bluuebunny/crossref_metadata_2025 huggingface dataset:
Influenza Immunization Practices and Policies for Health Care Students in Canada
Authors: Pianosi Kiersten , Chobotuk Tara , Halperin Beth A , Halperin Scott A
Published: March 2016

BACKGROUND: Influenza vaccine is recommended for all health care providers including health care students. Little is known about how health care student programs provide information about influenza vaccination to their students, deliver vaccines and document their vaccination status.

METHODS: A mixed‐methods approach was used and included key informant interviews of program coordinators for health care student programs in Halifax (Nova Scotia) and a national survey of program coordinators of health care student programs across Canada.

RESULTS: All 21 coordinators of programs that had students placed at the IWK Health Centre (Halifax, Nova Scotia) during the influenza season were interviewed. Surveys were completed by 93 (36.3%) of 256 eligible coordinators representing 134 different programs (response rate 52.3%). Most programs encouraged seasonal influenza vaccination but only 28 (20.9%) required it. None of the Halifax programs delivered influenza vaccine and most preferred a coordinated, centrally administered program. In contrast, many programs across Canada delivered influenza vaccine and did not desire a centralized process.

CONCLUSION: There is considerable variability in the delivery of influenza vaccine to health care students across Canada. Coordinated programs may be desirable where delivery programs do not already exist.
A Kit to Facilitate and Standardize the Processing of Sputum for Measurements of Airway Inflammation
Authors: Chaboillez Simone , Dasgupta Angira , Prince Philippe , Boulet Louis-Philippe , Lemière Catherine
Published: March 2016

BACKGROUND: The use of inflammometry has been shown to be effective for managing asthma. However, sputum processing can be time consuming. Furthermore, methods of sputum processing can vary among facilities. To help with standardization and to simplify the procedure for laboratory staff, a novel, commercially available processing device (Accufilter, Cellometrics Inc, Canada) has been developed.

OBJECTIVE: To assess the validity of the Accufilter device and kit for recovery of treated specimens, and for quantitative sputum inflammatory cell counts by comparing intrasample measurements with those using the same procedure without the Accufilter device and kit.

METHODS: The present study was a wet laboratory comparison of induced sputum cell counts obtained from sputum processed with versus without the device and kit. Comparisons of each sputum specimen were performed by the same technologist in random order.

RESULTS: A total of 39 samples were processed using both the standard method and the Accufilter device. The intraclass correlation coefficients were high for the weight of the filtrate, and for eosinophil and neutrophil differential counts.

CONCLUSION: A good degree of agreement of results was apparent when the two methods were compared. The differences noted between both methods were minimal and did not modify clinical interpretation. The use of the Accufilter device and kit can be used in place of the standard method for sputum quantitative analysis, especially in centres with large sample loads.
Prevalence and Incidence of Antimicrobial‐Resistant Organisms among Hospitalized Inflammatory Bowel Disease Patients
Authors: Vaisman Alon , Pivovarov Kevin , McGeer Allison , Willey Barbara , Borgundvaag Bjug , Porter Vanessa , Gnanasuntharam Piraveina , Wei Yanliang , Nguyen Geoffrey C
Published: March 2016

BACKGROUND: Patients with inflammatory bowel disease (IBD) experience frequent hospitalizations and use of immunosuppressive medications, which may predispose them to colonization with antimicrobial‐resistant organisms (ARO).

OBJECTIVE: To determine the prevalence of ARO colonization on admission to hospital and the incidence of infection during hospitalization among hospitalized IBD patients.

METHODS: A chart review comparing the prevalence of colonization and incidence of infection with methicillin‐resistant Staphylococcus aureus, vancomycin‐resistant enterococci and extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae (ESBL) in hospitalized IBD patients with those of non‐IBD controls was performed.

RESULTS: On admission, there were no significant differences between IBD inpatients and controls in the prevalence of colonization of methicillin‐resistant S aureus (1.0% versus 1.2%; P=0.74), vancomycin‐resistant enterococci (0.2% versus 0%; P=1.0) or ESBL (4.1% versus 5.5%; P=0.33). Pooling data from historical clinic‐based cohorts, IBD patients were more likely than controls to have ESBL colonization (19% versus 6.6%; P<0.05). Antibiotic use on admission was associated with ESBL colonization among IBD inpatients (OR 4.2 [95% CI 1.4 to 12.6]). The incidence of ARO infections during hospitalization was not significantly different between IBD patients and controls. Among IBD patients who acquired ARO infections during hospitalizations, the mean time interval from admission to infection was shorter for those who were already colonized with ARO on admission.

