera with antibody with a titre of 1:40 or greater likely reflected vaccination efforts and the relative level of activity of the various influenza types and subtypes during the 1991–92 influenza season. The data also suggested that influenza B had the greatest potential for significant activity during the 1992–93 influenza season.
Etiology of Cervicitis and Treatment with Minocycline
Authors: Bowie William R , Willetts Val , Binns Bernard A , Brunham Robert C
Published: March 2016

Objective: To evaluate the etiology of cervicitis using the recommended Canadian definition, and to evaluate the efficacy and tolerability of seven days of minocycline treatment, 100 versus 200 mg at bedtime.

Design: Randomized double‐blind study with initial microbiological evaluation, and intended follow‐up through 12 weeks.

Setting: Women attending the major sexually transmitted disease clinic in Vancouver and the major teaching hospital in Winnipeg.

Population Studied: Women with cervicitis (inclusion criteria were an off‐white or yellow colour of cervical mucus when viewed on a white‐tipped swab, and a mean of 10 or more polymorphonuclear leukocytes per oil immersion [× 1000] field on Gram stain of cervical mucus). Fourty‐four women were enrolled but two were excluded because of contaminated cultures.

Interventions: Treatment with two identical appearing capsules of 50 mg (100 mg dose) or 100 mg (200 mg dose) of minocycline taken at bedtime with water for seven days.

Main Results: Of the 42 evaluable women, Chlamydia trachomatis was initially isolated from 19 (45%) and Neisseria gonorrhoeae from four (10%). The study was prematurely terminated because of an unacceptable and significantly higher frequency of adverse reactions on the higher dose regimen of minocycline – severe reactions in one (4%) on 100 mg compared with six (30%) on 200 mg (P=0.05). Major reactions were dizziness, mood alterations and nausea. Clinical parameters, but not numbers of polymorphonuclear leukocytes, improved significantly irrespective of initial microbiology or the regimen received. Cultures became and stayed negative for C trachomatis in seven of eight on minocycline 100 mg and five of six on minocycline 200 mg. Both ‘failures’ had an intervening negative culture and were re‐exposed to untreated sexual partners.

Conclusions: Although not a definitive study in terms of proving efficacy of lower dose regimens, the results are consistent with efficacy and demonstrate the significant advantage of the lower dose regimen in terms of adverse reactions.
Cryptococcal cerebrospinal fluid shunt infection treated with fluconazole
Authors: Eymard Daniel , Lebel François
Published: March 2016

A 37‐year‐old woman with a cadaveric renal allotransplantation required intra‐cranial shunting devices after a presumptive episode of tuberculous meningitis. Six months later, she developed a culture‐proven cryptococcal meningitis. Without having her ventriculo‐auricular shunt removed, she was successfully treated with a short course of amphotericin B (335 mg) and flucytosine (nine days) followed by prolonged therapy with oral fluconazole (400 mg daily for 72 days). Three years post treatment she had no evidence of relapse, and normal renal graft function.
Human Herpesvirus 6 and Chronic Fatigue Syndrome
Authors: Eymard Daniel , Lebel François , Miller Mark , Turgeon François
Published: March 2016

The cause of chronic fatigue syndrome (CFS) is still enigmatic. Using indirect immunofluorescence testing for measuring antibody against human herpesvirus 6 (HHV‐6), this study investigated the association of CFS with infection by HHV‐6. Seventeen patients (group A) fulfilling the Centers for Disease Control (CDC) definition for CFS were compared with eight patients (group B) with chronic fatigue but not meeting the CDC criteria. No significant difference was found between the two groups for 30 parameters including sex, age, exposure to children and serology for Epstein‐Barr virus, cytomegalovirus, herpes simplex virus, and toxoplasma. Univariate analysis showed that patients in group A complained more frequently of a sore throat, headache and of recurrent type of fatigue. These three parameters are discriminant in identifying patients who will meet the CDC case definition of CFS. The titre of antibody against HHV‐6 in group A (1:99) was significantly higher than in group B (1:15) (P=0.007). Elevated HHV‐6 titres suggests that this virus could be a cofactor in the pathogenesis of CFS.
Salmonella thomson Outbreak in a Canadian Newborn Nursery
Authors: Lalonde Richard G
Published: March 2016

Objective: To determine the mode of salmonella transmission during an outbreak in a newborn nursery.

