bluuebunny/crossref_metadata_2025 huggingface dataset:
Lung Function in Preteenaged Canadian School Children: Comparison with Two Standard Prediction Equations and Examination of the Effect of Weight
Authors: Leech Judith A , Bartlett Sheryl , Walker Michael , Raizenne Mark
Published: March 2016

OBJECTIVES: To compare prediction curves for forced vital capacity (FVC) in children from a large population sample with the standard prediction curves currently in clinical use. A secondary objective was to assess the contribution of weight to the prediction of lung function in preteenagers.

DESIGN: The data used for this analysis were from a prospective cohort study of health effects of air pollution on children in 10 Canadian communities, five in Saskatchewan and five in Ontario.

PARTICIPANTS: A 96% response rate among a target population of 4935 boys and girls aged seven to 11 years was attained. After exclusion of non‐Caucasians and asthmatics there remained 3142 children.

ANALYSIS: FVC prediction curves for each sex were compared with the two standard prediction curves most frequently used in children′s hospitals in Canada with respect to mean values and the lower limits of normal. A random subsample of 500 subjects was selected and their values were interpreted as normal or abnormal by the three prediction equations. Rates of abnormalcy between prediction methods were compared by the uncertainty coefficient statistic. Regression equations within each sex were examined for the effect of weight in addition to height.

MAIN RESULTS: Prediction curves from this large population sample were not statistically different from two widely used prediction curves in the mean or lower limits of normal in boys or girls. In 1575 boys a small but significant effect of weight was demonstrated (r=0.024, P=0.001) after age, height and square of height were added to the model (overall r2=0.725). Similarly, a significant effect of weight was seen in girls (r=0.022, P=0.001, overall r2=0.756).

CONCLUSIONS: A large sample of nonsmoking Canadian children offers no further advantage in mean or lower limits of normal over standard predictions based on smaller convenience samples in generating prediction curves for normal FVC. In the youngest children who can perform pulmonary function tests, weight should be taken into account in epidemiological studies of pulmonary function. Although the effect may be small it is of the order of magnitude anticipated due to a number of different pneumotoxins (ie, air pollutants).
Benign Teratoma in the Left Pleural Space with Amylase in the Pleural Fluid
Authors: Guenter C Dale , Grant Gregory A , Walker Robert H , Ford Gordon T
Published: March 2016

The case of a 28‐year‐old man who experienced repeated episodes of pleuritic chest pain is reported. Eventual discovery of amylase in the pleural fluid and a supradiaphragmatic mass on computed tomography led to exploratory thoracotomy. A benign cystic teratoma was discovered in the pleural space overlying the left hemidiaphragm and connected by a peduncle to the thymus.
Sex Differences in Predictors of Response to Multidisciplinary Treatment of Chronic Pain
Authors: Burns John W , Johnson Barbara J , Mahoney Neil , Derleth Martha , Pawl Ronald
Published: March 2016

BACKGROUND: Multidisciplinary programs for treatment of chronic pain are generally effective, yet many patients fail to show significant improvement. The search for predictors of outcome has not explicitly considered sex.

OBJECTIVE: To examine mediation and moderation pathways through which sex may predict outcome.

DESIGN: Correlational outcome, exploratory, archival study.

PARTICIPANTS: A total of 156 chronic pain patients.

SETTING: Four‐week multidisciplinary pain program.

PREDICTOR AND OUTCOME MEASURES: Predictor variables of pain level, activity interference and perceived pain helplessness were culled from patient charts. Outcome was assessed with staff ratings of patient progress.

RESULTS: While men responded to treatment more poorly than women, regressions suggested that the greater number of surgeries for men mediated this link. Further analyses revealed that sex acted as a moderator. Among women, perceived pain helplessness was negatively related to outcome, while married women with dissatisfying marriages responded more poorly than unmarried women and women with satisfying marriages. These variables were not significant predictors of outcome among men.

CONCLUSIONS: Men and women may be differentially characterized by various risk factors for treatment failure. Moreover, relationships between pretreatment psychosocial factors and outcome may depend on sex.
Cervicogenic Headache
Authors: Edmeads John
Published: March 2016

That disease or dysfunction of the neck may present as headache is an idea that is not widely accepted in North American traditional medicine. This review focuses on ′cervicogenic headaches′. Topics include the mechanisms of cervicogenic headache, cervical signs to suspect that a patient′s headache originates in the neck, diagnostic manoeuvres that are nonspecific and unreliable, laboratory tests that may assist in establishing a diagnosis of cervicogenic headache and treatment of this condition.
Neuralgia: The History of a Meaning
Authors: Alam Chris N , Merskey H
Published: March 2016

A review is presented of the meaning of neuralgia ‐ from its introduction in 1801, to indicate an affection of one or more nerves causing pain, to its present day use. There was early dispute whether neuralgia required a lesion to be present in the nerve, and whether peripheral branches, nerve roots or the neuraxis was involved. Affections of organs were seen as a cause and the concept was extended to include links with psychological illness. In the last decades of the 19th century and throughout the 20th century, opinion on neuralgia gradually moved closer to the original meaning.
Seasonal Patterns in Asthma Hospitalization in Saaskatchewan, 1979 to 1989
Authors: Meleth Sreelatha , Senthilselvan A
Published: March 2016

OBJECTIVES: To determine whether monthly asthma hospitalization rates in Saskatchewan exhibited a seasonal pattern. Rates were studied from January 1979 to December 1989.

PATIENTS: The age groups studied were aged birth to four years, aged five to 14 years, 15 to 34 years, 35 to 49 years and 50 to 65 years. Sex differences in seasonal patterns in asthma hospitalization rates were also investigated.

