bluuebunny/crossref_metadata_2025 huggingface dataset:
Age Differences in the Quality of Chronic Pain: A Preliminary Study
Authors: Gagliese Lucia , Melzack Ronald
Published: March 2016

BACKGROUND: Recent studies of the relationship between age and the intensity of chronic pain report increases, decreases or no change in pain intensity as a function of age. These inconsistencies may be due in part to the pain assessment tools employed and their appropriateness with different age groups.

OBJECTIVES: To assess age differences in chronic pain by using several measures of pain intensity and a multidimensional measure of pain qualities in the same sample; to assess the consistency of pain intensity estimates obtained from different scales within age groups; to determine whether the failure rates for appropriately completing the scale (such as choosing more than one descriptor or making more than one mark on the Visual Analog Scale [VAS]) differ among age groups.

SUBJECTS: Seventy‐nine adults aged 27 to 79 years with chronic arthritis pain.

MEASUREMENTS: The unidimensional pain intensity scales used were the VAS, the Verbal Descriptor Scale and the Behavioural Rating Scale. The multidimensional pain scale used was the short form McGill Pain Questionnaire (SF‐MPQ). The Beck Depression Inventory was also administered.

RESULTS: Age‐related decreases were found in the sensory and affective dimensions of chronic pain as measured with the SF‐MPQ. No age differences in pain intensity were measured with any of the unidimensional scales. These results were maintained after controlling for the effects of concurrent depressive symptomatology. Pain intensity estimates differed within groups, with verbal descriptors yielding the most consistent estimates in the elderly group. The elderly were significantly more likely to fail on the VAS than younger subjects. There were no age differences on any other measure.

CONCLUSIONS: There may be age‐related changes in the quality but not in the intensity of chronic arthritis pain. Implications for clinical pain assessment in the elderly are discussed.
Does Vibrio Vulnificus Present a Health Threat to Canadians?
Authors: Stavric Stanislava , Buchanan Barbara
Published: March 2016

OBJECTIVE: To review recent data on Vibrio vulnificus and its properties, characteristics of disease and epidemiology, sources of infection, population at risk, infectious dose, documented cases of infection and health risk from V vulnificus infection in Canada.

DATA SOURCE: A MEDLINE and CURRENT CONTENTS search (1981 through September 1996) using the main heading ‘Vibrio vulnificus’, ‘Vibrio species’, ‘seafood’, etc. Relevant articles were also selected from the literature collection in the authors’ laboratory.

STUDY SELECTION AND DATA EXTRACTION: The authors judged articles relevant to the objective of the paper and selected them for a review.

DATA SYNTHESIS: V vulnificus, an important cause of septicemia, wound infections and gastroenteritis, is considered to be one of the most invasive and rapidly lethal human pathogens. Molluscan shellfish concentrate this organism from warm seawater and present the greatest danger to consumers. Infections with this pathogen have been reported throughout the world. Most deaths have resulted from the consumption of raw or undercooked oysters, fewer from contact with seawater. Individuals with underlying disease, particularly those with liver diseases and iron overload, are the most susceptible.

CONCLUSION: The two reported cases of V vulnificus wound infection in Canada might not represent the real situation. Infection with this organism may go unrecognized, unreported or simply may not occur. Medical professionals need to become aware of this pathogen and the dire consequences of infection in individuals with underlying disease.
Smoking and Non‐Neoplastic Lung Disease in Canadian Men and Women
Authors: Ashley Mary Jane , Choi Bernard CK , Pak Anita WP
Published: March 2016

MAIN OBJECTIVE: To document and assess the current health impact of non‐neoplastic lung disease (NNLD) in Canadian men and women that is attributable to smoking.

DESIGN: Comparison of three recent studies providing estimates of smoking‐attributable deaths, potential years of life lost, hospital separations and hospital days due to NNLD in Canada. Review of recent epidemiological studies providing relative risk estimates of smoking‐attributable mortality and morbidity for chronic obstructive pulmonary disease and pneumonia, including a meta‐analysis.

MAIN RESULTS: Each year at least 6700 Canadian men and women die from NNLD attributable to smoking. Smoking‐attributable NNLD deaths in men outnumber those in women by about 2 to 1. The majority of these deaths are due to chronic obstructive pulmonary disease, which is exceeded in importance as a smoking‐attributable cause of death only by lung cancer and ischemic heart disease. NNLD accounts for about 20% of all smoking‐attributable deaths in Canada, 14% of the potential years of life lost due to smoking, and 22% and 25% of all smoking‐attributable hospital separations and hospital days, respectively. Long term follow‐up assessments of large cohorts suggest that the impact of smoking on health has been underestimated. Recent studies also suggest that women may be more susceptible than men to the adverse effects of smoking on lung function.