Design: Outbreak investigation with retrospective review of medical, microbiological and work records, active case‐finding, and active surveillance. A case was defined as a newborn with salmonella isolated from any site.

Setting: University affiliated community hospital near Montreal with 125 active care beds and 3000 deliveries annually.

Patients: Cases were identified from the microbiology reports and public health notifications for one month before to six months after detection of the outbreak. All neonates with diarrhea had stool cultures during the period of observation.

Results: Four cases of neonatal salmonella infection were detected. The index infection was acquired at birth from a mother with severe gastroenteritis from contaminated chicken. The first of five secondary cases – three other neonates and two mothers – was only detected 11 days after departure of the index case. Three of the four infants required intensive treatment and one remained a chronic carrier and was rejected for daycare services. No food or health care worker was associated with infection of neonates. The diapering technique had been changed one month earlier because the hospital had stopped purchasing disposable washcloths.

Conclusions: Three of the four neonatal salmonella infections caused severe morbidity. The organism was easily transmitted when breaks in technique probably allowed contamination of fomites, survival in the inanimate environment, and subsequent cross‐infection to other neonates. Simple unexpected changes in the availability of material resources such as washcloths may have adversely influenced clinical practises with a resultant breakdown in infection control procedures.
Improving Surveillance of the Impact of Influenza and Its Prevention in Canada
Authors: Fedson David S
Published: March 2016

The organization of Canada’s provincial health care systems and the administrative databases that sustain them provide physicians, epidemiologists and public health officials with unique opportunities to improve surveillance of influenza and its prevention. These databases can be used to measure the impact of influenza on excess mortality, hospitalization and costs to the health care system. They can also be used to study the epidemiology of influenza vaccination practices. Studies using the administrative database for the province of Manitoba have established the epidemiological rationale for hospital‐based vaccination and have evaluated the clinical effectiveness of influenza vaccination. As pneumococcal vaccination becomes widespread in Canada, provincial databases should also prove useful in assessing the impact of the pneumococcal infections and their prevention with pneumococcal vaccine.
Long Term Therapy of Cytomegalovirus Retinitis with Ganciclovir in a Child with Acquired Immunodeficiency Syndrome
Authors: Halperin Scott A , La Roche G Robert
Published: March 2016

Cytomegalovirus retinitis is the most severe ophthalmological complication of patients with acquired immune deficiency syndrome (aids). Ganciclovir must be given continuously to control progression of the disease or relapse typically occurs. Data in children are limited; this report describes a nine‐year‐old boy with transfusion‐acquired aids who was treated with ganciclovir for 23 months for control of cytomegalovirus retinitis. The retinal disease was exacerbated when ganciclovir was temporarily withheld because of presumed drug toxicity, and improved with re‐institution of therapy. When ganciclovir was finally discontinued because of complete loss of vision, the patient rapidly deteriorated and died; widespread cytomegalovirus infection was found at autopsy. Subcapsular cataracts appearing during therapy were thought to be a toxic effect of ganciclovir. Ganciclovir can be effective in controlling cytomegalovirus retinitis in children; however, similarities in laboratory findings may lead to confusion between systemic drug toxicity and disease progression.
A Case of Group A Streptococcal Meningitis in an Adult
Authors: Pattullo Andrew LS , Bow Eric J
Published: March 2016