METHODS: The hospitalization data for asthma were obtained for the province of Saskatchewan from 1979 to 1989, inclusive. The time series was decomposed into its trend, seasonal and error component, using an additive model. Significance of the components was tested using a two‐way ANOVA.

RESULTS: Seasonal variations were observed in the monthly asthma hospitalization rates among Saskatchewan residents. Increases in asthma hospitalization rates were observed in the spring and fall months among children, in summer months among young adults aged 15 to 34 years and in winter months among the older age groups. Seasonal patterns in asthma hospitalization rates were similar for males and females in children and in adults aged 50 to 64 years. In young adults aged 15 to 34 years, increased asthma hospitalization rates were observed in spring months among men and in both spring and fall months among women. The 35‐ to 49‐year‐old men did not exhibit a statistically significant seasonal pattern, whereas the women did. No sex differences in seasonal patterns of asthma hospitalization rates were statistically significant.

CONCLUSIONS: Seasonal patterns were observed in asthma hospitalization rates for residents of Saskatchewan. Asthma hospitalizations were greater in spring and fall seasons for children and in winter for the older adults. More studies are required to examine possible reasons for these seasonal differences in asthma hospitalizations.
Apoptosis: Molecular Mechanisms, Regulation and Role in Pathogenesis
Authors: Hung Ryan Wei Yan , Chow Anthony W
Published: March 2016

OBJECTIVE: To review the current state of knowledge of apoptosis, with an emphasis on identifying potential and established roles for apoptosis in the pathogenesis of infectious diseases.

DATA SOURCES: MEDLINE and the University of British Columbia library system were searched using the search subject, “apoptosis”, for the years 1992 to 1996. Further search terms (eg, “pathogenesis”) were used to narrow the results. These review articles and reference books were used as the basis for locating original articles on particular studies.

DATA SELECTION: Approximately 40 studies were reviewed, with the criterion for selection being the relevance to either the molecular mechanisms behind apoptosis or roles for apoptosis in the pathogenesis of infectious diseases.

DATA EXTRACTION: Relevant information from each study was collated into categories specific to morphological and biochemical characterization, and the regulation and molecular mechanisms of apoptosis and its role in the pathogenesis of infectious diseases.

DATA SYNTHESIS AND CONCLUSIONS: Apoptosis is characterized by distinct morphological and biochemical changes that distinguish it from cell necrosis. Different signal transduction events and transcription factors can promote or inhibit apoptosis, although where and how these tie into the cell death pathway is still poorly understood. Apoptosis has been implicated in the pathogenesis of infectious diseases in two distinct ways: first, multicellular organisms use apoptosis to combat viral infections; and second, pathogens can alter the normal process of apoptosis in host cells by abnormal upregulation or downregulation. Many diseases have been shown to implicate apoptosis in their pathogenesis, raising the possibility of novel treatments for some disorders by therapeutically altering the occurrence and course of apoptosis. Therefore, further study of apoptosis in both health and disease needs to be rigorously pursued.
Lactate Kinetics during Exercise in Chronic Obstructive Pulmonary Disease
Authors: Maltais François , Bernard Sarah , Jobin Jean , Belleau Roger , LeBlanc Pierre
Published: March 2016

OBJECTIVES: To examine whether the lactate kinetics during exercise are abnormal in patients with chronic obstructive pulmonary disease (COPD) and to evaluate the relationship of lactate kinetics with functional status.

POPULATION: Fifty‐four patients with COPD (forced expiratory volume in 1 s [FEV1] [mean ± SD] 36±12% predicted, range 19 to 70) and 10 healthy, age‐matched normal men were included in this study.

INTERVENTION: Each subject performed a stepwise exercise test up to maximal capacity during which five‐breath averages of oxygen uptake (VO2) were obtained. Arterial plasma lactate (La) concentration was also measured at each one‐minute exercise step. The La/VO2 relationship during exercise was fitted by an exponential function where b represents the steepness of the relationship. Patients′ functional status was classified according to the peak VO2 : more than 16 mL/min/kg and 20 mL/min/kg or less indicated mild to moderate impairment (class B, n=15); more than 10 mL/min/kg and 16 or less mL/min/kg, moderate to severe impairment (class C, n=31); and more than 6 mL/min/kg and 10 mL/min/kg or less, severe impairment (class D, n=8). An average La/VO2 relationship was constructed for each functional class with the La and VO2 data obtained from each individual at each exercise step.

RESULTS: Parameter b was obtained in all normal subjects and in 46 of 54 patients with COPD. It averaged 2.66±0.47 and 4.49±1.72 in normal subjects and COPD patients, respectively (P<0.005). In 30 of 46 patients, parameter b was greater than the upper value obtained in the normal group. The rise in arterial lactate concentration during exercise became progressively greater with the worsening of functional status.

CONCLUSIONS: Lactate kinetics are frequently abnormal in patients with moderate to severe COPD compared with age‐matched normal subjects. Reduction in functional status from class B to D was associated with a progressively greater increase in arterial blood lactate during exercise.
Antituberculous Drug Resistance in Western Canada (1993 to 1994)
Authors: Long Richard , Fanning Anne , Cowie Robert , Hoeppner Vernon , Fitzgerald Mark , The Western Canada Tuberculosis Group
Published: March 2016

OBJECTIVES: To estimate the magnitude of antituberculous drug resistance and identify prospectively the risk factors for its development in tuberculosis (TB) patients in western Canada over a one‐year period.