CONCLUSIONS: This particular population of hospitalized IBD patients was not shown to have a higher prevalence or incidence of ARO colonization or infection compared with non‐IBD inpatients.
Successful Management of Nosocomial Ventriculitis and Meningitis Caused by Extensively Drug‐Resistant Acinetobacter baumannii in Austria
Authors: Hoenigl M , Drescher M , Feierl G , Valentin T , Zarfel G , Seeber K , Krause R , Grisold AJ
Published: March 2016

Nosocomial infections caused by the Gram‐negative coccobacillus Acinetobacter baumannii have substantially increased over recent years. Because Acinetobacter is a genus with a tendency to quickly develop resistance to multiple antimicrobial agents, therapy is often complicated, requiring the return to previously used drugs. The authors report a case of meningitis due to extensively drug‐resistant A baumannii in an Austrian patient who had undergone neurosurgery in northern Italy. The case illustrates the limits of therapeutic options in central nervous system infections caused by extensively drug‐resistant pathogens.
Spirometry in Primary Care
Authors: Coates Allan L , Graham Brian L , McFadden Robin G , McParland Colm , Moosa Dilshad , Provencher Steeve , Road Jeremy
Published: March 2016

Canadian Thoracic Society (CTS) clinical guidelines for asthma and chronic obstructive pulmonary disease (COPD) specify that spirometry should be used to diagnose these diseases. Given the burden of asthma and COPD, most people with these diseases will be diagnosed in the primary care setting. The present CTS position statement was developed to provide guidance on key factors affecting the quality of spirometry testing in the primary care setting. The present statement may also be used to inform and guide the accreditation process for spirometry in each province.

Although many of the principles discussed are equally applicable to pulmonary function laboratories and interpretation of tests by respirologists, they are held to a higher standard and are outside the scope of the present statement.
Immunoglobulin G4‐Related Disease Mimicking Asthma
Authors: Sekiguchi Hiroshi , Horie Ryohei , Aksamit Timothy R , Yi Eunhee S , Ryu Jay H
Published: March 2016

Immunoglobulin (Ig) G4‐related disease (also known as ‘IgG4‐related sclerosing disease’, ‘IgG4‐related systemic disease’ or ‘hyper‐IgG4‐disease’) is a recently recognized systemic fibroinflammatory disease associated with IgG4‐positive plasma cells in tissue lesions. IgG4‐related disease was initially described as autoimmune pancreatitis, but it is now known to affect virtually any organ. The authors describe a patient presenting with multi‐organ manifestations, including airway inflammation mimicking asthma, pulmonary parenchymal infiltrates, intrathoracic lymphadenopathy, submandibular gland swelling and a kidney mass.
Clinical Characteristics of Pediatric Patients Hospitalized with Methicillin‐Resistant Staphylococcus aureus in Canadian Hospitals from 2008 To 2010
Authors: Leifso Kirk Ryan , Gravel Denise , Mounchili Aboubaker , Kaldas Sherif , Le Saux Nicole
Published: March 2016

Methicillin‐resistant Staphylococcus aureus (MRSA) infections were uncommon in children in Canada until the 1990s. Using a standardized case report form, treating physicians reported children hospitalized due to MRSA infections in Canadian hospitals through the Canadian Pediatric Surveillance Program in a 24‐month period (2008 to 2010). Of 155 cases reported, 70% were ≤4 years of age and approximately one‐third had an underlying medical condition. The most common clinical infections involved skin and soft tissue (69%), the lower respiratory tract (12%), and bone and joint (10%). Almost one‐third had had contact with the health care environment in the previous year and 18% had a known household member with MRSA. Initial therapy with a beta‐lactam alone occurred in 65%, while 22% included vancomycin. No child in this cohort died but 14% required admission to the intensive care unit. Of 143 reports of individual isolates, 93% were reported susceptible to trimethoprim‐sulfamethoxazole, 63% to clindamycin and 50% to mupirocin.

The present study involved only children hospitalized with MRSA infections. It may not be representative of the children treated as outpatients nor children in selected areas of Canada where MRSA infections may be more endemic. Further targeted surveillance to identify risks and treatment practices in these populations may be important.
Determination of Susceptibility to Fosfomycin and Tigecycline of Enterobacteriaceae, Particularly Escherichia coli Isolates, Producing Extended‐Spectrum β‐Lactamases from Multiple Regional Canadian Hospitals
Authors: Beuk Carlee , Hill Christian , Whitehead Sue , Blondel-Hill Edith , Wagner Ken , Cheeptham Naowarat
Published: March 2016

BACKGROUND: The worldwide spread of extended‐spectrum β‐lactamase (ESBL)‐producing Enterobacteriaceae, particularly Escherichia coli, has significantly limited therapeutic options, especially for urinary tract infections. Although limited in their indications, fosfomycin and tigecycline are potential agents to treat infections due to ESBL‐producing organisms. Although not routinely performed, susceptibility testing to both is necessary to ensure there is not an increase in resistance.

METHODS: A total of 160 isolates of ESBL‐producing E coli were isolated from patients at multiple regional hospitals in the Interior Health Region of British Columbia from June 2009 to January 2012. Isolates were obtained from various body fluids and sites including urine (78.2%), wounds, blood, gall bladder drain and respiratory specimens. All isolates were tested using the E‐test method (Etest, bioMérieux, France) for tigecycline and Kirby Bauer disk diffusion method for fosfomycin using European Committee of Antimicrobial Susceptibility Testing breakpoints for tigecycline and Clinical and Laboratory Standards Institute zone sizes for fosfomycin.

RESULTS: All 160 isolates were found to be susceptible to tigecycline, while five isolates (3.1%) were resistant to fosfomycin (four resistant, one intermediate).

