bluuebunny/crossref_metadata_2025 huggingface dataset:
Amniocentesis in the HIV‐Infected Pregnant Woman: Is There Still Cause for Concern in the Era of Combination Antiretroviral Therapy?
Authors: Andany Nisha , Letchumanan Michelle , Bondy Lise , Murphy Kellie , Loutfy Mona R
Published: March 2016

The current standard of care in Canadian obstetrical practice is to offer pregnant women the opportunity for prenatal investigation to diagnose congenital abnormalities. Prenatal amniocentesis is Canada’s most commonly practiced invasive procedure for the diagnosis of chromosomal and single gene disorders. The potential risk of intrapartum HIV transmission during amniocentesis raises several ethical concerns and limits the availability of prenatal genetic testing for HIV‐positive pregnant women. Complete virological suppression with antiretroviral therapy may alleviate the risk of mother‐to‐child transmission during amniocentesis and increase accessibility of this important diagnostic tool in the HIV‐positive population. The present report describes a case involving a 32‐year‐old HIV‐positive pregnant woman whose plasma viral load was undetectable on antiretroviral therapy; she underwent successful prenatal amniocentesis without transmission of HIV to her infant.
Increasing HIV Subtype Diversity and Its Clinical Implications in a Sentinel North American Population
Authors: Siemieniuk Reed AC , Beckthold Brenda , Gill M John
Published: March 2016

BACKGROUND: HIV‐1 is a highly diverse virus; subtypes may exhibit differences in rates of transmission, disease progression, neurotoxicity, antiretroviral treatment failure profiles and accuracy of viral load measurements. To date, the HIV epidemic in Canada and the rest of the developed world has been largely due to subtype B; however, shifts in subtype epidemiology could have significant implications.

OBJECTIVE: To determine whether there has been an increase in HIV subtype diversity in southern Alberta, Canada.

METHODS: All 2358 patients receiving any HIV care between December 31, 2001 and December 31, 2010 were included in a retrospective analysis of subtype prevalence and incidence. In an indexed analysis, subtype trends from 1994 to 2010 were also evaluated.

RESULTS: Between 2001 and 2010, the prevalence of non‐B HIV subtypes in patients with a known subtype increased from 7% to 24%. In 2010, the most prevalent non‐B subtypes were C (65%), A (11%), CRF02_AG (9.7%), CRF01_AE (4.9%), D (3.9%), G (2.9%) and CRF06_cpx (1.5%). In the indexed analysis, there was an overall proportional increase in non‐B subtypes of 2.3% per year. The year‐over‐year increase in the prevalence of patients infected with a nonsubtype B virus increased from 13% from 1995 to 2002 to 27% from 2003 to 2010 (P=0.01). Incident non‐B subtype cases increased from 9.6% to 32.4% over these time periods.

CONCLUSIONS: This recent and dramatic shift in HIV strain diversity in Canada is unprecedented and may have important public health, research and clinical consequences.
Ice Hockey Lung – A Case of Mass Nitrogen Dioxide Poisoning in The Czech Republic
Authors: Brat Kristian , Merta Zdenek , Plutinsky Marek , Skrickova Jana , Ing Miroslav Stanek
Published: March 2016

Nitrogen dioxide (NO2) is a toxic gas, a product of combustion in malfunctioning ice‐resurfacing machines. NO2 poisoning is rare but potentially lethal. The authors report a case of mass NO2 poisoning involving 15 amateur ice hockey players in the Czech Republic. All players were treated in the Department of Respiratory Diseases at Brno University Hospital in November 2010 – three as inpatients because they developed pneumonitis. All patients were followed‐up until November 2011. Complete recovery in all but one patient was achieved by December 2010. None of the 15 patients developed asthma‐like disease or chronic cough. Corticosteroids appeared to be useful in treatment. Electric‐powered ice‐resurfacing machines are preferable in indoor ice skating arenas.
More than Just Great Quotes: An Introduction to the Canadian Tri‐Council’s Qualitative Requirements
Authors: Boffa Jody , Moules Nancy , Mayan Maria , Cowie Robert L
Published: March 2016

Although at times misunderstood by the general research community, qualitative research has developed out of diverse, rich and complex philosophical traditions and theoretical paradigms. In the most recent Canadian Tri‐Council policy statement on the ethical conduct of research involving humans, a chapter was devoted to a summary of methods and methodological requirements that characterize robust qualitative research, despite the diversity of approaches. To dispel common misperceptions about qualitative research and introduce the unfamiliar reader to these requirements, the work of a qualitative study on isoniazid preventive therapy for prophylaxis of tuberculosis published in AIDS is critiqued alongside each of the Tri‐Council’s nine requirements.
Depressive Attribution Style and Stressor Uncontrollability Increase Perceived Pain Intensity after Electrical Skin Stimuli in Healthy Young Men
Authors: Müller Matthias J
Published: March 2016

BACKGROUND: Depressive and pain symptoms often occur concurrently in patients with psychiatric disorders or somatic diseases, but the contribution of pre‐existing dysfunctional cognitive schemata to pain perception remains unclear.