CONCLUSION: NNLD caused by smoking has an important health impact in Canada. Tobacco control strategies must be enhanced.
Epidemiological Investigation of Salmonella Tilene by Pulsed‐Field Gel Electrophoresis and Polymerase Chain Reaction
Authors: Anand Chandar M , Fonseca Kevin , Longmore Ken , Rennie Robert , Chui Linda , Lingley Mike , Woodward David
Published: March 2016

Pulsed‐field gel electrophoresis (PFGE) and DNA fingerprinting by the polymerase chain reaction (PCR) were performed on 11 isolates of Salmonella tilene. Five strains were from a cluster of human patients, six from sugar gliders and pygmy hedgehogs kept as family pets or from local pet retailers, and one isolate from the first North American case of S tilene described in Washington State in 1994. The PFGE restriction patterns showed all isolates to be similar. However, PCR using primers to the 16S and 23S rRNA genes of Escherichia coli demonstrated that the Washington State isolate differed from the rest of the other isolates, which were all similar based upon their DNA fingerprint. This study indicates that reliance on one technique alone may be insufficient to show nuances between strains that are, in many respects, closely related.
Understanding Economic Evaluation: A Policy Perspective for Clinicians
Authors: Giacomini M , Hurley J
Published: March 2016

The rhetoric of ‘efficiency’ frames much current debate about how limited health care resources should be used. Clinicians increasingly turn to economic evaluation literature to discern evidence‐based claims of ‘efficiency’ or ‘cost effectiveness’ from empty ones. Economic evaluation research is designed to compare health services on the basis of their efficiency (eg, how well they produce health benefits relative to resource costs). Although economic studies appear throughout the respirology literature, relatively few are complete economic evaluations. Economic evaluation studies serve various purposes, including critical evaluation and persuasive marketing, which produce studies that vary in research agendas and scientific rigour. This paper is intended to serve clinicians and consumers of economic evaluation studies by: introducing economic evaluation research information as a policy making tool; describing the three basic elements and three basic types of economic evaluation (cost‐benefit, cost‐effectiveness, and cost‐utility analyses); and reviewing some limitations of economic evaluation information for policy decision making. The usefulness of economic evaluation research for policy making depends not only on the scientific merit of the analysis but also crucially on whose specific concerns the research questions address.
Myofibroblasts in Nasal Polyposis: Regulation by Topical Steroids
Authors: Tremblay Guy M , Nonaka Manabu , Särnstrand Bengt , Dolovich Jerry , Gauldie Jack , Jordana Manel
Published: March 2016

OBJECTIVES: To compare numbers of myofibroblasts, a fibroblast phenotype associated with chronically inflamed tissue, in nasal polyp tissues from untreated and corticosteroid‐treated subjects. To study whether corticosteroids can directly affect myofibroblast differentiation in vitro.

PATIENTS AND METHODS: Immunolocalization of alpha‐smooth muscle actin (alpha‐SMA) as a marker of myofibroblast differentiation, vimentin and transforming growth factor (TGF)‐beta in nasal polyp tissues from nine patients who had taken no steroids for at least a month before polypectomy and from eight patients who had received intranasal budesonide or beclomethasone dipropionate continuously for four to 12 months before polypectomy. Cultured nasal polyp fibroblasts were exposed to budesonide for six days and alpha‐SMA expression was determined by immunocytochemistry.

RESULTS: Nasal polyp tissues from untreated subjects were characterized by the presence of a substantial number of myofibroblasts compared with tissues from corticosteroid‐treated subjects. The median percentages of alpha‐SMA positive cell areas per total area for the two groups were 6.4% (0.5 to 11.5) and 1.3% (0.1 to 4.7), respectively. This difference in alpha‐SMA staining between the two groups was not due to a decrease in fibroblast numbers (vimentin‐positive spindle‐shape cells). Numbers of TGF‐beta positive cells were similar in the two groups of subjects. In vitro, budesonide treatment decreased the number of alpha‐SMA positive fibroblasts in primary lines in a dose dependent manner.

CONCLUSIONS: The difference in myofibroblast numbers between nasal polyp tissues from untreated and corticosteroid‐treated subjects, as shown by immunolocalization of alpha‐SMA, suggests a new therapeutic effect of nasal topical corticosteroids in nasal polyposis. This could be a direct effect of the drug on fibroblast differentiation and/or modulation of cytokine production.
Malaria: Probably Locally Acquired in Toronto, Ontario
Authors: Baqi Mahin , Gamble Ken , Keystone Jay S , Kain Kevin C
Published: March 2016

Although local acquisition of malaria has been reported in the United States, no such cases have been reported in Canada. The authors report a case of Plasmodium vivax malaria in a patient with no travel to a malarious area in the preceding nine years, and postulate local acquisition as the most likely explanation for her infection. The only other plausible alternative explanation of equal biological interest would be that this case represents the latest relapse of vivax malaria ever reported.
Absence of the Genetic Marker IS6110 from a Strain of Mycobacterium tuberculosis Isolated in Ontario
Authors: Howard Susan T , Oughton Matthew T , Haddad Albert , Johnson Wendy M
Published: March 2016

A 35‐year‐old female patient from Waterloo, Ontario was diagnosed with pulmonary tuberculosis in June 1995. Records indicated that the patient had emigrated from Laos circa 1990. A culture grown from a bronchoalveolar lavage specimen was identified as Mycobacterium tuberculosis by standard biochemical methods. Drug‐susceptibility testing indicated the strain was resistant to pyrazinamide (PZA), and a mutation was detected within pncA, a gene associated with PZA resistance. Sequence data from the 16S rRNA gene and the 16S/23S rRNA gene spacer confirmed that the strain was a member of the M tuberculosis complex, and analysis of the mpcA and pncA genes supported the identification of the strain as M tuberculosis rather than Mycobacterium bovis. However, the insertion element IS6110, which is used for epidemiological tracing of M tuberculosis, was not detected in this strain by either restriction fragment length polymorphism analysis or by polymerase chain reaction. Two other genetic markers associated with the M tuberculosis complex, IS1081 and the direct repeat element, were present. The arrival of immigrants with tuberculosis from southeast Asia, where most strains of M tuberculosis lacking IS6110 have been traced, has important implications for epidemiological studies of tuberculosis in North America.
Pain Research and Treatment in the Gerontological Context: A Discussion of the Issues
Authors: Gibson Margaret C , Thomas Michael R , Cook Andrew J
Published: March 2016