CONCLUSION: Although resistance to these antibiotics has previously been reported, the present study confirmed that isolates of ESBL‐producing E coli from the Interior Health Region of British Columbia remain highly susceptible to both tigecycline and fosfomycin.
Pulmonary blastomycosis in a professional diver: An occupational risk
Authors: Kroll Ryan R , Grossman Ronald F
Published: March 2016

In certain parts of the United States and Canada, and northern Ontario in particular, the dimorphic fungus Blastomyces dermatitidis is endemic and can cause infection in exposed individuals. The site of infection is usually pulmonary, causing respiratory and constitutional symptoms, but can also affect other sites in the body. Symptom severity can vary substantially from no symptoms to fatal acute respiratory distress syndrome. The present report describes a 27‐year‐old professional diver who had recently worked in northern Ontario, who developed symptoms of pneumonia and exhibited atypical findings on chest imaging. He was diagnosed with blastomycosis based on histopathological findings and fungal culture, and was treated with amphotericin B and itraconazole in accordance with treatment guidelines. While outdoor occupations in endemic areas increase the risk of infection, there is no literature specifically identifying professional diving as an occupational risk for blastomycosis.
Acute Interstitial Nephritis due to Leptospira grippotyphosa in the Absence of Weil’s Disease
Authors: Schmidhauser Tanja , Curioni Simona , Bernasconi Enos
Published: March 2016

Anicteric leptospirosis is a self‐limited flu‐like disease, whereas the icteric form is a severe illness characterized by multiple organ involvement or even failure. A case involving a patient with rapidly progressing renal insufficiency requiring intermittent renal replacement therapy due to Leptospira grippotyphosa in the absence of a Weil’s disease is reported.
Predictors of Recurrent Ingestion of Gastrointestinal Foreign Bodies
Authors: Grimes Ian C , Spier Bret J , Swize Lisa R , Lindstrom Mary J , Pfau Patrick R
Published: March 2016

BACKGROUND: Gastrointestinal foreign bodies are commonly encountered; however, little knowledge exists as to the causes of foreign body ingestions and why they occur repeatedly in some patients.

OBJECTIVE: To identify and define patients at high risk for recurrent foreign body ingestion.

METHODS: A retrospective chart review of foreign body ingestion was conducted at a tertiary care medical centre over an 11-year period. Variables analyzed included age, sex, incarceration status,Diagnostic and Statistical Manual of Mental Disorders-IVdiagnosis, success of endoscopy, type of sedation used, method of extraction, complications, presence of gastrointestinal pathology, and incidence of recurrent food impaction or foreign body.

RESULTS: A total of 159 patients with a foreign body ingestion were identified. One hundred fourteen (77%) experienced a single episode of ingestion and 45 (23%) experienced multiple ingestions. Of the patients with multiple ingestions, 27 (60%) had recurrent food impactions while 18 (40%) ingested foreign objects. In the recurrent ingestor group, a psychiatric disorder had been diagnosed in 16 patients (35.6%) and there were 13 incarcerated individuals (28.9%). The average number of recurrences was 2.6 per patient (117 total recurrences). Individuals with a psychiatric disorder experienced 3.9 recurrences per patient, while prisoners averaged 4.1 recurrences per patient. The combination of a psychiatric disorder and being incarcerated was associated with the highest recurrence rate (4.33 per patient). Multivariable logistic regression revealed that male sex (OR 2.9; P=0.022), being incarcerated (OR 3.0; P=0.024) and the presence of a psychiatric disorder (OR 2.5; P=0.03) were risk factors for recurrent ingestion.

CONCLUSION: Risk factors for recurrent ingestion of foreign bodies were male sex, being incarcerated and the presence of a psychiatric disorder.
Hedgehog Signalling is Downregulated in Celiac Disease
Authors: Liang Rui , Hinds Rupert , Abud Helen E , Cheng Wei
Published: March 2016

BACKGROUND: Celiac disease (CD) is a common autoimmune disorder of the small intestine that occurs in genetically predisposed individuals. Animal studies have suggested that the hedgehog (Hh) signalling pathway is involved in gut inflammation, injury and repair.

OBJECTIVE: To examine the expression of components of the Hh signalling pathway in CD.

METHODS: Children undergoing gastroscopy investigation for CD at Monash University (Victoria, Australia), and other children undergoing gastroscopy in whom small bowel pathology was not expected (ie, controls), were included in the present study. One histopathologist, who was blinded to the biopsy data, analyzed the biopsies and a diagnosis of CD was made according to standard Marsh criteria. From these samples, RNA was extracted and complementary DNA was synthesized using reverse transcription polymerase chain reaction. The levels of Hh ligand Sonic hh, Indian hh, protein patched homologue 1 (PTCH 1) and bone morphogenetic protein 4 (BMP4) messenger RNA were quantified by real-time polymerase chain reaction. Relative expression quantification was performed using the ΔΔCt method.

RESULTS: Duodenal biopsies were collected from 37 children. There were 20 CD specimens and 17 normal controls. The relative expression of Sonic hh from CD patients was 58% lower than that of the controls; similarly, Indian hh expression was decreased in children with CD by 44%. Compared with controls, the expression of Hh receptor PTCH 1 decreased by 71% and the expression of the Hh target geneBMP4by 42%.