Group A streptococci are an important cause of soft tissue infections but have rarely been reported as the cause of pyogenic meningitis since the advent of antibiotics. A case of group A streptococcal meningitis in an adult is presented along with a review of similar cases reported in the literature. This case serves to illustrate the virulent nature of this pathogen in infections of the meninges, the potential for associated complications, and the need for rapid diagnosis and appropriate treatment. The source of infection in this and many other cases in the literature is the upper respiratory tract. The case presented responded well to antibiotics but resulted in permanent auditory‐vestibular dysfunction.
Prevalence of Gastrointestinal Infection among International Travellers Returning to Canada
Authors: Russell Margaret L , Love Edgar J , Temple Larissa KF
Published: March 2016

Objective: To describe the prevalence of parasitic and bacterial gastrointestinal infection (excluding enterotoxigenic Escherichia coli) among international travellers attending the International Travel Clinic at The University of Calgary.

Methods: Data were abstracted from the records of the first visit after travel of all persons making a post travel visit between January 1, 1986 and March 31, 1990.

Results: Data were available for 886 first visits (840 persons). Stools were submitted by 692 travellers. The frequency of stool submission varied by the duration of travel abroad, and the frequency of diarrhea either during or after the trip was greater among those who had submitted a stool specimen. The prevalence of stools positive for ova, parasites or pathogenic bacteria was 41.2%. When only pathogenic organisms were considered, the prevalence of infection was 19.4%. The most commonly isolated pathogenic parasites were Dientamoeba fragilis, Giardia lamblia, and Entamoeba histolytica. The most commonly isolated bacteria were Campylobacter species and Salmonella species.

Conclusions: Although the prevalence of positive stool screens among returned travellers in this population was high, only about one‐fifth of persons tested were positive for pathogens.
Changing Pattern of Clinical Illness in Children with Group A Streptococcal Bacteremia
Authors: Burrows Kim J , Halperin Scott A , Swift Margaret , Bortolussi Robert
Published: March 2016

Objective: To test the hypothesis that bacteremia caused by group A streptococci (gas) has become more common and the presentation of the infection more severe in the Izaak Walton Killam Hospital for Children during the past decade.

Design: Retrospective analysis by laboratory log and chart review.

Setting: A pediatric teaching hospital providing primary and tertiary care.

Results: There was no difference in the frequency of detection of gas bacteremia between the two periods studied (1980 to 1988 and 1988 to 1991). However, severe gas infection with deep tissue invasion was more common in the last three‐year period (77% versus 11%, P=0.01). Severity, as measured by length of hospital stay, was also greater in the recent group (17.9 days versus 3.3 days, P=0.03). A recent group of four children was identified with a unique clinical syndrome of rash, severe myalgias, hyperesthesia, and refusal to bear weight.

Conclusion: The number of cases of severe gas disease has increased in the past several years, and gas infection should be included in the differential diagnosis of seriously ill children, gas infection must be managed aggressively with vigilance for additional deep tissue involvement, even while on appropriate antimicrobial therapy.
Herpetic Pneumonitis Following Posterior Fossa Surgery
Authors: Ladouceur Denis , Duperval Raymond , Cantin André , Frost Eric H
Published: March 2016

Reactivation of Herpes simplex virus (HSV) following manipulation of the trigeminal nerve root. has been reported in a substantial number of immunocompetent patients. Usually it was manifest as an oral mucocutaneous lesion and considered a benign postoperative complication. In the case described here, however, severe respiratory distress due to herpetic pneumonia developed following a pontocerebellar angle surgery complicated by an orolabial herpetic lesion. The delays necessary to confirm HSV diagnosis prior to initiating treatment are discussed, considering the rarity of this complication following neurosurgery.
Immunotherapy of Airborne Tuberculosis in Mice Via the Lung‐Specific Delivery of Cytokines
Authors: Denis Michel , Ghadirian Esfandiar
Published: March 2016