OBJECTIVE: To investigate the relationship between depression‐related attribution styles and perceived pain intensity (PPI) after controllable versus uncontrollable electrical skin stimulation in healthy male individuals.

METHODS: Causal attributions for negative events were measured using the attribution style questionnaire (ASQ) on the dimensions internal versus external (INT), global versus specific (GLO) and stable versus unstable (STA) in 50 men (20 to 31 years of age). Additionally, symptoms of anxiety and depression (measured using the Depression Scale) as well as baseline helplessness were assessed. Participants were randomly assigned to receive self‐administered (controllable) or experimenter‐administered (uncontrollable) painful skin stimuli. PPI was assessed after stress exposure using a visual analogue scale (0 to 100). Relationships between PPI and depression‐related cognitions were calculated using correlation and multiple regression analyses.

RESULTS: Correlation analyses revealed a moderate correlation between PPI and ASQ‐INT scores (r=0.46). Following uncontrollable stress exposure, significantly higher PPI ratings (P=0.001) and a higher correlation between PPI and ASQ‐INT (r=0.70) were observed. Multiple regression analysis showed an independent influence of stressor controllability (ß=0.39; P=0.003) and ASQ‐INT (ß=0.36; P=0.006) on PPI.

DISCUSSION: These findings highlight the interaction of specific depression‐related cognitions and stress controllability on pain intensity perception.

CONCLUSIONS: The results of the present study may facilitate understanding of the cognitive aspects of pain intensity perception and improve psychological pain therapies focusing on attributions and controllability.
Reduction of Pain Thresholds in Fibromyalgia after Very Low‐Intensity Magnetic Stimulation: A Double‐Blinded, Randomized Placebo‐Controlled Clinical Trial
Authors: Maestú Ceferino , Blanco Manuel , Nevado Angel , Romero Julia , Rodríguez-Rubio Patricia , Galindo Javier , Lorite Juan Bautista , de las Morenas Francisco , Fernández-Argüelles Pedro
Published: March 2016

BACKGROUND: Exposure to electromagnetic fields has been reported to have analgesic and antinociceptive effects in several organisms.

OBJECTIVE: To test the effect of very low‐intensity transcranial magnetic stimulation on symptoms associated with fibromyalgia syndrome.

METHODS: A double‐blinded, placebo‐controlled clinical trial was performed in the Sagrado Corazón Hospital, Seville, Spain. Female fibromyalgia patients (22 to 50 years of age) were randomly assigned to either a stimulation group or a sham group. The stimulation group (n=28) was stimulated using 8 Hz pulsed magnetic fields of very low intensity, while the sham group (n=26) underwent the same protocol without stimulation. Pressure pain thresholds before and after stimulation were determined using an algometer during the eight consecutive weekly sessions of the trial. In addition, blood serotonin levels were measured and patients completed questionnaires to monitor symptom evolution.

RESULTS: A repeated‐measures ANOVA indicated statistically significant improvement in the stimulation group compared with the control group with respect to somatosensory pain thresholds, ability to perform daily activities, perceived chronic pain and sleep quality. While improvement in pain thresholds was apparent after the first stimulation session, improvement in the other three measures occurred after the sixth week. No significant between‐group differences were observed in scores of depression, fatigue, severity of headaches or serotonin levels. No adverse side effects were reported in any of the patients.

CONCLUSIONS: Very low‐intensity magnetic stimulation may represent a safe and effective treatment for chronic pain and other symptoms associated with fibromyalgia.
A Simple Method to Improve Adenoma Detection Rate During Colonoscopy: Altering Patient Position
Authors: Köksal Aydin Şeref , Kalkan İsmail Hakkı , Torun Serkan , Taşkıran İsmail , Öztaş Erkin , Kayaçetin Ertuğrul , Şaşmaz Nurgül
Published: March 2016

BACKGROUND: Colonoscopy is currently considered to be the gold standard method for detecting and removing adenomatous polyps. However, tandem colonoscopy studies reveal a pooled polyp miss rate of 22%.

OBJECTIVE: A prospective randomized trial was conducted to assess whether alteration of patient position during colonoscopy withdrawal increases the adenoma detection rate (ADR).