CONCLUSIONS: The expression of the Hh signalling pathway genes was consistently downregulated in untreated CD children. These results suggest that the Hh signalling pathway plays a role in the mucosal lesions encountered in CD.
Pacing: A Concept Analysis of a Chronic Pain Intervention
Authors: Jamieson-Lega Kathryn , Berry Robyn , Brown Cary A
Published: March 2016

BACKGROUND: The intervention of pacing is regularly recommended for chronic pain patients. However, pacing is poorly defined and appears to be interpreted in varying, potentially contradictory manners within the field of chronic pain. This conceptual lack of clarity has implications for effective service delivery and for researchers’ ability to conduct rigorous study. An examination of the background literature demonstrates that while pacing is often one part of a multidisciplinary pain management program, outcome research is hindered by a lack of a clear and shared definition of this currently ill‐defined construct.

OBJECTIVES: To conduct a formal concept analysis of the term ‘pacing’.

METHODS: A standardized concept analysis process (including literature scoping to identify all uses of the concept, analysis to determine defining attributes of the concept and identification of model, borderline and contrary cases) was used to determine what the concept of pacing does and does not represent within the current evidence base.

RESULTS: A conceptual model including the core attributes of action, time, balance, learning and self‐management emerged. From these attributes, an evidence‐based definition for pacing was composed and distributed to stakeholders for review. After consideration of stakeholder feedback, the emergent definition of pacing was finalized as follows: “Pacing is an active self‐management strategy whereby individuals learn to balance time spent on activity and rest for the purpose of achieving increased function and participation in meaningful activities”.

CONCLUSION: The findings of the present concept analysis will help to standardize the use and definition of the term pacing across disciplines for the purposes of both pain management and research.
Evaluation of MALDI‐TOF Mass Spectrometry and Sepsityper Kit™ for the Direct Identification of Organisms from Sterile Body Fluids in a Canadian Pediatric Hospital
Authors: Tadros Manal , Petrich Astrid
Published: March 2016

Matrix‐assisted laser desorption/ionization time of flight mass spectrometry (MALDI‐TOF MS) can be used to identify bacteria directly from positive blood and sterile fluid cultures. The authors evaluated a commercially available kit – the Sepsityper Kit (Bruker Daltonik, Germany) – and MALDI‐TOF MS for the rapid identification of organisms from 80 flagged positive blood culture broths, of which 73 (91.2%) were blood culture specimens and seven (8.7%) were cerebrospinal fluid specimens, in comparison with conventional identification methods. Correct identification to the genus and species levels was obtained in 75 of 80 (93.8%) and 39 of 50 (78%) blood culture broths, respectively. Applying the blood culture analysis module, a newly developed software tool, improved the species identification of Gram‐negative organisms from 94.7% to 100% and of Gram‐positive organisms from 66.7% to 70%.

MALDI‐TOF MS is a promising tool for the direct identification of organisms cultured from sterile sites.
CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core: Canadian Guidelines for Management and Treatment of HIV/Hepatitis C Coinfection in Adults
Authors: Hull Mark , Klein Marina , Shafran Stephen , Tseng Alice , Giguère Pierre , Côté Pierre , Poliquin Marc , Cooper Curtis , on behalf of The CIHR Canadian HIV Trials Network HIV/Hepati
Published: March 2016

BACKGROUND: Hepatitis C virus (HCV) coinfection occurs in 20% to 30% of Canadians living with HIV, and is responsible for a heavy burden of morbidity and mortality. HIV‐HCV management is more complex due to the accelerated progression of liver disease, the timing and nature of antiretroviral and HCV therapy, mental health and addictions management, socioeconomic obstacles and drug‐drug interactions between new HCV direct‐acting antiviral therapies and antiretroviral regimens.

OBJECTIVE: To develop national standards for the management of HCV‐HIV coinfected adults in the Canadian context.

METHODS: A panel with specific clinical expertise in HIV‐HCV co‐infection was convened by The CIHR HIV Trials Network to review current literature, existing guidelines and protocols. Following broad solicitation for input, consensus recommendations were approved by the working group, and were characterized using a Class (benefit verses harm) and Level (strength of certainty) quality‐of‐evidence scale.

RESULTS: All HIV‐HCV coinfected individuals should be assessed for HCV therapy. Individuals unable to initiate HCV therapy should initiate antiretroviral therapy to slow liver disease progression. Standard of care for genotype 1 is pegylated interferon and weight‐based ribavirin dosing plus an HCV protease inhibitor; traditional dual therapy for 24 weeks (for genotype 2/3 with virological clearance at week 4); or 48 weeks (for genotypes 2–6). Therapy deferral for individuals with mild liver disease may be considered. HIV should not be considered a barrier to liver transplantation in coinfected patients.

DISCUSSION: Recommendations may not supersede individual clinical judgement.
Reduction of Central Line‐Associated Bloodstream Infection Rates in a Neonatal Intensive Care Unit after Implementation of a Multidisciplinary Evidence‐Based Quality Improvement Collaborative: A Four‐Year Surveillance
Authors: Ting Joseph Y , Goh Vicki SK , Osiovich Horacio
Published: March 2016

BACKGROUND: The use of central venous catheters has permitted lifesaving treatment for critically ill neonates; however, the attributable mortality rate for central line‐associated bloodstream infections (CLABSIs) has been estimated to be between 4% and 20%. In 2006/2007, the authors’ neonatal intensive care unit (NICU) had a CLABSI rate that was nearly twofold higher than that reported by other Canadian NICUs.