An appreciation of the context in which gerontological health care occurs is crucial to the successful and ethical collection, interpretation and utilization of data on the pain experiences of elderly people. Important contextual considerations for researchers and clinicians who are addressing pain in the elderly are identified. It is argued that topics that are the focus of current attention in the field of pain and ageing, such as the effect of dementia on memory for pain and the responsiveness of the elderly to psychosocial pain treatment, would be clarified by an understanding of the broader sociopolitical context in which ageing occurs.
Influenza Vaccine Match with Circulating Strains and Indicators of Influenza Strain Impact ‐ Canada 1980 to 1992
Authors: Ellis Edward , Weber John M , Cuff Wilf , Mackenzie Susan G
Published: March 2016

OBJECTIVES: To determine the similarity between influenza vaccine antigens and viruses associated with laboratory‐confirmed infections by virus type/subtype, strain and influenza season; to correlate pneumonia and influenza hospitalization and mortality rates with the number of laboratory‐confirmed influenza infections in an influenza season; and to develop predictive indicators of the likely incidence of current strains in the following season.

DESIGN: Ecological study using national laboratory, pneumonia and influenza hospitalization and mortality data.

SETTING: Canada, influenza seasons from 1980 to 1992.

POPULATION STUDIED: Individuals with laboratory‐confirmed influenza infections, pneumonia and influenza hospitalizations or deaths.

INTERVENTION: Influenza immunization.

MAIN RESULTS: Similarity of circulating strains and vaccine antigens was 99% for A(H1N1), 65% for A(H3N2) and 65% for B strains. During outbreaks, pneumonia and influenza hospitalization, and mortality rates increased 19% or less and 21% or less for A(H1N1), respectively; 28% or less and 51% or less for A(H3N2), and 19% or less and 16% or less for B strains. There were usually fewer than 25 laboratory‐confirmed A(H1N1) infections with a particular strain in a season if there had been more than 25 infections with similar strains the previous season. For A(H3N2), the figure was 100, and for B it was 150.

CONCLUSIONS: Matches were excellent for A(H1N1) and good for A(H3N2) plus B strains. Hospitalization and mortality rates increased substantially during outbreaks, eg, estimated 1609 excess deaths during a widespread A(H3N2) outbreak. This study identifies relationships that provide some ability to predict the incidence of a particular influenza strain in a coming season based on the incidence of strains similar to it in the previous season.
Seroprevalence of Cytomegalovirus, Toxoplasma gondii, Syphilis, and Hepatitis B and C Virus Infections in a Regional Population Seropositive for HIV Infection
Authors: Johns Daniel G , Gill M John
Published: March 2016

OBJECTIVE: To determine the prevalence of exposure to cytomegalovirus (CMV), Toxoplasma gondii, syphilis, hepatitis B virus (HBV) and hepatitis C virus (HCV) in a large, well characterized, regional population presenting for human immunodeficency virus (HIV) care.

DESIGN: Demographic and serological data compiled prospectively in a relational database used for routine patient care. Results were analyzed for statistically significant trends within demographic subpopulations known to be at risk of such infections.

PATIENTS AND SETTING: A total of 1274 persons with documented HIV infection in southern Alberta have sought medical care since 1985. Serological status to CMV, T gondii, syphilis, HBV and HCV infections were routinely requested as part of the initial assessment. All patients with serological results available were included in the analysis.

RESULTS: CMV infection was found in 84.1% of patients. A lower prevalence of CMV infection in those under 30 yeasr old (P<0.001), intravenous drug users (IVDUs) (P=0.001) and in patients with transfusion‐acquired HIV (P<0.001) was seen. T gondii seropositivity was found in 10.6% of patients, with an increased risk of seropositivity in those born outside of Canada (P<0.001). Syphilis seropositivity was present in 5.1% of patients, with a higher prevalence in gay males (P=0.1). HBV carrier status was noted in 8.0% of patients, with males having an increased risk (P=0.025). Since 1990, there has been a 17.6% prevalence of HCV, predominantly in IVDUs (P<0.001).

CONCLUSION: Seroprevalence to common pathogens in HIV disease varies significantly among subpopulations, necessitating individual testing.
In Celebration of the 200th Anniversary of Edward Jenner’s Inquiry into the Causes and Effects of the Variolae Vaccinae
Authors: Brunham Robert C , Coombs Kevin M
Published: March 2016

This review commemorates the 200th anniversary of Edward Jenner’s development of a vaccine for variola, the cause of smallpox, and the 20th anniversary of its eradication. Jenner’s original 23 case reports are briefly revisited within the context of earlier attempts to prevent this dreaded disease and in light of the current understanding of vaccinology and immunology. In addition, with molecular biological information available about many pox viruses and detailed sequence knowledge of some, it is now possible to appreciate Jenner’s prescient accomplishments more fully.
T Lymphocyte Immunity in Host Defence against Chlamydia trachomatis and Its Implication for Vaccine Development
Authors: Yang X , Brunham RC
Published: March 2016