The immunotherapeutic potential of interleukin‐2 (IL‐2), tumour necrosis factor alpha (TNFα) and interferon gamma (IFN‐γ) administered by aerosol was examined on mice infected with Mycobacterium tuberculosis by the aerogenic route. Infection of balb/c mice with 104 colony forming units (cfu) of M tuberculosis led to death of all mice at day 35 post infection after progressive microbial growth in the lungs. Aerosolization of IL‐2 (100 μg per mouse) did not promote an increase in resistance to tuberculosis, as seen by growth of M tuberculosis in the lungs. Administration of IFN‐γ or TNFα (100 μg) by the aerosol route led to a significant reduction in microbial growth in the lungs and a 100% survival of infected mice at day 60. Similarly, aerosolization of TNFα and IFN‐γ combined led to a very high degree of tuberculostatic activity in the lungs of infected animals, but not superior to that seen with either cytokine alone. Administration of similar amounts of cytokines by repeated intraperitoneal infusions led to a very marginal improvement in mouse resistance. These results suggest that localized cytokine administration may be beneficial in the treatment of lung diseases.
A prospective Comparison of Porta‐Sonic and Fisoneb Ultrasonic Nebulizers for Administering Aerosol Pentamidine
Authors: McIvor Andrew , Flood Diane , Lee-Pack Leslie , Rachlis Anita , Berger Philip , Chan Charles K , Favell Kim , Lewis Carmen , Moore Margaret , Rawji Mustafa , the Toronto Aerosolized Pentamidine Study (TAPS) group
Published: March 2016

Objective: To report patient acceptability and overall therapeutic effectiveness of two different ultrasonic nebulizers, Fisoneb and Porta‐sonic, for the administration of aerosol pentamidine for Pneumocysitis carinii prophylaxis in human immunodeficiency virus (hiv)‐infected individuals.

Design: Prospective assessment of a random subgroup of 174 individuals from an inception cohort of 1093 patients attending a central aerosol pentamidine treatment centre in Toronto, Ontario.

Methods: One hundred and seventy‐four patients who had been receiving aerosolized pentamidine for more than 10 weeks using Fisoneb at 60 mg every two weeks were switched to Porta‐sonic. Subjective evaluation included three standard 10 cm visual analogue scales rating cough/wheeze, aftertaste and overall preference. The individuals were also asked to compare the duration of time spent on the aerosol treatments. Objective evaluation included spirometry performed immediately before and 15 mins after pentamidine administration. Prospective surveillance of the entire cohort was preformed to record and document episodes of breakthrough P carinii pneumonia.

Results: Porta‐sonic was the overall preferred nebulizer in 82% of patients. Less time was spent on aerosol treatment using the Porta‐sonic nebulizer compared with the Fisoneb in 66% of patients. The Porta‐sonic nebulizer system produced less aftertaste compared with Fisoneb. Both nebulizers produced significant but modest reduction in flow rates. During the study period there was no statistically significant difference in the rates of breakthrough P carinii pneumonia between the two groups. A total of 91 episodes occurred, at a rate of 0.5 episodes per patient‐month on Porta‐sonic compared with 0.7 episodes per patient‐month on Fisoneb (P=0.2536).

Discussion: Aerosol pentamidine remains the proven second‐line prophylaxis against P carinii pneumonia in hiv/aids for those intolerant to trimethoprim‐sulphamethoxazole. Cough, bronchospasm and poor taste are side effects that may limit patient tolerance and acceptability. The results of this study show that the Porta‐sonic nebulizer system significantly reduces some of these side effects and increases patient preference.

Conclusion: This study suggests that Porta‐sonic, the newer nebulizer system, with more ideal in vitro characteristics may become a favoured device in clinical practice.
What do Parents Learn by Reading a DPT Vaccine Information Form?
Authors: Gold Ronald , Bjornson Gordean L
Published: March 2016

Objective: Information forms are commonly used to inform parents about childhood vaccination. This study assessed the knowledge of mothers about pertussis and pertussis vaccine before and after reading a form about diphtheria‐pertussis‐tetanus (dpt) vaccine.