OBJECTIVE: To implement a quality improvement collaborative to reduce the incidence of neonatal CLABSI.

METHODS: A retrospective observational study was performed to compare CLABSI in neonates admitted to the authors’ level III NICU between August 2007 and March 2011. The entire study period was divided into four time periods to evaluate secular trends. A comprehensive catheter‐related bloodstream infection prevention initiative was implemented in August 2007. The initiatives included staff education, standardization of skin preparation protocol, introduction of new antiseptic agents, implementation of central catheter insertion and maintenance checklists, reinforcement of the use of maximal sterile barrier precautions, and revision of the central catheter configuration and maintenance protocols.

RESULTS: The median CLABSI rate of 7.9 per 1000 catheter days at the beginning of the study (period 1 [August 2007 to June 2008]) gradually decreased over the entire study period (P=0.034): period 2 (July 2008 to May 2009), 3.3 per 1000 catheter days; period 3 (June 2009 to April 2010), 2.6 per 1000 catheter days; and period 4 (May 2010 to March 2011), 2.2 per 1000 catheter days.

CONCLUSION: A multidisciplinary evidence‐based quality improvement collaborative resulted in a significant reduction in the CLABSI rate. Continuous quality improvement measures are required to reduce catheter‐related bloodstream infections among low‐birth‐weight infants.
Potential Consequences of Essential Drug Shortages in Canada: Brain Abscess due to Nocardia farcinica Associated with Dapsone Prophylaxis for Pneumocystis jirovecii Pneumonia
Authors: Wuerz Terry C , Bow Eric J , Seftel Matthew D
Published: March 2016

In 2012, Canadian pharmacies experienced a shortage of trimethoprim‐sulfamethoxazole tablets. Drug shortages may result in unintended clinical consequences such as infection with pathogens against which the alternative medication is ineffective. This is highlighted in the present article, which describes a case of brain abscess due to Nocardia species that developed while receiving dapsone as an alternative for prophylaxis against Pneumocystis jirovecii pneumonia in a highly immune‐suppressed patient. Clinicians should be cognizant of these issues when prescribing alternative agents.
Motor Function Predicts Parent‐Reported Musculoskeletal Pain in Children with Cerebral Palsy
Authors: Barney Chantel C , Krach Linda E , Rivard Patrick F , Belew John L , Symons Frank J
Published: March 2016

BACKGROUND: The relationship between pain and motor function is not well understood, especially for children and adolescents with communication and motor impairments associated with cerebral palsy (CP).

OBJECTIVES: To determine whether a predictive relationship between motor function and musculoskeletal pain exists in children with CP.

METHODS: Following informed consent, caregivers of 34 pediatric patients with CP (mean [± SD] age 9.37±4.49 years; 80.0% male) completed pain‐ and function‐related measures. Parents completed the Dalhousie Pain Interview and the Brief Pain Inventory based on a one‐week recall to determine whether pain had been experienced in the past week, its general description, possible cause, duration, frequency, intensity and interference with daily function. The Gross Motor Function Classification System (GMFCS) was used to classify the motor involvement of the child based on their functional ability and their need for assistive devices for mobility.

RESULTS: GMFCS level significantly predicted parent‐reported musculoskeletal pain frequency (P<0.02), duration (P=0.05) and intensity (P<0.01). Duration of pain was significantly related to interference with activities of daily living (P<0.05).

CONCLUSIONS: Children with CP with greater motor involvement, as indexed by GMFCS level, may be at risk for increased pain (intensity, frequency and duration) that interfers with activities of daily living. The clinical index of suspicion should be raised accordingly when evaluating children with developmental disability who cannot self‐report reliably.
Impact of Obesity on Perinatal Outcomes among Asthmatic Women
Authors: Thuot Meggie , Coursol Marc-André , Nguyen Sonia , Lacasse-Guay Vanessa , Beauchesne Marie-France , Fillion Anne , Forget Amélie , Kettani Fatima-Zohra , Blais Lucie
Published: March 2016

BACKGROUND: Only one study has investigated the combined effect of maternal asthma and obesity on perinatal outcomes; however, it did not consider small‐for‐gestational age and large‐for‐gestational age infants.

OBJECTIVES: To examine the impact of obesity on perinatal outcomes among asthmatic women.

METHODS: A cohort of 1386 pregnancies from asthmatic women was reconstructed using three of Quebec’s administrative databases and a questionnaire. Women were categorized using their prepregnancy body mass index. Underweight, overweight and obese women were compared with normal weight women. The primary outcome was the birth of a small‐for‐gestational‐age infant, defined as a birth weight below the 10th percentile for gestational age and sex. Secondary outcomes were large‐for‐gestational‐age infants (birth weight >90th percentile for gestational age) and preterm birth (<37 weeks’ gestation). Logistic regression models were used to obtain the ORs of having small‐for‐gestational‐age infants, large‐for‐gestational‐age infants and preterm birth as a function of body mass index.

RESULTS: The proportions of underweight, normal weight, overweight and obese women were 10.8%, 53.3%, 19.7% and 16.2%, respectively. Obese asthmatic women were not found to be significantly more at risk for giving birth to small‐for‐gestational‐age infants (OR 0.6 [95% CI 0.4 to 1.1]), large‐for‐gestational‐age infants (OR 1.2 [95% CI 0.7 to 2.2]) or having a preterm delivery (OR 0.7 [95% CI 0.4 to 1.3]) than normal‐weight asthmatic women.