Chlamydia trachomatis is an obligate intracellular bacterial pathogen that causes several significant human infectious diseases, including trachoma, urethritis, cervicitis and salpingitis, and is an important cofactor for transmission of human immunodeficiency virus. Until very recently, over three decades of research effort aimed at developing a C trachomatis vaccine had failed, due mainly to the lack of a precise understanding of the mechanisms for protective immunity. Although most studies concerning protective immunity to C trachomatis have focused on humoral immune responses, recent studies have clearly shown that T helper‐1 (Th1)‐like CD4 T cell‐mediated immune responses play the dominant role in protective immunity. These studies suggest a paradigm for chlamydial immunity and pathology based on the concept of heterogeneity (Th1/Th2) in CD4 T cell immune responses. This concept for chlamydial immunity offers a rational template on which to base renewed efforts for development of a chlamydial vaccine that targets the induction of cell‐mediated Th1 immune responses.
Prevalence of Sleep Disordered Breathing in a Population of Canadian Grainworkers
Authors: Keenan Sean P , Ferguson Kathleen A , Chan-Yeung Moira , Fleetham John A
Published: March 2016

OBJECTIVES: To determine the prevalence of sleep disordered breathing (SDB) in a Canadian population of industrial workers (grainworkers). To determine the clinical features that are predictive of SDB and the validity of self‐reported snoring.

DESIGN: Cross‐sectional, interviewer‐administered questionnaire with selective recruitment of subjects for home sleep monitoring.

SETTING: Community setting, Vancouver, British Columbia.

PARTICIPANTS: All male grainworkers at grain elevators in Vancouver were approached for completion of a questionnaire. Eighty‐three per cent of 524 subjects completed the questionnaire and were divided by presumed risk for SDB into four groups. All subjects in the highest risk group (group 1‐ frequent snoring and witnessed apneas) and a random sample of 40 subjects in the other three groups (group 2 ‐ frequent snoring without witnessed apneas; group 3 ‐ infrequent snoring rare; group 4 ‐ nonsnoring) were approached for home sleep monitoring and 42% consented.

INTERVENTIONS: Interviewer‐administered questionnaire and home sleep monitoring.

RESULTS: The overall prevalence of SDB in this relatively overweight group was estimated to be 25%, with a stepwise increase from group 4 to group 1 (7%, 29%, 40%, 60%). Presence of snoring and witnessed apneas, a greater body‐mass index and a larger neck circumference were associated with SDB. Self‐reported snoring was not found to be predictive.

CONCLUSIONS: This first study of the prevalence of SDB in Canada suggests that SDB is at least as prevalent in Canada as in other industrialized nations and may actually be more common than previously thought. Further studies are required to determine the morbidity, mortality and economic loss associated with SDB in industrial workers.
Frontal Osteomyelitis (Pott’s Puffy Tumour) Associated with Pasteurella multocida – A Case Report and Review of the Literature
Authors: Skomro Robert , McClean Karen L
Published: March 2016

A 58‐year‐old woman presented with progressive midforehead swelling and erythema with frontal headache. Investigations revealed erosion of the anterior wall of the frontal sinus with subgaleal abscess formation, establishing a diagnosis of Pott’s puffy tumour. Pasteurella multocida was isolated in pure growth from an aspirate of the abscess. P multocida is a rare cause of sinusitis. It is isolated from the respiratory tract of asymptomatic individuals and, more commonly, patients with chronic respiratory conditions. Although a cause of osteomyelitis associated with animal bites or scratches, P multocida has not previously been implicated as a cause of frontal osteomyelitis or Pott’s puffy tumour. A review of reported cases of Pott’s puffy tumour, including clinical presentation, microbiology, treatment and outcome, is provided.
Puerperal Fever and Neonatal Pleural Empyema and Bacteremia Caused by Group A Streptococcus
Authors: Lequier Laurance , Vaudry Wendy L
Published: March 2016

A term neonate developed early onset of sepsis and pleural empyema with group A streptococcus. Her mother also became septic with group A streptococcus in the early postpartum period. The infant required initial chest tube drainage. After reaccumulation of pleural fluid after removal of the chest tube, a thoracotomy with decortication was performed. The isolates of group A streptococcus were analyzed and found to be identical serotypes of the same bacterium. The serotyping revealed both to be M type 1, T pattern 1. Polymerase chain reaction detected the genomic sequence for streptococcal pyrogenic exotoxin A and B in both isolates. With the increase in invasive streptococcal infections in the community, serious perinatal infections may become more frequent.
Effects of Different Imagery Strategies in the Psychological Treatment of Chronic Headache
Authors: Peters Gisela
Published: March 2016