Design: A test was administered to mothers before and after the first vaccination of their infant. By random allocation, one‐half of the mothers received the form (study group) in addition to the routine counselling by a public health nurse given to the others (control group).

Setting: Public health immunization clinics in suburban Vancouver, British Columbia.

Subjects: One hundred and fifty‐one mothers who were scheduled to bring their infant for the first dpt immunization were recruited, of whom 145 (96%) completed the study.

Interventions: A test consisting of 20 true/false questions was administered by telephone two weeks before and two weeks after the first dpt vaccination. Additional data about sources of vaccine information, maternal education, number of children and maternal age were obtained.

Outcome Measures: Mean scores and mean change in scores on test.

Results: The mean changes in scores between tests 1 and 2 in study and control groups were +22.2% and +6.9%, respectively, on the disease‐related questions (P<0.001) and +14.6% and +10.7%, respectively, on the vaccine‐related questions (P=0.16). The forms were considered to be very useful by the mothers and clearly enabled them to score higher on a test of their knowledge of pertussis and pertussis vaccine.

Conclusions: Reading a dpt vaccine form enabled mothers to improve their knowledge of pertussis and pertussis vaccine.
Trends and Rural‐Urban Differences in Asthma Hospitalizations in Saskatchewan 1970‐1989
Authors: Senthilselvan A
Published: March 2016

OBJECTIVE: To examine the trends in hospitalization rates for
atsthma in Saskatchewan from 1970 to 1989 and to investigate the
differences in asthma hospitalization rates between rural and urban
dwellers.

DESIGN: Asthma hospitalization rates were calculated for the age
groups O to 4, 5 to 9. 10 to 14, 15 to 24. 25 to 34. 35 to 49 and 50
to 64 years for the period between 1970 and 1989. Only the first
admission in each year for each person was included in the analysis. As the classification of asthma changed in 1978.
trends in asthma hospitalization rates were investigated separately for the
periods 1970 to 1978 and 1979 to 1989. respectively. Rate ratios
were obtained for male/female and rural/urban comparisons by
fitting Poisson regression models.

SETTING: The hospitalization data for respiratory diseases for the
province of Saskatchewan were examined by age group, sex and
place or residence.

RESULT: No significant increases were observed in asthma hospitalization rates lrorn 1970 to 1978. In the period 1979 to 1989.
asthma hospitalization rates increased significantly among children under four years from 4.31/1000 in 1979 to 7.04/1000 in
1989. Among children under 14 years. asthma hospitalization rates
were greater in boys than in girls . The converse was true for adults
aged 15 and above, with women having a higher hospitalization
rate for asthma than men . In adults aged 35 and above. rural
dwellers had higher hospitalization rates for asthma than urban
dwellers throughout the study period. In other age groups, although
rural dwellers had higher asthma hospitalization rates than
did urban dwellers during 1970 to 1984. the differences disappered duri ng 1985 to 1989.

CONCLUSION: Further studies are required to find reasons for the
increase in asthma hospitalizations among young children under
four years old and for the differences between rural and urban
dwellers in the age group 35 years and above.
Q fever in Quebec (1989–93): Report of 14 Cases
Authors: Goyette Monique , Poirier André , Bouchard Jean , Morrier Eric
Published: March 2016

Q fever, a zoonosis acquired by inhalation of the rickettsia Coxiella burnetii, is rarely diagnosed in Canada. The world incidence has been increasing since 1960, because of progressive dissemination of this microorganism in animal populations, particularly domestic ruminants. Some recent outbreaks were caused by cats. Of 14 cases reported in Quebec between 1989 and the beginning of 1993, nine occurred successively in an 18‐month period in the rural region surrounding Trois‐Rivières, after contact with livestock or cats. These cases are reported here, with the results of serological screening of the workers of an abattoir where one of the cases worked. Five additional cases reported in Quebec during the same period are briefly reviewed.
Emphysema Then and Now
Authors: Thurlbeck William M
Published: March 2016