CONCLUSIONS: No significant negative interaction between maternal asthma and obesity on adverse perinatal outcomes was observed.
Emergence of Non‐Serotype b Encapsulated Haemophilus influenzae as a Cause of Pediatric Meningitis in Northwestern Ontario
Authors: Sadeghi-Aval Pouya , Tsang Raymond SW , Jamieson Frances B , Ulanova Marina
Published: March 2016

Before the introduction of the conjugate vaccine, Haemophilus influenzae serotype b (Hib) was the leading cause of bacterial meningitis in children. Although successful in reducing Hib cases, the vaccine confers no protection against other serotypes of H influenzae, such as a (Hia), or f (Hif). The emergence of invasive disease caused by non‐Hib in northwestern Ontario (38 cases between 2002 and 2008) with predominance of Hia was previously reported by the authors. At that time, no cases of pediatric meningitis caused by H influenzae were recorded in the region. Continued surveillance identified 12 new cases of invasive non‐Hib between January 2009 and July 2011. Among these cases, three young children developed meningitis with severe complications caused by Hia or Hif. The present article describes these cases along with the characteristics of recent H influenzae isolates from the region, (ie, their genetic background and antibiotic sensitivity). The findings point to the clonal nature of circulating Hia strains as well as to an increase in frequency and severity of pediatric invasive H influenzae infections in northwestern Ontario.
Primary Musculoskeletal Hydatid Cyst of the Thigh: Diagnostic and Curative Challenge for an Unusual Localization
Authors: Argy Nicolas , Abou Bacar Ahmed , Boeri Cyril , Lohmann Caroline , Pfaff Alexander W , Hansmann Yves , Christmann Daniel , Candolfi Ermanno , Lefebvre Nicolas
Published: March 2016

Primary muscular echinococcosis is an uncommon localization of hydatid cysts. The nonspecific clinical presentation and possible post‐therapeutic complications lead to problems for the diagnosis of this infection and the support of the patient. The authors describe an unusual case of double hydatid cyst of the vastus intermedius muscle. After a precise preoperative evaluation based on clinical, radiological and biological examinations, a surgical excision by pericystectomy combined with perioperative chemotherapy enabled the authors to treat the patient and to prevent postoperative complications. The diagnostic tools and the treatment of this particular type of echinococcosis are discussed.
Pets are ‘Risky Business’ for Patients undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Al-Fifi Yahya Salim Yahya , Sathianathan Chris , Murray Brenda-Lee , Alfa Michelle J
Published: March 2016

The authors report the first case in Manitoba of a patient undergoing continuous ambulatory peritoneal dialysis who experienced three successive infections with Pasteurella multocida and Capnocytophaga species over an eight‐month period. These zoonotic infections were believed to originate from contact with the patient’s household pets. To prevent such infections, the authors recommend the development and implementation of hygiene guidelines outlining the risks associated with owning domestic pets for continuous ambulatory peritoneal dialysis patients.
Evaluation of a Novel Method of Teaching Endobronchial Ultrasound: Physician‐ Versus Respiratory Therapist‐Proctored Simulation Training
Authors: Stather David Ryan , Chee Alex , MacEachern Paul , Dumoulin Elaine , Hergott Christopher A , Gelberg Jacob , Scott Sandra D , De Guzman Sylvia , Tremblay Alain
Published: March 2016

BACKGROUND: Computer endobronchial ultrasound (EBUS) simulators have been demonstrated to improve trainee procedural skills before attempting to perform EBUS procedures on patients.

OBJECTIVE: To compare EBUS performance following training with computer simulation proctored by EBUS‐trained respiratory therapists versus the same simulation training proctored by an interventional respirologist.

METHODS: The present analysis was a prospective study of respiratory medicine trainees learning EBUS. Two cohorts of trainees were evaluated using a previously validated method using simulated cases with performance metrics measured by the simulator. Group 1 underwent EBUS training by performing 15 procedures on an EBUS simulator (n=4) proctored by an interventional respirologist. Group 2 received identical training proctored by a respiratory therapist with special training in EBUS (n=10).

RESULTS: No significant differences between group 1 and group 2 were apparent for the primary outcome measures of total procedure time (15.15±1.34 min versus 14.78±2.88 min; P=0.816), the percentage of lymph nodes successfully identified (88.8±5.4 versus 80.91±8.9; P=0.092) or the percentage of successful biopsies (100.0±0.0 versus 98.75±3.95; P=0.549). The learning curves were similar between groups, and did not show an obvious plateau after 19 simulated procedures in either group.