This study investigates the effects of four different imagery techniques: pleasant imagery versus imaginative transformations, and response versus stimulus imagery. One may expect imaginative transformations to be more effective than pleasant imagery. Response imaginative transformations should be more effective than stimulus imaginative transformations, while the pleasant imagery conditions are not expected to have different effects. In a 2x2 design, treatment conditions were compared. Forty patients (33 females, seven males) with different types of chronic headache were referred by their physicians and took part in the study. Pain diaries and questionnaires of pain experience and pain behaviour were used as outcome measures. Imaginative transformations ‐ irrespective of response or stimulus orientation ‐ were found to be more effective than pleasant imagery in reducing headache frequency. Reductions remained stable over an eight‐month follow‐up. There are no significant differences between response and stimulus imagery. Treatment effects were manifested in a reduction of headache frequency, while headache duration and headache intensity did not change. Suffering and avoidance behaviours were reduced in all treatment groups, while the use of distraction strategies was increased. The reductions in suffering were significantly greater in the groups treated with imaginative transformations. In the eight‐month follow‐up, group differences in reductions in suffering were no longer significant, which is probably due to the reduced sample size. The results support the hypothesis that a cognitive redefinition is responsible for the beneficial treatment effects because only instructions to imagine a change in pain sensations and/or pain responses led to significant improvements.
First Case of (Imported) Babesiosis Diagnosed in Canada
Authors: Kunimoto Dennis , Krause Kevin , Morrison Doug
Published: March 2016

This paper describes the first case of babesiosis diagnosed in Canada. This case highlights the need for clinicians to be aware of diseases that may be endemic elsewhere and the importance of a travel history in a patient’s assessment.
Treatment of Recurrent Aphthous Ulcers in an HIV Patient – An Emerging Use for Pentoxifylline
Authors: Slayter Kathryn Lynn , Marrie Thomas J
Published: March 2016

Patients with human immunodeficiency virus (HIV) infection often suffer from persistent, painful ulcers that commonly occur on the soft palate, buccal mucosa, tonsillar area or tongue, which are referred to as aphthous ulcers. This paper reports the case in which pentoxifylline was successfully used to treat recurrent aphthous ulcers in an HIV patient.
Whiplash Injuries: An Update
Authors: Teasell Robert W , Shapiro Allan P
Published: March 2016

Whiplash injuries remain a significant public health problem throughout the developed industrialized world, with significant socioeconomic consequences. Studies looking at the natural history of whiplash injuries have suffered from problems of selection bias, retrospective reviewing and unclear outcomes. Etiology continues to be controversial, largely because of the misconception that all soft tissue injuries heal within six weeks. Recent studies have implicated the cervical facet joint as a cause of whiplash injury pain. A recent treatment study that successfully eliminated whiplash‐associated facet joint pain demonstrated abnormal psychological profiles secondary to pain which normalized with successful pain elimination. The impact of compensation on recovery remains controversial, while the concept that mild traumatic brain injury occurs in the absence of loss of consciousness has been largely refuted. The Quebec Task Force on Whiplash‐Associated Disorders recently published a report in which the scientific literature was exhaustively reviewed and has made recommendations regarding the prevention and treatment of whiplash and its associated disorders. The Quebec Task Force highlighted the paucity of good scientific evidence; however, they still provided consensus treatment guidelines, which have not been validated. There continues to be a need for further research.
Cognitive Functioning and Pain Reactions in Hospitalized Elders
Authors: Hadjistvropoulos Thomas , LaChapelle Diane , MacLeod Farley , Hale Carla , O’Rourke Norm , Craig Kenneth D
Published: March 2016

BACKGROUND: Objectively coded facial activity provides a useful index of pain among elders who have difficulty in reporting pain because of cognitive impairments. However, limitations of previous research include no direct assessment of participants′ level of cognitive impairment; no comparison of the reactions of elders with cognitive impairments with those of nonimpaired elders; observers′ expectations about pain levels could have influenced judgements about the severity of pain experienced when global rather than objectively coded measures were used because the painful medical procedure was visible on film.

OBJECTIVE: To extend previous findings by incorporating improvements in design and methodology in response to the aforementioned limitations.

PARTICIPANTS: Fifty‐nine in‐patients with a mean age of 73 years.

METHODS: Facial reactions were filmed during routine blood tests and coded objectively using the Facial Action Coding System (FACS). Observer ratings of pain were also obtained.

RESULTS: FACS indexes revealed substantial changes from baseline to venepuncture indiscriminate of whether elders were cognitively impaired. Furthermore, these changes were apparent to both nurse and student observers although the nurses rated the pain displayed by the patients as being lower.

CONCLUSION: After addressing limitations of previous work in this area, the validity of nonverbal indexes of pain in the assessment of elders with cognitive impairments was demonstrated. Such indexes are uniquely suited as outcome measures within the context of clinical trial methodology.
Mycotic Pulmonary Arterial Aneurysms in an Intravenous Drug User
Authors: McLean Laura , Sharma Sat , Maycher Bruce
Published: March 2016

A case of mycotic pulmonary artery aneurysm (PAA) in an intravenous drug user in whom resolution occurred with conservative therapy is described. The natural history of PAA is not well described in the literature. Although PAA is potentially fatal, resolution may occur in patients who do not have hemoptysis. Clinical presentation, diagnosis and management of PAA are reviewed.
Development of the Pain Appraisal Inventory: Psychometric Properties
Authors: Unruh Anita M , Ritchie Judith A
Published: March 2016

OBJECTIVE: To discuss the development, content validity, internal consistency and factor structure of a Pain Appraisal Inventory (PAI).

DESIGN: A PAI was constructed with a threat appraisal scale and a challenge appraisal scale. Content validity was demonstrated with a panel of health experts. A sample of 309 individuals participated in a random community survey about troublesome pain in the two weeks preceding the telephone interview.