METHOD: The study group included 120 patients who presented for elective colonoscopic examination. After reaching the cecum, patients were randomly assigned in a 1:1 ratio to examination in either the left lateral position or other positions (left lateral position for the cecum, ascending colon and hepatic flexure; supine for transverse colon; and supine and right lateral position for splenic flexure, descending and sigmoid colon) first. Examination of the colon was performed segment by segment. The size, morphology and location of all polyps were recorded. Polyps were removed immediately after examination of a colon segment when all positions were completed. ADR and polyp detection rates (PDR) were calculated.

RESULTS: A total of 102 patients completed the study. Examination in the left lateral position revealed 66 polyps in 31 patients (PDR 30.3%) and 42 adenomas in 24 patients (ADR 23.5%). PDR increased to 43.1% (81 polyps in 44 patients) and the ADR to 33.3% (53 adenomas in 34 patients) after the colon was examined in the additional positions (P<0.001 and P=0.002, respectively). The increase in the number of adenomas detected was statistically significant in the transverse and sigmoid colon. The addition of position changes led to a 9.8% increase in the ADR in the transverse colon, splenic flexure, and descending and sigmoid colon. The frequency of surveillance interval was shortened in nine (8.8%) patients after examination of the colon in dynamic positions.

CONCLUSION: Alteration of patient position during colonoscopy withdrawal is a simple and effective method to improve ADR.
Spirometry‐Related Pain and Distress in Adolescents and Young Adults with Cystic Fibrosis: The Role of Acceptance
Authors: Casier Annabelle , Goubert Liesbet , Vervoort Tine , Theunis Marleen , Huse Danielle , De Baets Frans , Matthys Dirk , Crombez Geert
Published: March 2016

OBJECTIVE: To investigate the occurrence of spirometry‐related pain and distress in adolescents and young adults with cystic fibrosis (CF), and to investigate the role of acceptance of illness in spirometry‐related pain and distress.

METHODS: A total of 36 adolescents and young adults with CF (12 to 22 years of age) completed a questionnaire assessing acceptance of illness. Spirometry‐related distress was assessed using self‐report (ie, anxiety/worry about the procedure) and physiological outcomes (ie, heart rate and heart rate variability) before spirometry. Spirometry‐related pain was assessed using self‐report (ie, expected pain and pain‐related thoughts). Self‐reported distress and pain during spirometry were also assessed.

RESULTS: Eighty‐nine per cent of subjects reported distress before spirometry, 67% experienced distress during spirometry, 28% expected pain during spirometry and 22% actually experienced pain. Interestingly, partial correlations revealed that more acceptance was related to less expected pain and pain‐related thoughts. Acceptance, however, was unrelated to distress, anxiety and pain during spirometry.

DISCUSSION: The present study suggests that a non‐negligible number of adolescents and young adults with CF experience pain and distress during spirometry. Furthermore, results indicate that acceptance may play a protective role in the more indirect consequences of CF such as expected pain and pain‐related thoughts during medical procedures. Acceptance, however, was not related to distress before and during spirometry, nor to experienced pain. These findings contribute to the increasing evidence that acceptance may play a protective role in managing the consequences of living with CF.
Clinical Application of a Single-Operator Direct Visualization System Improves the Diagnostic and Therapeutic Yield of Endoscopic Retrograde Cholangiopancreatography
Authors: AlAmeel Turki , Bain Vincent , Sandha Gurpal
Published: March 2016

BACKGROUND: Single-operator cholangioscopy enables direct diagnostic visualization and therapeutic intervention in the biliary tree. There is increasing evidence of its clinical utility in the assessment of biliary strictures and treatment of difficult stones.

OBJECTIVE: To describe the first reported Canadian experience with managing biliary disease using single-operator cholangioscopy.

METHODS: The present study was a retrospective analysis of data collected from all sequential patients undergoing single-operator cholangioscopy for assessment of biliary strictures and treatment of biliary stones. The main outcome measures were the ability to make an overall diagnosis of stricture (based on visual appearances and tissue histology), and to fragment and extract biliary stones.

RESULTS: Thirty patients (17 women), mean age 66 years (range 41 to 89 years) underwent single-operator cholangioscopy. In biliary strictures (20 patients), overall accuracy for visual and tissue diagnosis was 84% and 81%, respectively. Successful electrohydraulic lithotripsy with stone clearance was achieved in 90% of the 10 patients who failed previous conventional therapy. The mean (± SD) procedure time was 61±21 min (range 20 min to 119 min). One patient developed mild postendoscopic retrograde cholangioscopy pancreatitis.