The present definition or emphysema has three components:
enlargement of airspaces. destruction or their walls
and lack of fibrosis. Enlargement can be recognized by
measuring the intcralvcolar wall distance or by comparing
the airspaces under cnnsiJcration with adjacent or distant
normal lung. Most recently. destruction has been defined as
disappearance or disturbance or the orderly appearance or
the pulmonary acinus (gas exchanging tissue). Other
authors have also suggested that destruction can be recognized by abnonnal holes (fenestrae) in airspace walls or by
the ′destructive index ′. fibrosis appears to be an integral
part of centrilobular. distal acinar and irregular airspace
enlargement. The presence of fibrosis should not preclude
emphysema by definition. Emphysema should be recognized by practicable methods and should be measured in
some way. Evidence is presented that abnormal elastic
properties of the lung are not due to emphysema but reside
in the surrounding lung; the altered elastic properties may
be due to alterations in the glycoprotein matrix of the lung.
Altered elastic properties arc a relatively poor predictor of
emphysema as gellerally defined and recognized. Computed
tomography can recognize emphysema quite well,
but appears to underestimate it and is not accurate in lungs
with mild or no emphysema. Emphysema can be best diagnosed
in life with an in tegrated approach using clinical data.
radiological evidence of lung enlargement and the single
breath diffusing capacity (transfer factor) for carbon monoxide.
While knowledge of emphysema has dramatically
increased in the past 30 years. much more remains to be
done. and this requires new and more thorough approaches.
Tunga penetrans Acquired while Traveling in Africa
Authors: Proctor Eileen M
Published: March 2016

Three cases of tungiasis acquired in the course of travel are briefly described, and the biology of the jigger flea, Tunga penetrans, is reviewed.
Disseminated Mycobacterium chelonae Infection Presenting as Progressive Multifocal Osteomyelitis: Report of Two Cases and a Review of the Literature
Authors: Oelberg David A , Mendelson Jack , Miller Mark A , Dascal Andre
Published: March 2016

Two long term hospitalized patients developed disseminated infections caused by Mycobacterium chelonae, subspecies chelonae, over an eight‐month period. In both cases, the disease was characterized by cutaneous and osseous involvement. The infections were indolent and marked by progressive bony destruction. These cases and a review of the literature are presented.
Comparison of Culture, Cytotoxin Assay and Two Eia Tests with Clinical Diagnosis of Clostridium difficile‐Associated Diarrhea
Authors: Binning Marilyn , John Michael A , Schieven Berend C , Austin Thomas W , Lannigan Robert , Hussain Zafar
Published: March 2016

Objective: The most common etiology of infectious diarrhea in hospitalized patients is Clostridium difficile. No single laboratory test yields a definitive diagnosis. Four methods were evaluated for their sensitivity and specificity in patients who had clinically defined C difficile‐associated diarrhea.

Methods: Clinical criteria for C difficile‐associated diarrhea were defined. All adult in‐hospital patients whose stools were tested for C difficile were prospectively followed. Stools were examined with culture on a selective medium, a commercial cytotoxicity assay (cta), and two commercially available enzyme immunoassays (eias) for toxin A (Meridian) and toxin AB (cbc).

Results: During the study period 235 stool specimens from 185 patients were tested. Fifty‐one patients were positive for C difficile or its markers, cta was most sensitive (80%), whereas cbc-eia was most specific (98%). Differences in the sensitivities of cta and Meridian‐eia were minor (80% versus 73.3%) and they were equally specific (95.5%).