RESULTS: Confirmatory factor analysis produced a two‐factor structure comprising threat appraisal and challenge appraisal. Cronbach′s alphas were 0.86 for the threat scale and 0.81 for the challenge scale. Threat appraisal was correlated with respondents′ scores on the McGill Pain Questionnaire, the Pain Disability Index, and measures of pain intensity and emotional upset due to pain. Challenge appraisal was reported by only 14% of the sample and limited the usefulness of statistical analyses for this variable.

CONCLUSIONS: Appraisal of pain may be key to the underlying overall adjustment of an individual to pain. The PAI distinguishes between threat and challenge appraisal of pain, and may have considerable utility for the measurement of appraisal in experimental, epidemiological and clinical pain research.
Clinical, Physiological and Radiological Features in Asthma with Incomplete Reversibility of Airflow Obstruction Compared with Those of COPD
Authors: Boulet Louis-Philippe , Turcotte Hélène , Hudon Catherine , Carrier Guy , Maltais François
Published: March 2016

OBJECTIVES: To compare clinical features, pulmonary function and high-resolution computed chest tomography (HRCT) findings of asthmatic patients with a component of incomplete reversibility of airflow obstruction (AIRAO) with those of patients with smoking-induced chronic obstructive pulmonary disease (COPD).

METHODS: Thirteen patients with COPD (six males and seven females, mean age 59 years, mean smoking 50.5 pack-years) and 14 patients with AIRAO (six males and eight females, mean age 52 years) despite optimal treatment, with no significant smoking history (mean 1.5 pack-years) and no significant environmental exposure or any other respiratory disease, were studied. Patients had respiratory questionnaires, pulmonary function tests, allergy skin-prick tests and an HRCT to evaluate possible parenchymal or bronchial abnormalities. Eight patients in each group also had exercise tests. All patients were stable at the time of the study.

RESULTS: As expected, atopy was more prevalent in AIRAO (n=13) than in COPD (n=1) patients. Mean forced expiratory volume in 1 s (FEV1) and forced vital capacity (percentage of predicted value) were 39% and 61%, respectively, in COPD patients and 49% and 71%, respectively, in AIRAO patients; FEV1improved by 18% in COPD patients and and by 22% in AIRAO patients after use of inhaled salbutamol. Mean functional residual capacity was greater in COPD patients than in AIRAO patients (178% versus 144% of the predicted value), while the mean carbon monoxide diffusing capacity of the lungs (DLCO) was lower in COPD patients than in AIRAO patients (62% versus 89% of the predicted value). Exercise tolerance was similar in both groups, as were postexercise changes in arterial oxygen pressure (PaO2). Emphysematous changes were observed in COPD patients and AIRAO patients who had evaluable HRCTs (10 versus two patients, although very mild in asthma), bronchial dilations (zero versus six patients), bronchial wall thickening (two versus eight patients) and an acinar pattern (one versus five patients). Mean thickness of the large airway wall to outer diameter (intermediary bronchus) ratio was 0.176 in COPD and 0.183 in AIRAO (P>0.05).

CONCLUSIONS: Asthma may lead to physiological features similar to COPD but may be distinguished by demonstrating a preserved DLCO and a higher ratio of airway to parenchymal abnormalities on HRCT scan.
Predictors of Longitudinal Changes in Pulmonary Function among Swine Confinement Workers
Authors: Kirychuk Shelley P , Senthilselvan Ambikaipakan , Dosman James A , Zhou Chen , Barber Ernie M , Rhodes Chuck S , Hurst Tom S
Published: March 2016

OBJECTIVE: To determine predictors of longitudinal changes in pulmonary function in swine confinement workers.

DESIGN: Longitudinal study conducted from November 1989 to June 1991 and January 1994 to May 1995.

SETTING: Swine confinement workers in Saskatchewan.

PARTICIPANTS: Forty‐two swine confinement workers who were studied in 1989/90 and studied again in 1994/95.

RESULTS: Of 98 male swine confinement workers (mean age ± SD 36.3±11.1 years) studied at baseline, 42 were studied again five years following. Complete information on baseline across‐shift pulmonary function (preshift forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC], and every 2 h FEV1 and FVC during the shift), and five‐year follow‐up pulmonary function (with FEV1 and FVC) were available on all 42 subjects. Mean across‐shift changes (preshift measurement to last measurement of the day) at baseline were ‐159.8±61.7 mL in FEV1 and ‐35.3±65.6 mL in FVC. Mean annual rate change between baseline and follow‐up for FEV1 was ‐53.9±61.7 mL/year and for FVC ‐48.9±71.6 mL/year. After adjusting for age, height, smoking and hours spent in the barn, the baseline across‐shift change in FEV1 and FVC was a significant predictor of annual rate change in FEV1 (P=0.01) and FVC (P=0.02), respectively. To determine the effects of indoor air quality on longitudinal lung function decline, indoor air environmental measurements were analysed. Complete information on respiratory health and indoor air quality was available on 34 of the 42 subjects. Assessment of indoor environment of swine barns included a summer and winter measurement for airborne dust, gases and endotoxin levels. After adjusting for age, height, smoking, ammonia and hours spent in the barn, the endotoxin level (Eu/mg)was a significant predictor of annual rate change for FEV1 but not FVC.