DESIGN: Comparison of drug‐resistant and nondrug‐resistant cases of TB.

SETTING: Western Canada.

PATIENTS: All people with TB reported to the TB registries of Manitoba, British Columbia, Alberta and Saskatchewan between February 1, 1993 and January 31, 1994.

MAIN OUTCOME MEASURES: Drug susceptibility testing was performed in all cases of culture‐positive tuberculosis. Patients at risk for human immunodeficiency virus (HIV) infection were serotested.

RESULTS: Of 534 culture positive cases of TB, 37 (6.9%) were drug resistant. Odds ratios suggested that the risk of drug resistance was significantly higher among those with reactivation than among those with new disease, and among those born outside of Canada than among those born in Canada. Ninety per cent of the foreign‐born patients with drug‐resistant disease were from Asia. Of the 35 patients with drug resistance whose type of resistance was known, 76% had initial and 24% had acquired drug resistance. The initial resistance rate in Asian‐born patients was 14%. Most of the 37 drug‐resistant cases were resistant to isoniazid (68%), streptomycin (49%) or both (22%). Twelve (32%) of the 37 cases were resistant to two or more first‐line drugs. Of 14 patients who were HIV seropositive only one, a foreign‐born patient, was drug resistant.

CONCLUSION: Antituberculous drug resistance is low among Canadian‐born patients in western Canada, but not uncommon among those born outside Canada. Initial therapy of foreign‐born patients should include four first‐line drugs.
Genetic Characterization of the Hemagglutinin Gene of Influenza B Virus which Predominated in the 1985/86 Canadian Influenza Season
Authors: Zou Shimian , Prud’homme Isabelle , Weber John M
Published: March 2016

OBJECTIVE: To characterize the hemagglutinin (HA) gene of B/Canada/3/85, a prototype strain of influenza B virus variants that emerged in the 1984/85 influenza season and predominated in the 1985/86 season in Canada.

DESIGN: Sequencing and comparison of the HA genes of B/Canada/3/85 and the vaccine strains for the 1985/86 season, B/USSR/100/83, and for the 1986/87 season, B/Ann Arbor/1/86.

RESULTS: B/Canada/3/85 was similar to B/Ann Arbor/1/86 and significantly different from B/USSR/100/83. Phylogenetic analysis of the HA1‐coding sequences indicated that B/Canada/3/85 and several other 1985 strains isolated in distant parts of the world were very closely related and were early variants representing the emergence of a new lineage, the B/Victoria/2/87 lineage. B/Canada/3/85 differed from B/USSR/100/83 in nucleotide sequence by 3.44% and in amino acid sequence by 3.33%. There was also an insertion of two amino acids in the HA1 region of B/Canada/3/85.

CONCLUSIONS: B/Canada/3/85 was one of the herald strains for the 1985/1986 influenza B epidemic. The amino acid mutations and the two‐codon insertion together may account for the observed antigenic changes in the HA of the influenza B variants.
Chronic Use of Opioids for Nonmalignant pain: A Prospective Study
Authors: Fuchs Perry N , Gamsa Ann
Published: March 2016

OBJECTIVE: To assess the effects of long term opioid therapy on pain, mood, and social and leisure activities in patients with chronic nonmalignant pain.

METHODS: Fourteen patients (eight males and six females) were treated with opioid medications for chronic nonmalignant pain not improved by previous treatments. Baseline measures of pain intensity were obtained before introducing opioids. Patients were monitored throughout the study, with outcome measured four to 32 months after opioids were started. The final measures examined drug dose, side effects, pain level, pain relief, emotional status, and involvement in social and leisure activities.

RESULTS: A total of 64.3% of patients reported good to excellent pain relief with opioid medication, and 64.3% reported reduced pain intensity, the decrease ranging from 25% to 100% (from baseline measures) on a scale rated from 0 to 10. As well, 64.3% scored their emotional state as 5 or better on the 0 to 10 scale (0 indicating greatest distress), and 64.3% reported at least moderate (at least 5 on the 0 to 10 scale) involvement in leisure and social activities. There was a significant negative correlation between pain intensity and amount of leisure and social activity; 88.9% of patients who reported moderate to full involvement in leisure and social activities also noted decreased pain on the 0 to 10 scale. Other than one patient who developed tolerance, there were no notable problems with dose escalation or with any other form of substance abuse.

CONCLUSIONS: Some patients with chronic nonmalignant pain benefit from long term opioid therapy without developing unmanageable side effects, tolerance or substance abuse problems. These results, together with previous findings, show that opioids can be a safe and useful long term treatment for chronic nonmalignant pain.
Emotional Components of Pain
Authors: Hale Carla J , Hadjistavropoulos Thomas
Published: March 2016

BACKGROUND: Current definitions of pain suggest that emotion is an essential component of pain, however, the presumed relationship between emotion and pain, and the specific emotions that are involved in pain experiences have yet to be clarified.

OBJECTIVE: To address these issues in order to assist in making current conceptualizations of pain more explicit.

DESIGN: Thirty adult patients undergoing routine blood tests were videotaped. Spontaneous facial reactions were examined for distinct expressions of emotion and pain occurring at baseline, swabbing and venepuncture intervals. Expressions were assessed objectively with the Facial Action Coding System (FACS) and rated subjectively by 48 untrained judges. Patients also provided baseline and postneedle self‐reports of experienced pain.

RESULTS: Comparison of venepuncture, swabbing and baseline segments revealed that objective measures of pain‐related facial activity, subjective ratings of pain expression and self‐reported ratings of pain increased significantly from baseline to venepuncture and that measures of disgust, anger, fear and happiness also varied significantly across segments. Regression analyses indicated that measures of pain could be predicted from measures of specific emotions.