Conclusions: The sensitivity and specificity of eia for toxin A is similar to other tests. However, due to rapidity and ease of performance, it may be a more practical test for the diagnosis of C difficile‐associated diarrhea, especially if the cytotoxin assay is not available.
Bronchocentric Granulomatosis: Clinical Course Illustrated by Serial Computerized Tomography of the Chest
Authors: Granton John T , Chamberlain Dean W , Hyland Robert H
Published: March 2016

Bronchocentric granulomatosis is a pathological process
characterized by granulomatous inflammation in conducting
airways. A case of bronchoccntric granulomatosis of
unknown etiology in a previously well 24‐year‐old female
is reported. The variable and often rluctuating course of this
entity and its response to corticosteroids is demonstrated by
serial computerized tomography nr the chest. The pathology,
etiology and therapy ofbronchoccntric granulomatosis
is reviewed.
Airways Hyperresponsiveness and Atopy: A Comparison of Inuit and Montreal Schoolchildren
Authors: Hemmelgarn Brenda , Loozen Esther , Saralegui Sheila , Chatwood Susan , Ernst Pierre
Published: March 2016

OBJECTIVE: To compare the prevalence ol exercise induced bronchial hyperresponsiveness in Inuit children with that or children in Montreal, and to identify possible genetic and environmental determinants of the differences observed.

DESIGN: Cross‐sectional survey.

SETTING: Salluit, an isolated Inuit community in northern Quebec, and Montreal.

POPULATION STUDIED: All children attending school in Salluit in grades 2 to 6 were eligible to participate. For the Montreal study, 18 schools were selected and from each of these one class from each of grades 1, 3 and 5 were chosen.

MEASUREMENTS: Data collection for both locations included an exercise challenge test to assess exercise induced bronchial hyperresponsiveness (EIBH), allergy skin testing, a questionnaire for parents regarding details or the home environment as well as the child’s history of respiratory symptoms, and collection of dust samples from the bedroom floor and mattress for the presence of house dust mite.

RESULTS: The prevalence or EIBH (defincd as a decline of 15% or more between pre‐exercise forced expiratory volume in 1 s [FEV1] and that at 5 or 10 mins postexercise) was 19.5% (23 of 118) among the Inuit children, compared with 8.8% (87 of 989) among the Montreal children. In contrast. only 8.6% of the Inuit children had a positive allergy skin test compared with 34% in Montreal.

CONCLUSIONS: A higher prevalence of EIBH was found in Inuit schoolchildren compared with children of similar age in Montreal, although the prevalence of atopy was considerably lower.
Fibreoptic Bronchoscopy in the Diagnosis of Pulmonary Disease in the Immunocompromised Host in Northern Alberta
Authors: Crocket Jennifer A , Chaput Michelle R , Lien Dale C
Published: March 2016

OBJECTIVES: To determine the diagnostic utility of bronchoscopy in a population of immunocompromised hosts in northern Alberta.

PATIENTS AND METHODS: Results from bronchoscopy in 86 immunocompromised patients who underwent a total of 101 procedures were retrospectively reviewed.

RESULTS: The overall diagnostic yield was 57% with the highest yield in patients on immunosuppressive drug therapy (80%) and the lowest yield in the group of bone marrow transplant patients (27%).

CONCLUSIONS: Bronchoscopy is a valuable tool for the evaluation of pulmonary disease in the immunocompromised host. Overall diagnostic yield of 57% is comparable with that reported in the literature.
Comparative Activity of Cefepime with Several Antimicrobials against Aerobic Gram‐Negative and Gram‐Positive Organisms Isolated from Patients across Canada in 1993
Authors: Low Donald E , The Canadian Antimicrobial Resistance Study Group
Published: March 2016