CONCLUSIONS: These results suggest that shift change is an important predictor of longitudinal changes in lung function in swine confinement workers and that endotoxin exposures may mediate annual decline in FEV1 in these workers.
Corticosteroids and Azathioprine Do Not Prevent Radiation‐Induced Lung Injury
Authors: Kwok Eva , Chan Charles K
Published: March 2016

The case of a man who presented with dyspnea and a dry cough six weeks after mediastinal radiotherapy for malignant thymoma is described. The patient was on prednisone (30 mg/day) and azathioprine (100 mg/day) throughout the course of radiation. The respiratory difficulties developed as the dose of prednisone was gradually decreased to 20 mg/day postradiation. Chest x‐ray showed bilateral pulmonary infiltrates. Computed tomography scan of the thorax confirmed bilateral ground glass opacities, with well‐defined lateral margin on the right side corresponding to the field of radiation. However, the airspace opacities extended beyond the radiation field into the periphery of the lungs together with mild airway dilation on the left side compatible with bronchiolitis obliterans organizing pneumonia (BOOP) or cryptogenic organizing pneumonia. Bronchoalveolar lavage performed on the nonirradiated area showed an intense lymphocytosis. No cause of BOOP other than radiation was found. Treatment with high dose corticosteroids (80 mg/day) resulted in rapid clinical and radiological improvement, and resolution of chest x‐ray abnormalities. Focal mediastinal radiation therapy may induce diffuse lung injury including BOOP. In addition, the concurrent use of moderate dose prednisone and azathioprine during the periradiotherapy period does not prevent the development of either BOOP or classic radiation pneumonitis.
Right‐Sided Endocarditis due to Staphylococcus lugdunensis: First Reported Case
Authors: Cooper CL , Choudhri SH , Hoeschen RJ
Published: March 2016

Staphylococcus lugdunensis is a coagulase‐negative organism first identified in 1988. It is often incorrectly identified as Staphylococcus aureus, and has been isolated as the etiological agent in over 20 cases of left‐sided endocarditis. This report describes the first documented case of right‐sided endocarditis caused by S lugdunensis. This experience suggests that S lugdunensis can infect native valves in the absence of any predisposing risk factors such as injection drug use.
Neuralgic Amyotrophy: A Rare Cause of Bilateral Diaphragmatic Paralysis
Authors: Shinder Neil , Polson Alasdair , Pringle Elizabeth , O′Donnell Denis E
Published: March 2016

Neuralgic amyotrophy, also known as brachial neuritis, is a well described clinical entity. Diaphragmatic dysfunction, as a result of phrenic nerve root involvement (cervical roots 3 to 5), is an uncommon, but increasingly recognized association. The case of a previously healthy 61‐year‐old woman who, after a prodrome of neck and shoulder discomfort, presented with severe orthopnea is described. Pulmonary function and electrophysiological studies led to a diagnosis of bilateral diaphragmatic paralysis. The patient′s clinical course and the exclusion of other nerve entrapment syndromes and neurological disorders strongly favoured the diagnosis of neuralgic amyotrophy.
Airway Inflammation and Structural Changes in Airway Hyper‐Responsiveness and Asthma: An Overview
Authors: Boulet Louis-Philippe , Chakir Jamila , Dubé Jean , Laprise Catherine , Boutet Michel , Laviolette Michel
Published: March 2016

Asthma treatment has moved from bronchodilator therapy to an emphasis on anti‐inflammatory therapy. Airway inflammation is believed to induce airway hyper‐responsiveness (AHR) through the release of mediators that increase the airway response to agonists. However, the exact contribution of airway inflammation in the physiology of airway hyper‐responsiveness remains undefined. Structural modifications in airways resulting from inflammation may contribute to the development and persistence of AHR and the development of asthma. This paper reviews some of the main components of airway inflammation and structural changes in asthma, and discusses how these processes may interact to modify airway function and induce respiratory symptoms.
Utility of Bronchoscopy with Bronchoalveolar Lavage in Diagnosing Pulmonary Infection in Hospitalized Patients with Underlying Malignancy
Authors: Chow CW , McGeer A , Kasupski G , Senathiragah N , Gallant P , Chan CK
Published: March 2016

Objectives: To evaluate the clinical utility of bronchoscopy with bronchoalveolar lavage (BAL) for diagnosing pulmonary infection in patients with underlying malignancy and to evaluate the impact of positive microbiology results on antimicrobial therapy.

Design: Retrospective chart review.

Setting: University‐affiliated downtown teaching hospital in Toronto.

Patient population: All patients who underwent bronchoscopy with BAL from November 1990 to September 1992.

Results: One hundred and thirty‐nine BALs were performed, of which 82 (59%) were positive for microorganisms. These 82 charts were reviewed. The main underlying diagnosis was hemotogenous malignancy (70 of 82). Primary indiction for bronchoscopy was the presence of pulmonary symptoms with or without radiographic abnormality. Common organisms identified were fungi (n=50), primarily Candida albicans and cytomegalovirus (CMV) (27), and 16 ‘usual’ pathogens. Less common were herpes simplex virus (six), Pneumoncystis carinii pneumonia (PCP) (four), Legionella pneumoniae and Mycoplasma pneumoniae (one each). Eighty‐seven per cent of patients were on broad spectrum antibiotics at the time of bronchoscopy. Although antiibiotic therapy was altered postbronchoscopy in 47 of the 82 cases, only 26 instances could be directly attributed to the results of BAL. Pathogens that commonly initiated specific therapy were CMV (16 of 27) and PCP (three of four). Diagnostic yield was highest in allogenic bone marrow transplant recipients (BMT). They comprised only 49% (40 of 82) of the cases but accounted for 85% (22 of 26) of those whose therapy was directly altered by the results of BAL. Of these 22 cases, 20 were attributed to the isolation of CMV.