CONCLUSIONS: Emotion is an essential component of the acute phasic pain experienced during venepuncture. Although the occurrence of specific emotions varied as a function of pain, objective behavioural indexes and subjective behavioural ratings of pain were predicted by different emotional components than patients′ self‐reports.
Rhomboencephalitis Caused by Listeria Monocytogenes
Authors: Workman Stephen , Theal Michael
Published: March 2016

Listerial rhomboencephalitis is a rare, devastating treatable disease. A previously well 72‐year‐old man presented with a one‐week history of fever and headache. Four days before admission he developed right facial numbness and ataxia. Diagnosis and treatment are described, including the relevant clinical, laboratory and radiological findings.
Disseminated Nocardia Otitidiscaviarum in a Patient with AIDS
Authors: Sandre Roger M , Summerbell Richard C
Published: March 2016

A case of disseminated infection due to Nocardia otitidiscaviarum is described in a Caucasian man infected with the human immunodeficiency virus. The patient presented with no previous AIDS‐defining conditions, a CD4 lymphocyte count of 206 cells/mm3 and enlarging intra‐abdominal and chest wall abscesses with bilateral pulmonary infiltrates. Aggressive surgical debridement and antimicrobial therapy with trimethoprim/sulfamethoxazole and amikacin resulted in clinical cure. Long term suppressive therapy was needed to prevent relapse.
150 Years of Blowing: Since John Hutchinson
Authors: Milic-Emili Joseph , Marazzini Luigi , D’Angelo Edgardo
Published: March 2016

Three recent advances in assessment of routine lung function are reviewed. In both normal subjects and patients with obstructive lung disease, the flows during the forced vital capacity (FVC) manoeuvre depend significantly on the pattern of the preceding inspiratory manoeuvre. Accordingly, the latter should be standardized in clinical and epidemiological studies. Although the nature of this phenomenon is not fully understood, stress relaxation of lung tissues probably plays the primary role. The negative expiratory pressure technique provides a simple and reliable tool for detecting expiratory flow limitation both at rest and during exercise. The method does not require body plethysmography or the patient’s cooperation and coordination, and can be applied in any desired body posture. A simple method for monitoring FVC performance has been developed. It allows detection of flow limitation during the FVC manoeuvre.
Detection of Antibody to Envelope (E2) Antigen of Hepatitis C Virus
Authors: Chaudhary RK , Burres E
Published: March 2016

One hundred and four clinical specimens from provincial public health laboratories were tested for antibody to hepatitis C virus (HCV) envelope protein (anti‐E2). To evaluate the effect of hypervariability of E2 region on anti‐E2 assay, 49 recombinant immunoblot assay (RIBA) 3.0 positive samples were genotyped. All 49 genotyped samples were positive for anti‐E2. Eight of 12 (67%) indeterminate, HCV RNA positive samples were anti‐E2 reactive. Nine of 30 (30%) indeterminate, HCV RNA negative samples were also positive for anti‐E2. Anti‐E2 was detected in two of 13 (15%) RIBA‐negative and enzyme immunoassays‐positive samples. Although small number of samples were tested, the results showed that it may be possible to resolve indeterminate samples with the anti‐E2 assay.
Preliminary Report on the Effect of Ketamine in Patients with Central Pain
Authors: Rostaing-Rigatti Sylvie , Cesaro Pierre , N’Guyen Jean-Paul , Ejzenbaum Jean-François , Pollin Bernard , Bonnet Francis
Published: March 2016

This preliminary open prospective study reports on the effect of ketamine, an N‐methyl‐D‐aspartate (NMDA)‐receptor noncompetitive antagonist, in five patients suffering from central poststroke pain (CPSP). Patients were evaluated at rest on a visual analogue scale (VAS) graded from 0 to 10. Pain measurement was repeated at 15 and 30 mins following intravenous administration of 0.15 to 0.25 mg/kg ketamine and then every 30 mins for 6 h. Pain evoked by light touch or cold stimulation was also measured in three patients at those times. Patients were monitored for arterial pressure, heart rate, sedation and side effects during the study. Ketamine provided a significant improvement in pain at rest and in evoked pain. A 51% to 84% decrease in the VAS score for pain at rest was observed within 60 to 180 mins. Satisfactory pain relief (more than 50% decrease in the VAS score) lasted for 150 to 210 mins. Two patients had a prolonged improvement over two or three days. Arterial pressure and heart rate did not change significantly. Mild or moderate sedation was noticed in all patients for 20 to 30 mins. These results suggest that blockade of NMDA receptors may provide pain relief in patients suffering from CPSP.
Efficacy of 12 Hourly Controlled‐Release Condeine Compared with as Required Dosing of Acetaminophen Plus Codeine in Patients with Chronic Low Back Pain
Authors: Hale Martin E , Speight Kevin L , Harsanyi Zoltan , Iwan Tad , Slagle N Susan , Lacouture Peter G , Darke Andrew C
Published: March 2016

OBJECTIVE: To compare pain relief and stability of pain control in patients with chronic low back pain treated with scheduled 12 hourly doses of controlled‐release codeine or as required doses of a fixed combination of acetaminophen and codeine.

PATIENTS AND METHODS: Patients were assigned to five days of treatment with controlled‐release codeine (Codeine Contin; Purdue Frederick) 100 mg q12h or placebo q12h in a randomized, double‐blind, parallel group study. Acetaminophen 325 mg q4h prn was available as rescue to the codeine group and acetaminophen 325 mg plus codeine 30 mg q4h prn was available to the placebo group. Pain intensity was assessed pretreatment and four times daily using a four‐point categorical scale. Acceptability of therapy was assessed twice daily on a five‐point scale.