DISCUSSION: Acquisition of basic EBUS technical skills can be achieved using computer EBUS simulation proctored by specially trained respiratory therapists or by an interventional respirologist. There appeared to be no significant advantage to having an interventional respirologist proctor the computer EBUS simulation.
When to Suspect Occupational Asthma
Authors: Lemière Catherine
Published: March 2016

Occupational asthma (OA) is a difficult diagnosis to make. The present review describes the work environments in which workers are at risk for developing OA, the characteristics of the individuals in whom OA should be suspected and the investigation that can be performed to diagnose the condition. Accurately diagnosing OA is crucial because of the major social and economic consequences of this diagnosis on the patient.
Gastric Biopsies: The Gap between Evidence-Based Medicine and Daily Practice in the Management of GastricHelicobacter pyloriInfection
Authors: El-Zimaity Hala , Serra Stefano , Szentgyorgyi Eva , Vajpeyi Rajkumar , Samani Amir
Published: March 2016

BACKGROUND: Many consider histology to be the gold standard forHelicobacter pyloridetection. Because the number and distribution ofH pyloriorganisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum.

OBJECTIVE: To assess the influence of clinical practice on the histopathological detection ofH pyloriinfection.

METHODS: Electronic patient records were evaluated for the sites of gastric sampling and PPI use at endoscopy. One hundred fifty cases with biopsies taken from both antrum and body were randomly selected for pathological re-review with special stains. The gastric regions sampled,H pyloridistribution and influence of clinical factors on pathological interpretation were assessed.

RESULTS: Between 2005 and 2010, 10,268 biopsies were taken to detectH pylori. Only one region was sampled in 60% of patients (antrum 47%, body 13%). Re-review of biopsies taken from both antrum and body indicated that the correct regions were sampled in only 85 (57%) patients. Of these, 54 wereH pyloripositive and 96 wereH pylorinegative.H pyloriwas present in the antrum in only 15% of the patients and body only in 21%. Of 96H pylori-negative patients, two were reinterpreted as positive. Forty-seven per cent of patients were taking PPIs at endoscopy, contributing to both false-negative and false-positive diagnoses.

CONCLUSION: Despite national and international guidelines for managingH pyloriinfection, the American Gastroenterological Association guidelines are infrequently adhered to, with PPIs frequently contributing to false diagnosis; sampling one region only increases the likelihood of missing active infection by at least 15%.
The Evolution of Sputum Cytometry to Assess Bronchitis
Authors: Lim Hui Fang , Nair Parameswaran
Published: March 2016

Erratum to “The Evolution of Sputum Cytometry to Assess Bronchitis”10.1155/2014/941719
Ten‐Year Review of Candidemia in a Canadian Tertiary Care Centre: Predominance of Non‐albicans Candida Species
Authors: Al-Rawahi Ghada N , Roscoe Diane L
Published: March 2016

OBJECTIVE: To review the epidemiology and associated risk factors for candidemia at a tertiary care centre, in view of recent reports on the changing epidemiology of bloodstream infection due to Candida species.

METHODS: Between January 2000 and December 2009, patients with blood culture samples positive for Candida species were identified using the microbiology laboratory information system. Patient data were collected by retrospective chart review of clinical characteristics including demographic data, underlying medical diagnoses and risk factors.

RESULTS: A total of 266 candidemia episodes were included in the final analysis. Fifty‐nine per cent of these episodes occurred in males and 51% were in patients >60 years of age. The most common risk factor for candidemia was previous antibiotic use (85%). The most frequent species was Candida albicans (49%), followed by Candida glabrata (30%). C albicans was the predominant species in all study years with the exception of 2002, in which C glabrata was more frequent. The likelihood of recovering a non‐albicans Candida species was found to be significantly associated with previous antifungal therapy (P=0.0004), immunosuppressive therapy (P=0.002), abdominal surgery (P=0.003) and malignancy (P=0.05). Mixed candidemia was found in 10 episodes (4%); 80% grew C albicans and C glabrata. Risk factors for mixed candidemia were not significantly different from those with monomicrobial candidemia.

CONCLUSION: C albicans remains the most commonly isolated species in this setting, consistent with findings from other Canadian centres. However, non‐albicans Candida species were overall predominant. Mixed‐species candidemia does not appear to be more prevalent in patients with identified risk factors.
‘Bobo‐Newton Syndrome’: An Unwanted Gift from Man’s Best Friend
Authors: Popiel Kristin Y , Vinh Donald C
Published: March 2016

Capnocytophaga canimorsus is a facultative Gram‐negative bacillus that is typically a constituent of the oral flora of dogs and cats. It was first isolated by Bobo and Newton in 1976 from a man presenting with meningitis following a dog bite. Transmission to humans follows various animal‐related injuries, which may be gross or subtle. C canimorsus can cause a spectrum of syndromes ranging from skin and soft tissue infection to invasive disease such as meningitis or endocarditis. The present article reports a case of C canimorsus meningitis in a patient with the classic risk factor of alcoholic liver cirrhosis. Clinical suspicion was confirmed by culture and genetic identification of the blood isolate. The present article reviews the Capnocytophaga genus, the clinical syndromes most commonly associated with this zoonotic organism, its laboratory identification and treatment.
Combination of Culture, Antigen and Toxin Detection, and Cytotoxin Neutralization Assay for Optimal Clostridium difficile Diagnostic Testing
Authors: Alfa Michelle J , Sepehri Shadi
Published: March 2016

BACKGROUND: There has been a growing interest in developing an appropriate laboratory diagnostic algorithm for Clostridium difficile, mainly as a result of increases in both the number and severity of cases of C difficile infection in the past decade. A C difficile diagnostic algorithm is necessary because diagnostic kits, mostly for the detection of toxins A and B or glutamate dehydrogenase (GDH) antigen, are not sufficient as stand‐alone assays for optimal diagnosis of C difficile infection. In addition, conventional reference methods for C difficile detection (eg, toxigenic culture and cytotoxin neutralization [CTN] assays) are not routinely practiced in diagnostic laboratory settings.