Conclusions: The overall raw diagnostic yield from bronchoscopy with BAL was high at 59%. Of those with positive BAL cultures, a change in antimicrobial management occurred in 32% of cases. In a patient poulation with underlying hematogenous malignancy, particularly BMT recipients, bronchoscopy with BAL is useful for a specfic diagnosis of pulmonary infection.
Determinants of Risk Factors for Asthma
Authors: Busse William W
Published: March 2016

There are a number of risk factors for the development of asthma, including genetic and environmental components. Moreover, there is mounting evidence that a variety of genes are associated with the features of asthma, such as persistent wheezing, airway responsiveness and chronic bronchial inflammation. However, for expression of these features, other factors must also come into play. This paper focuses on the importance of environmental factors in the development of asthma, including allergens and respiratory infections. From current evidence, it appears that in subjects with the appropriate genetic make‐up, infections and allergens induce a proinflammatory cytokine response that causes airway inflammation and that in turn leads to the initiation and persistence of altered airway function.
Severe Hepatic Complications of Antituberculous Therapy
Authors: Turner Mark O , Elwood R Kevin
Published: March 2016

Hepatotoxicity from antituberculous therapy is well described, but fortunately severe complications are rare. The optimal methods of monitoring for significant hepatotoxicity while on treatment are uncertain. Some authorities recommend measuring liver enzymes only if symptoms develop, whereas others recommend regular liver enzyme monitoring throughout the course of therapy. In British Columbia, from 1990 to 1997, 2624 active and approximately 8000 chemoprophylaxis cases have been treated, but only two severe complications directly related to antituberculous therapy have occurred. A 33‐year‐old male developed fulminant hepatic failure seven months after starting isoniazid chemoprophylaxis and required a liver transplant. The other patient died from hepatic failure that developed in the first month of triple‐drug therapy for proven active pulmonary tuberculosis. The early and late onset of hepatic failure associated with antituberculous therapy in these cases underline the difficulties in identifying a monitoring protocol that will totally negate the risk of severe complications.
Constrictive Bronchiolitis and Ulcerative Colitis
Authors: Ward Heather , Fisher Kendra L , Waghray Ranjit , Wright Jody L , Card Sharon E , Cockcroft Donald W
Published: March 2016

Pulmonary complications occur in an estimated 0.21% of patients with inflammatory bowel disease. The most common presentation of pulmonary manifestations is large airway disease, such as tracheobronchitis, chronic bronchitis or bronchiectasis. Small airway disease, such as constrictive bronchiolitis or bronchiolitis obliterans with organizing pneumonia, is less frequently reported, and is described as occurring in isolation from large airway disease. A case of a postcolectomy ulcerative colitis in a patient who has both large airway involvement, tracheobronchitis and bronchiectasis, and constrictive bronchiolitis is presented.
Cost Effectiveness of Transbronchial Needle Aspiration
Authors: Crocket Jennifer A , Wong Eric YL , Lien Dale C , Nguyen Khanh Gia , Chaput Michelle R , McNamee Ciaran
Published: March 2016

OBJECTIVE: To evaluate the yield and cost effectiveness of transbronchial needle aspiration (TBNA) in the assessment of mediastinal and/or hilar lymphadenopathy.

DESIGN: Retrospective study.

SETTING: A university hospital.

POPULATION STUDIED: Ninety‐six patients referred for bronchoscopy with computed tomographic evidence of significant mediastinal or hilar adenopathy.

RESULTS: Ninety‐nine patient records were reviewed. Three patients had two separate bronchoscopy procedures. TBNA was positive in 42 patients (44%) and negative in 54 patients. Of the 42 patients with a positive aspirate, 40 had malignant cytology and two had cells consistent with benign disease. The positive TBNA result altered management in 22 of 40 patients with malignant disease and one of two patients with benign disease, thereby avoiding further diagnostic procedures. The cost of these subsequent procedures was estimated at $27,335. No complications related to TBNA were documented.

CONCLUSIONS: TBNA is a high‐yield, safe and cost effective procedure for the diagnosis and staging of bronchogenic cancer.
Nicotine Microaerosol Inhaler
Authors: Andrus Paul G , Rhem Rod , Rosenfeld Jack , Dolovich Myrna B
Published: March 2016

OBJECTIVE: To measure the droplet size distribution of a nicotine pressurized metered‐dose inhaler using a nicotine in ethanol solution formulation with hydrofluoroalkane as propellant.

MATERIALS AND METHODS: Sizing was performed at room temperature by multistage liquid impinger and quartz crystal impactor.

RESULTS: The mass median aerodynamic diameter of the nicotine aerosol produced was measured at 1.6 μm by multistage liquid impinger and 1.5 μm by quartz crystal impactor.

CONCLUSIONS: The inhaler formulation used produces a microaerosol of sufficiently fine droplet size that mimics the puff‐by‐puff pulmonary arterial bolus nicotine delivery of tobacco smoke. The absence of combustion products such as heat, carcinogens and carbon monoxide permits safer nicotine delivery via the inhaler than is possible via smoked tobacco.