RESULTS: Of 104 patients enrolled, 82 were able to be evaluated for safety and efficacy. Sum of pain intensity differences scores were significantly lower on controlled‐release codeine than on as required acetaminophen plus codeine at all assessments. The number of changes in pain intensity throughout the day was higher with acetaminophen plus codeine than with codeine alone (8.6±0.7 versus 6.1±0.6, respectively, P=0.011). Mean total daily codeine dose was 200 mg in the codeine group and 71.1±6.6 mg in the acetaminophen plus codeine group (P=0.0001). Mean total daily prn acetaminophen consumption was 542.2±86.5 mg in the codeine group and 770.8±71.5 mg in the fixed combination group (P=0.0452).

CONCLUSION: Twelve hourly dosing of controlled‐release codeine provides greater and more stable pain relief in patients with chronic low back pain than as required dosing of an acetaminophen plus codeine combination.
Invasion of Eukaryotic Cells by Legionella Pneumophila: A Common Strategy for all Hosts?
Authors: Hoffman Paul S
Published: March 2016

Legionella pneumophila is an environmental micro‐organism capable of producing an acute lobar pneumonia, commonly referred to as Legionnaires’ disease, in susceptible humans. Legionellae are ubiquitous in aquatic environments, where they survive in biofilms or intracellularly in various protozoans. Susceptible humans become infected by breathing aerosols laden with the bacteria. The target cell for human infection is the alveolar macrophage, in which the bacteria abrogate phagolysosomal fusion. The remarkable ability of L pneumophila to infect a wide range of eukaryotic cells suggests a common strategy that exploits very fundamental cellular processes. The bacteria enter host cells via coiling phagocytosis and quickly subvert organelle trafficking events, leading to formation of a replicative phagosome in which the bacteria multiply. Vegetative growth continues for 8 to 10 h, after which the bacteria develop into a short, highly motile form called the ‘mature form’. The mature form exhibits a thickening of the cell wall, stains red with the Gimenez stain, and is between 10 and 100 times more infectious than agar‐grown bacteria. Following host cell lysis, the released bacteria infect other host cells, in which the mature form differentiates into a Gimenez‐negative vegetative form, and the cycle begins anew. Virulence of L pneumophila is considered to be multifactorial, and there is growing evidence for both stage specific and sequential gene expression. Thus, L pneumophila may be a good model system for dissecting events associated with the host‐parasite interactions.
Study of the Comparative Activity of Piperacillin/Tazobactam with Currently Available Antibiotics against 8206 Aerobic Isolates
Authors: Forward Kevin R , Low Donald E , Laverdiere Michel , Rennie Robert , Simor Andrew E , Franks Patricia A , Members of the Canadian Piperacillin/Tazobactam Study Group
Published: March 2016

OBJECTIVES: To compare the activity of piperacillin‐tazobactam with piperacillin and other parenterally administered antibiotics against aerobic Gram‐negative bacilli and Gram‐positive cocci isolated from across Canada, and to determine the prevalence of resistance mediated by extended‐spectrum cephalosporinases.

METHODS: Sixty‐one laboratories participated. Disk diffusion testing was performed in accordance with methods outlined by the National Committee for Clinical Laboratory Standards. Susceptibilities were performed on 8206 strains. Escherichia coli and Klebsiella pneumoniae with reduced susceptibilities to third‐generation cephalosporins were screened for extended‐spectrum beta‐lactamases (ESBLs).

RESULTS: Piperacillin‐tazobactam was active against 92% of the strains, piperacillin against 81% and ticarcillin‐clavulanic acid against 88%. Few differences were observed in the relative susceptibility of strains from teaching or community hospitals, from different anatomic sites or from different regions of the country. Aerobic Gram‐negative bacilli tested tended to be more susceptible to all the agents than was recently reported in a similar American study. Only 43% of Enterococcus faecium were susceptible to ampicillin and 42% to piperacillin piperacillin with and without tazobactam. Only two enterococcal strains were resistant to vancomycin, and 19 had intermediate zone sizes. Of the 10 strains of E coli and eight strains of K pneumoniae with reduced susceptibility to extended spectrum cephalosporins, only one demonstrated typical ESBL activity.

CONCLUSIONS: Canadian aerobic Gram‐positive cocci and Gram‐negative bacilli remain highly susceptible to many currently available antibiotics. The findings confirm a broad spectrum of activity of piperacillin‐tazobactam and indicate that the pattern of susceptibility is quite uniform from different body sites, in both teaching and community hospitals, and across the country.
Polyarteritis Nodosa and Bronchiolitis Obliterans with Organizing Pneumonia, an Unusual Association
Authors: Dasgupta Kaberi , Watters A Kevin , Zidulka Arnold
Published: March 2016

Bronchiolitis obliterans and organizing pneumonia (BOOP) is an inflammatory, fibrotic disorder of the small airways, alveoli and pulmonary intersitium. Often idiopathic and usually benign, this condition may cause dyspnea and influenza‐like symptoms. Polyarteritis nodosa (PAN) is a small and medium vessel vasculitis, which usually involves the kidney and other viscera but rarely results in vasculitis of the lungs. This is the second case of BOOP associated with PAN reported in the literature. Knowledge of this association is likely to be of value because an undiagnosed vasculitis can rapidly become fatal.
Birthweight and Preterm Birth in Relation to Indicators of Childhood Asthma
Authors: Demissie Kitaw , Ernst Pierre , Joseph Lawrence , Becklake Margaret R
Published: March 2016

BACKGROUND: Early life events may have long term consequences on respiratory health including the risk of developing asthma.