CONCLUSION: The results of this experience reaffirms the clinical utility and safety of single-operator cholangioscopy for the management of biliary pathology. Further improvements can be achieved with increasing operator experience and refinements in optical technology.
Feasibility and Effectiveness of a Home‐Based Exercise Training Program Before Lung Resection Surgery
Authors: Coats Valérie , Maltais François , Simard Sébastien , Fréchette Éric , Tremblay Lise , Ribeiro Fernanda , Saey Didier
Published: March 2016

BACKGROUND: Patients with lung cancer often experience a reduction in exercise tolerance, muscle weakness and decreased quality of life. Although the effectiveness of pulmonary rehabilitation programs is well recognized in other forms of cancers and in many pulmonary diseases, few researchers have studied its impact in patients with lung cancer, particularly in those awaiting lung resection surgery (LRS).

OBJECTIVES: To investigate the feasibility of a short, home‐based exercise training program (HBETP) with patients under investigation for non‐small cell lung cancer and potential candidates for LRS, and to determine the effectiveness of this program on exercise tolerance, skeletal muscle strength and quality of life.

METHODS: Sixteen patients with lung cancer awaiting LRS participated in a four‐week HBETP including moderate aerobic activities (walking and cycling) and muscle training performed three times weekly. Before and after the intervention, a cardiopulmonary exercise test, a 6 min walk test and the assessment of muscle strength and quality of life were performed.

RESULTS: Thirteen patients completed the four‐week HBETP and all the patients completed >75% of the prescribed exercise sessions. The duration of the cycle endurance test (264±79 s versus 421±241 s; P<0.05) and the 6 min walk test distance (540±98 m versus 568±101 m; P<0.05) were significantly improved. Moreover, the strength of the deltoid, triceps and hamstrings were significantly improved (Δ post‐pre training 1.82±2.83 kg, 1.32±1.75 kg and 3.41±3.7 kg; P<0.05, respectively).

CONCLUSION: In patients with lung cancer awaiting LRS, HBETP was feasible and improved exercise tolerance and muscle strength. This may be clinically relevant because poor exercise capacity and muscle weakness are predictors of postoperative complications.
Canadian Practice Assessment in Chronic Obstructive Pulmonary Disease: Respiratory Specialist Physician Perception Versus Patient Reality
Authors: Hernandez Paul , Balter Meyer S , Bourbeau Jean , Chan Charles K , Marciniuk Darcy D , Walker Shannon L
Published: March 2016

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is a common respiratory condition and the fourth leading cause of death in Canada. Optimal COPD management requires patients to participate in their care and physician knowledge of patients’ perceptions of their disease.

METHODS: A prospective study in which respiratory specialist physicians completed a practice assessment questionnaire and patient assessments for 15 to 20 consecutive patients with COPD. Patients also completed a questionnaire regarding their perceptions of COPD and its management.

RESULTS: A total of 58 respiratory specialist physicians from across Canada completed practice assessments and 931 patient assessments. A total of 640 patients with COPD (96% with moderate, severe or very severe disease) completed questionnaires. Symptom burden was high and most patients had experienced a recent exacerbation. Potential COPD care gaps were identified with respect to appropriate medication prescription, lack of an action plan, and access to COPD educators and pulmonary rehabilitation. Perceived knowledge needs and gaps differed between physicians and patients.

CONCLUSIONS: Despite the dissemination of Canadian and international COPD clinical practice guidelines for more than a decade, potential care gaps remain among patients seen by respiratory specialist physicians. Differing perceptions regarding many aspects of COPD among physicians and patients may contribute to these care gaps.
Incidental Finding and Management of Intralobar Sequestration of the Lung in A 24‐Year‐Old Man
Authors: Litt Dhanjit , Gandhi Sumeet , Bhinder Sacha , Blitz Maurice , McIntyre Kieran
Published: March 2016

Pulmonary sequestration is described as a dysplastic mass of lung tissue that lacks communication with the tracheobronchial tree and receives systemic rather than pulmonary arterial blood supply. Two distinct classifications, intralobar and extralobar, have been described. The present article discusses the etiology, clinical and radiographic features of pulmonary sequestration as well as the management of this condition when it is discovered incidentally.
Zoonotic Infections in Communities of the James Bay Cree Territory: An Overview of Seroprevalence
Authors: Sampasa-Kanyinga Hugues , Lévesque Benoit , Anassour-Laouan-Sidi Elhadji , Côté Suzanne , Serhir Bouchra , Ward Brian J , Libman Michael D , Drebot Michael A , Makowski Kai , Dimitrova Kristina , Ndao Momar , Dewailly Éric
Published: March 2016