To compare the activity of cefepime, a fourth‐generation cephalosporin, with several available antimicrobials, in vitro susceptibility studies were carried out on bacteria commonly associated with various infections, including sepsis. Ten tertiary care hospital laboratories in six provinces provided 1276 clinically relevant isolates of aerobic Gram‐negative bacilli and Gram‐positive cocci during 1993. When the activity of each of the antimicrobials was determined against all isolates submitted, cefepime, piperacillin/tazobactam, imipenem and ciprofloxacin all had minimal inhibitory concentrations for 90% of the organisms (mic90) two or more dilutions below the mic resistant category. Gentamicin’s mic90 against all organisms tested was one dilution below the mic resistant category. The mic90s of the third‐generation cephalosporins, piperacillin and ticarcillin/clavulanate, for Enterobacter species fell in the resistant category. This is presumably due to constitutive high level chromosomal cephalosporinase production. The mic90s of cefepime for Enterobacter species was three or more dilutions below the mic resistant category. The mic90s of all antimcrobials against Staphylococcus aureus, with the exception of ceftazidime and piperacillin, had mic90 categories two or more dilutions below the resistant category. The activity of cefepime, piperacillin/tazobactam, imipenem, ciprofloxacin and gentamicin make them excellent candidates for the empirical therapy of serious infections due to aerobic Gram‐negative bacilli and S aureus.
Smoking and Health: A Physician Responsibility—A Statement of the Joint Committee on Smoking and Health
Authors: Joint Committee on Smoking and Health
Published: March 2016

Tobacco use, particularly cigarette smoking, is a major cause of preventable disease and premature death worldwide. Both smokers and nonsmokers exposed to environmental tobacco smoke are at risk. Cessation of smoking reduces risks. Although the addicting properties of nicotine can make cessation difficult, both medical interventions aimed at helping smokers quit and social policies aimed at control of cigarette smoking can have significant benefits. Physicians should play an active role in control of smoking by ensuring that counselling and pharmacological therapy be available for the individual smoker. Physicians should also participate in the public debate regarding smoking both individually and through medical organizations. As smoking represents a threat to the public health, physicians must take a strong and active role seeking its control.
Transient in Vivo Selection of a Constitutively Cephalosporin Resistant Enterobacter Cloacae Causing Ventriculitis
Authors: Joffe Ari , Kabani Amin , Ramotar Karam , Krulicki Wally , Cadrain Gisele , Jadavji Taj
Published: March 2016

A case of neonatal ventriculitis complicating a ventriculoperitoneal shunt and caused by one strain of Enterobacter cloacae (as shown on pulsed field gel electrophoresis) is presented. Daily ventricular fluid cultures from day 1 to 9 revealed inducible cephalosporin resistance in all isolates except on days 3, 4 and 5 of therapy when isolates were constitutively resistant. This emergence of resistance due to constitutive Bush class 1 beta‐lactamase production is an excellent example of the rapid emergence of a predominant strain of bacteria depending on antibiotic selection pressures in vivo. The transient nature of the predominant resistant phenotype may have been due to missing a dose of cefotaxime on day 5 or in vivo factors allowing persistence of sensitive organisms in antibiotic protected sites. Caution is advised in the use of cephalosporins alone for serious Enterobacter species infections. Repeat culture and sensitivity should be done in severe infections that are slow to respond to cephalosporin therapy.
Are There Jobs in Academic Pulmonary Medicine in Canada? A Resident’s View of the Future
Authors: Yang Jae , Chan Charles K
Published: March 2016

A survey of all Canadian academic institutions with an adult pulmonary training program was undertaken in 1992 to investigate the number of positions in pulmonary medicine that would be available up to 1997. The positions were divided into clinician scientist (75% research) and clinician teacher (75% clinical) categories. Inquiry into specific areas of interests and prerequisite training requirements were made. Ten of 14 centres responded; 35 to 44 positions were identified, 22 to 27 for clinician scientists with at least two to four years’ research training after completion of a clinical pulmonary fellowship. For the remaining 13 to 17 clinician teacher positions, the requirement was for two to three years of additional clinical training beyond the clinical pulmonary fellowship. Some centres did not specify whether available positions were in the clinician scientist or in the clinician teacher group. The results of the survey suggest that there are jobs available in academic pulmonary medicine but that they are mainly in the basic research area, requiring at least an MSc, and preferably a PhD or equivalent research training. A questionnaire is included in an attempt to obtain information about other opportunities in both academic and community hospitals.