OBJECTIVE: To examine the independent roles of birthweight and preterm birth on childhood asthma after accounting for socioeconomic status.

METHODS: A total of 989 elementary school children performed spirometry before and after a free‐running exercise challenge. A subsample of 327 children underwent methacholine bronchoprovocation and allergy skin prick tests to common inhaled aeroallergens. Information on birthweight and preterm birth was obtained by parental interview. Socioeconomic status was established using parental occupation.

RESULTS: After adjusting for the effects of important confounding variables, birthweight was positively associated with forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1); FVC increased 4.5% per kg (95% CI 1.7 to 7.4) and FEV1 4.4% per kg (95% CI 1.8 to 7.2). Birthweight was not related to exercise‐induced bronchospasm or an asthma diagnosis, but airway responsiveness to methacholine increased as birthweight decreased (P=0.01). Preterm birth independent of birthweight was associated with a lower FEV1/FVC (‐1.7%; 95% CI ‐2.8 to ‐0.5).

CONCLUSIONS: Birthweight appears to be related to lung size and methacholine responsiveness while preterm birth appears to diminish airway size.
Prospective, Randomized Comparison of Intravenous and Oral Ciprofloxacin with Intravenous Ceftazidime in the Treatment of Nosocomial Pneumonia
Authors: Saginur Raphael , Garber Gary , Darling Gail , Shafran Stephen , Cameron William , Jones Gwynne , Auclair Francois , the Canadian Infectious Disease Society Multicenter Nosocomi
Published: March 2016

OBJECTIVE: To compare the efficacy of intravenous and oral ciprofloxacin and intravenous ceftazidime in the treatment of nosocomial pneumonia.

DESIGN: Randomized, nonblinded, multicentre comparative trial.

SETTING: Seven Canadian university hospitals.

POPULATION: Adult patients with moderate to severe pneumonia developing 72 h or longer after hospitalization.

METHODS: After informed consent was obtained, patients were randomized to receive intravenous ciprofloxacin 300 mg every 12 h or ceftazidime 2 g every 8 h. After three days, patients in the ciprofloxacin arm could be switched to oral ciprofloxacin, 750 mg every 12 h. Concomitant clindamycin was allowed for three days in patients with syndromes consistent with Gram‐positive or anaerobic infection. Erythromycin could be used if cultures revealed no pathogen.

RESULTS: A total of 149 patients were enrolled, of whom 124 were eligible for efficacy analysis. Of 119 pathogens identified in 87 patients, 84 were Gram‐negative, and 35 Gram‐positive. The mean duration of ciprofloxacin therapy was 12.1 days, of which 9.2 days were given intravenously. Ceftazidime was given for a mean of 9.8 days. There was eradication or reduction of pathogens in 75.7% of ciprofloxacin patients and 70.6% of the ceftazidime group. Clinical resolution or improvement occurred in 87.1% of ciprofloxacin recipients and 87.3% of the ceftazidime group. Eight ciprofloxacin and six ceftazidime patients died. Overall outcomes were considered to be successful in 85.2% of ciprofloxacin patients and 87.1% of ceftazidime recipients. Adverse events were mild.

CONCLUSIONS: There were similar efficacy and safety of intravenous and oral ciprofloxacin and intravenous ceftazidime in the treatment of patients with hospital‐acquired pneumonia. Physicians were reluctant to use oral therapy in patients.
Out‐Patient Cognitive‐Behavioural Treatment of Fibromyalgia: Impact on Pain Response and Health Status
Authors: Nielson Warren R , Harth Manfred , Bell David A
Published: March 2016

OBJECTIVE: To evaluate a cognitive‐behavioural out‐patient program for patients with fibromyalgia syndrome.

PATIENTS AND METHODS: A quasi‐experimental design was used to evaluate 101 patients who participated in a four‐week program that included psychological, family educational, occupational therapy and physiotherapy interventions. After discharge, patients were seen four times over one year for day‐long review sessions. Five pain response scales from the Multidimensional Pain Inventory (MPI) and the Fibromyalgia Impact Questionnaire (FIQ) were used to assess treatment effects. Data were analyzed using multivariate ANOVAs followed by multiple comparisons using Tukey′s honestly significant difference test.

RESULTS: The overall multivariate effect for the MPI was significant (P<0.0001). Subsequent multiple comparisons indicated consistent improvement in pain severity, life interference, life control, emotional distress and activity level scores at discharge, but no change during a no‐treatment waiting list control interval. These effects were maintained at a 12‐month follow‐up with the exception of activity level. The multivariate effect across the FIQ scales was significant (P<0.01). Multiple comparisons indicated that all variables except physical impairment improved at discharge. Impairment (P<0.05), anxiety and well‐being (P<0.01) improved at follow‐up compared with scores at admission.

CONCLUSIONS: Pain response and health status improve following intensive cognitive‐behavioural treatment. These effects persist at one year but are generally weaker than at discharge. The largest effects were on indexes that reflect emotional status and general well‐being. Implications of these findings for fibromyalgia treatment programs are discussed.
Correlations between Ratings of Pain, Disability and Impairment in Chronic Whiplash‐Associated Disorder
Authors: Vernon Howard
Published: March 2016

OBJECTIVE: To investigate the level of correlation among pain, disability and physical impairment scores in chronic whiplash‐associated disorder patients.