OBJECTIVE: To review the four‐step algorithm used at Diagnostic Services of Manitoba sites for the laboratory diagnosis of toxigenic C difficile.

RESULT: One year of retrospective C difficile data using the proposed algorithm was reported. Of 5695 stool samples tested, 9.1% (n=517) had toxigenic C difficile. Sixty per cent (310 of 517) of toxigenic C difficile stools were detected following the first two steps of the algorithm. CTN confirmation of GDH‐positive, toxin A‐ and B‐negative assays resulted in detection of an additional 37.7% (198 of 517) of toxigenic C difficile. Culture of the third specimen, from patients who had two previous negative specimens, detected an additional 2.32% (12 of 517) of toxigenic C difficile samples.

DISCUSSION: Using GDH antigen as the screening and toxin A and B as confirmatory test for C difficile, 85% of specimens were reported negative or positive within 4 h. Without CTN confirmation for GDH antigen and toxin A and B discordant results, 37% (195 of 517) of toxigenic C difficile stools would have been missed. Following the algorithm, culture was needed for only 2.72% of all specimens submitted for C difficile testing.

CONCLUSION: The overview of the data illustrated the significance of each stage of this four‐step C difficile algorithm and emphasized the value of using CTN assay and culture as parts of an algorithm that ensures accurate diagnosis of toxigenic C difficile.
Group a Rotaviruses in Children with Gastroenteritis in a Canadian Pediatric Hospital: The Prevaccine Era
Authors: Chetrit Estelle , L’Homme Yvan , Sohal Jagdip Singh , Quach Caroline
Published: March 2016

BACKGROUND: A publicly funded, group A rotavirus (RVA) vaccination program was implemented in Quebec in November 2011.

OBJECTIVES: To evaluate trends in RVA infections and describe circulating genotypes before the implementation of a publicly funded vaccination program.

METHODS: The Montreal Children’s Hospital (Montreal, Quebec) virology laboratory database was reviewed for RVA ELISA performed between July 2006 and June 2011. A five‐week moving average was used to follow the proportion of positive RVA ELISA test results. A season was defined as starting with the first two and ending with the final two consecutive weeks in which the percentage of specimens testing positive for RVA was ≥10%. Duplicate tests were excluded. A random sample of 39 RVA‐positive fecal samples from the final season (2010/2011) was genetically characterized: VP4, VP6, VP7 and NSP4 gene segments were genotyped using sequence analysis.

RESULTS: Of the 3403 nonduplicate tests, 433 were RVA positive: 15.1% (2006/2007) to 9.3% (2010/2011) of the samples were positive during the study period, with a proportionally larger decrease in the percentage of positive tests compared with the decrease in the number of tests performed. The most common RVA strain types detected were G9P[8]I1 (n=19) and G1P[8]I1 (n=14), followed by G2P[4]I2 (n=4), G3P[6]I1 (n=1) and G4P[8]I2 (n=1). Mixed RVA infection was observed in two samples.

CONCLUSION: Before the implementation of the vaccination program, the proportion of positive RVA tests had already begun to steadily decline. The present study was the first to report the genetic makeup of human RVA collected from a Canadian hospital based on the genotyping of four gene segments. The present study provided a baseline with which to monitor the impact of the universal vaccination program.
Transcervical Intrauterine Levobupivacaine or Lidocaine Infusion for Pain Control during Endometrial Biopsy
Authors: Kosus Nermin , Kosus Aydın , Demircioglu Ruveyda I , Simavli Serap A , Derbent Aysel , Keskin Esra Aktepe , Turhan Nilgun O
Published: March 2016

BACKGROUND: Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction.

OBJECTIVES: To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double‐blinded trial in pre‐ and postmenopausal women.

METHODS: Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intra‐uterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged.

RESULTS: Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group.

CONCLUSION: Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intra‐uterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.
An Unusual Case of Streptococcus anginosus Group Pyomyositis Diagnosed Using Direct 16S Ribosomal DNA Sequencing
Authors: Walkty Andrew , Embil John M , Nichol Kim , Karlowsky James
Published: March 2016

Bacteria belonging to the Streptococcus anginosus group (Streptococcus intermedius, Streptococcus constellatus and Streptococcus anginosus) are capable of causing serious pyogenic infections, with a tendency for abscess formation. The present article reports a case of S anginosus group pyomyositis in a 47‐year‐old man. The pathogen was recovered from one of two blood cultures obtained from the patient, but speciation was initially not performed because the organism was considered to be a contaminant (viridans streptococci group). The diagnosis was ultimately confirmed using 16S ribosomal DNA sequencing of purulent fluid obtained from a muscle abscess aspirate. The present case serves to emphasize that finding even a single positive blood culture of an organism belonging to the S anginosus group should prompt careful evaluation of the patient for a pyogenic focus of infection. It also highlights the potential utility of 16S ribosomal DNA amplification and sequencing in direct pathogen detection from aspirated fluid in cases of pyomyositis in which antimicrobial therapy was initiated before specimen collection.