SUBJECTS: Adults with chronic whiplash‐associated disorder referred for secondary independent assessment.

METHODS: Forty‐four subjects (16 males, 28 females) were included in the sample. Self‐rated pain was measured on a five‐point verbal rating scale. Self‐rated disability was measured using the Neck Disability Index (NDI) and the Disability Rating Index (DRI). Physical impairment was measured as active cervical ranges of motion obtained with a cap goniometer. Descriptive statistics were reported and Pearson product moment correlations were obtained with the P value at 0.01.

RESULTS: Mean ± SD age of the subjects was 36.4±8.7 years. Mean duration of complaint was 15.2±12.3 months. Mean pain score out of 5 was 2.5±1.2. Mean NDI and DRI scores were 23.2±9.3 out of 50 and 21.6±9.1 out of 48, respectively. These scores correlated very highly (r=0.89, P=0.0001). The average reduction of ranges of motion compared with published norms was approximately 25%. The correlations among ranges of motion, NDI, DRI and pain scores ranged from ‐0.32 to ‐0.66 (P<0.05 to P=0.0001). Age and duration of complaint correlated poorly with ranges of motion.

CONCLUSIONS: The self‐ratings of pain and disability obtained from these chronic whiplash‐associated disorder sufferers appear to be consistent with, and correlate reasonably well with, levels of physical impairment. Physical impairment ratings do not appear to correlate well with duration, which suggests that factors related to pain and physical impairment may play an important role in the development of chronicity in whiplash‐associated disorder.
Ventilatory Care in Status Asthmaticus
Authors: Smyth Robert J
Published: March 2016

Asthma continues to pose a significant medical problem in terms of both morbidity and mortality. A number of patients with a severe exacerbation of asthma fail medical therapy and require urgent intubation and mechanical ventilation. New modalities of ventilatory support, including noninvasive ventilation, have been shown to provide effective ventilation even in the presence of severe bronchoconstriction. An intrinsically high level of auto positive end‐expiratory pressure in these patients requires a precise balance between respiratory frequency, tidal volume and inspiratory flow rates. Pressure support ventilation reduces the risk of barotrauma and lowers the work of breathing in these patients. Adjuvant therapy with inhaled anesthetics and bronchoalveolar lavage may also be indicated in patients requiring high pressures to achieve adequate ventilation.
The Patient Level Cost of Asthma in Adults in South Central Ontario
Authors: Ungar Wendy J , Coyte Peter C , Chapman Kenneth R , MacKeigan Linda , the Pharmacy Medication Monitoring Program Advisory Board
Published: March 2016

OBJECTIVE: To assess the annual cost of asthma per adult patient from the perspectives of society, the Ontario Ministry of Health and the patient.

DESIGN: Prospective cost of illness evaluation.

SETTING: Ambulatory out‐patients residing in southern central Ontario.

POPULATION STUDIED: Nine hundred and forty patients with asthma over 15 years of age studied between May 1995 and April 1996.

OUTCOME MEASURES: Direct costs, such as respiratory‐related visits to general/family practitioners, respiratory specialists, emergency rooms, hospital admissions, laboratory tests, prescription medications, dispensing fees, devices and out‐of‐pocket expenses, were calculated. Indirect costs, such as absences from work or usual activities, and travel and waiting time, were studied.

MAIN RESULTS: Unadjusted annual costs were $2,550 per patient. Hospitalizations and medications each accounted for 22% of the total cost and indirect costs 50% of the total costs. More severe disease, older age, smoking, drug plan availability and retirement were significant predictors of costs. Annual costs per patient varied from $1,255 (95% CI $1,061 to $1,485) in young nonsmokers with no drug plan and mild disease to $5,032 (95% CI $4,347 to $5,825) in older smokers with drug plans and severe disease. Clinically important reductions in the quality of life occurred with increasing severity.

CONCLUSIONS: Interventions aimed at reducing productivity losses, admissions to hospital and medication costs may result in savings to society, the provincial government and the patient. The quality of policy and allocation decisions may be enhanced by cost of illness estimates that are comprehensive, precise and incorporate multiple perspectives.
Current Practices of Adjunctive Therapy for Pertussis at Six Canadian Tertiary Care Pediatric Hospitals
Authors: Naugler Christopher T , Halperin Scott A
Published: March 2016

OBJECTIVE: To document initial investigations and treatment used in the management of children hospitalized with pertussis.

DESIGN: Retrospective chart review encompassing admissions from January 1, 1991 to June 1, 1995.

SETTING: Six Canadian pediatric hospitals representing about 39% of the pediatric tertiary care beds in Canada.

PATIENTS: Four hundred and forty children who met the inclusion criterion of a primary admitting diagnosis of pertussis and who did not meet the exclusion criterion of nosocomially acquired pertussis or a prior admission for pertussis during the study period.

MAIN RESULTS: Most patients had cultures positive for Bordetella pertussis, although the proportion of positive tests varied widely among hospitals. Erythromycin was the most commonly used medication; however, only 47% of children received the recommended dosage. Salbutamol and corticosteroids were used most often in patients with reactive airways disease. Younger children and those with reactive airways disease had longer lengths of stay in hospital.

CONCLUSIONS: Pertussis treatment varied widely among the six hospitals studied, and was often not consistent with current Canadian recommendations. The results will allow practitioners to place their practices in a national perspective and provide a baseline for further studies.
Flexible Bronchoscopy in the Management of Congenital Lobar Emphysema in the Neonate
Authors: Phillipos EZ , Libsekal K
Published: March 2016

This paper describes the case of a 3 kg neonate who had congenital lobar emphysema of the left upper lobe (LUL). He was in severe respiratory distress with a fraction of inspired oxygen of 0.8. Chest x‐ray showed hyperlucent expanded left hemithorax and marked mediastinal shift. Following flexible bronchoscopy and introduction of ultrathin bronchoscope into the LUL bronchus, symptoms and chest x‐ray improved markedly. Flexible bronchoscopy resulted in emergency relief of his initial respiratory distress, and left upper lobe lobectomy was performed electively three days later.
Susceptibility of Group A Beta‐Hemolytic Streptococci in the Lower St Lawrence Region, Quebec
Authors: DesRosiers Annie , Dolcé Patrick , Jutras Philippe , Jetté Louise P
Published: March 2016

OBJECTIVE: To determine the susceptibility of group A beta‐hemolytic streptococci (GABHS) in the lower St Lawrence region, Quebec to different antibiotics, particularly macrolides, and to compare different antibiogram methods (disk diffusion, E‐test and microdilution) and incubation atmospheres (ambient air and 5% carbon dioxide).

METHODS: A total of 384 strains of GABHS isolated from 377 patients (throat 335; other sites 49) from three hospitals in the lower St Lawrence region were analyzed for their susceptibility to erythromycin, clarithromycin, azithromycin, penicillin, clindamycin, cephalothin, rifampin and vancomycin by disk diffusion on Mueller‐Hinton (MH) agar supplemented with 5% defibrinated sheep blood (MHB) at 35ºC in 5% carbon dioxide. Strains that were found to be intermediately resistant or resistant to one of the antibiotics by disc diffusion, strains from sites other than throat, and a sample of 97 pharyngeal strains were evaluated by E‐test on MHB (35ºC, 5% carbon dioxide) for their susceptibility to the antibiotics erythromycin, clarithromycin, azithromycin, penicillin, clindamycin and ceftriaxone. In addition, minimum inhibitory concentrations (MICs) were determined for erythromycin and azithromycin by broth microdilution using MH broth supplemented with 2.5 % of lysed horse blood (35ºC, ambient air) on strains that were resistant or intermediately resistant to the macrolides (erythromycin, clarithromycin, azithromycin). An evaluation was also carried out on these strains to determine the influence of the incubating atmosphere (ambient air versus 5% carbon dioxide) on susceptibility results obtained by disk diffusion (erythromycin, clarithromycin and azithromycin) and E‐test (erythromycin and azithromycin) methods.

RESULTS: Nine strains (2%) from nine patients (throat eight, pus one) were resistant to all macrolides as tested by three different techniques (disk diffusion, E‐test and microdilution). All strains were susceptible to all the other antibiotics tested. For the strains intermediately resistant or resistant to macrolides, incubation in a 5% carbon dioxide atmosphere was associated with a reduction in the diameter of inhibition determined by disk diffusion (P<0.001) with frequent minor variations in interpretation, and with an increase in the MIC by E‐test (P<0.001), which had no impact on interpretation.

CONCLUSIONS: Resistance of GABHS to macrolides was not common (2%) in the lower St Lawrence Region. GABHS susceptibility to erythromycin seemed to predict the susceptibility to the other macrolides. Significant variation in antibiogram results (disk diffusion and E‐test) of GABHS susceptibility to macrolides was related to the incubation atmosphere and may have an impact on the interpretation of disk diffusion results.
Assessing Patients with Chronic Pain Using the Basic Personality Inventory as a Complement to the Multidimensional Pain Inventory
Authors: Burton Howard J , Kline Stephen A , Hargadon Robin , Cooper Barry S , Shick Roger D , Ong-Lam May C
Published: March 2016

OBJECTIVE: To examine the utility of the Basic Personality Inventory (BPI) as a complementary tool to the Multidimensional Pain Inventory (MPI) for the evaluation of patients with chronic pain. It was hypothesized that patients labelled ′dysfunctional′ on the MPI would exhibit the highest levels of psychological distress as indicated by scores on BPI, followed in order by those labelled ′interpersonally distressed′, and those described as ′adaptive copers′. It was anticipated that this pattern would be independent of sex. In addition, validity of the BPI as a measure of psychological distress among patients with pain was examined using psychiatric diagnostic ratings as independent criteria.

METHODS: Three hundred and twenty‐six patients with non‐malignant chronic pain seeking admission to a private pain clinic, an inpatient treatment program or a short term, multidisciplinary outpatient chronic pain program completed both the MPI and the BPI at a single sitting as part of a routine assessment procedure. The majority of patients underwent psychiatric assessment which specified Diagnostic and Statistical Manual of Mental Disorders‐III‐R (DSM‐III‐R) or DSM‐IV diagnosis. Psychiatric diagnosis was determined for a subsample of 110 patients in the present investigation by conducting a random chart review.

RESULTS: The MPI patients classified as ′dysfunctional′ manifested significantly higher levels of BPI measured psychopathology than both ′interpersonally distressed′ and ′adaptive coper′ groups. ′Adaptive copers′ reported the lowest levels of psychological dysfunction while those labelled ′interpersonally distressed′ exhibited intermediate levels of dysfunction. Individuals with high levels of emotional distress as determined from the BPI were more likely to have an axis 1 disorder.

CONCLUSIONS: The BPI is an accepted valid and reliable generic measure of emotional well‐being and may be used as a complementary index to the disease‐specific MPI in assessing chronic pain patients. A psychometric assessment battery consisting of the MPI and BPI can assist both clinicians and researchers in identifying problem areas that may impede treatment of patients with chronic pain and in assessing treatment outcomes.