The Cree communities of James Bay are at risk for contracting infectious diseases transmitted by wildlife. Data from serological testing for a range of zoonotic infections performed in the general population (six communities), or trappers and their spouses (one community), were abstracted from four population‐based studies conducted in Cree territory (Quebec) between 2005 and 2009. Evidence of exposure to Trichinella species, Toxoplasma gondii, Toxocara canis, Echinococcus granulosus, Leptospira species, Coxiella burnetii and Francisella tularensis was verified in all communities, whereas antibodies against Sin Nombre virus and California serogroup viruses (Jamestown Canyon and snowshoe hare viruses) were evaluated in three and six communities, respectively. Seroprevalence varied widely among communities: snowshoe hare virus (1% to 42%), F tularensis (14% to 37%), Leptospira species (10% to 27%), Jamestown Canyon virus (9% to 24%), C burnetii (0% to 18%), T gondii (4% to 12%), T canis (0% to 10%), E granulosus (0% to 4%) and Trichinella species (0% to 1%). No subject had serological evidence of Sin Nombre virus exposure. These data suggest that large proportions of the Cree population have been exposed to at least one of the targeted zoonotic agents. The Cree population, particularly those most heavily exposed to fauna, as well as the medical staff living in these regions, should be aware of these diseases. Greater awareness would not only help to decrease exposures but would also increase the chance of appropriate diagnostic testing.
The effect of inhaled menthol on upper airway resistance in humans: A randomized controlled crossover study
Authors: Pereira Effie J , Sim Lauren , Driver Helen S , Parker Chris M , Fitzpatrick Michael F
Published: March 2016

BACKGROUND: Menthol (l-menthol) is a naturally-occurring cold receptor agonist commonly used to provide symptomatic relief for upper airway congestion. Menthol can also reduce the sensation of dyspnea. It is unclear whether the physiological action of menthol in dyspnea reduction is through its cold receptor agonist effect or whether associated mechanical changes occur in the upper airway.

OBJECTIVE: To determine whether menthol inhalation alters upper airway resistance in humans.

METHODS: A randomized, sham-controlled, single-blinded crossover study of inhaled menthol on upper airway resistance during semirecumbent quiet breathing in healthy subjects was conducted. Ten healthy participants (eight female) with a mean (± SD) age of 21±1.6 years completed the study.

RESULTS: Nasal resistance before testing was similar on both occasions. No differences were found in respiratory frequency (mean ± SEM) (menthol 17.0±1.1 cmH2O/L/s; sham 16.9±0.9 cmH2O/L/s), minute ventilation (menthol 7.7±0.5 cmH2O/L/s; sham 7.9±0.5 cmH2O/L/s) or total inspiratory time/total breath time (menthol 0.4±0.1 cmH2O/L/s; sham 0.4±0.1 cmH2O/L/s). The upper airway resistance was similar during menthol (3.47±0.32 cmH2O/L/s) and sham (3.27±0.28 cmH2O/L/s) (P=0.33) inhalation.

CONCLUSION: Inhalation of menthol does not alter upper airway resistance in awake human subjects.
Respiratory Infection and Otitis Media Visits in Relation to Pneumococcal Conjugate Vaccine Use in Saskatchewan
Authors: Khuc Ngoc-Hang , Tan Ben , Tuchscherer Rosalie , Rawson Nigel SB , De Wals Philippe
Published: March 2016

BACKGROUND: In Saskatchewan, pneumococcal conjugate vaccination (PCV) was offered to high‐risk children in 2002 and to all infants in 2005.

OBJECTIVE: To describe trends in the frequency of medical visits for lower respiratory tract infection (LRI) and otitis media (OM) in relation to PCV use during the period 1990 to 2008.

METHODS: Statistics regarding the number of children covered by the health insurance plan, PCV administration, and medical visits with a diagnostic code associated with LRI and OM were provided by Saskatchewan Health. Monthly rates were analyzed using dynamic state space models.

RESULTS: In all series, there was a marked seasonal cycle and some higher‐than‐expected winter peak values, possibly associated with epidemics of specific respiratory viruses. Three abrupt decreases in baseline rate were observed for LRI and the final one, in February 2007, could be related to the increased proportion of children vaccinated with PCV. There was no statistical correlation between PCV use and OM visit frequency.

CONCLUSION: Many environmental, biological and administrative factors may influence health services use, and an effect of low magnitude of a particular vaccine pertaining to nonspecific outcomes could be obscured in time‐series analyses.
Bats, Fever and Adenopathy – What Is the Link?
Authors: Manolakos Joshua J , Cooray Mohan , Patel Ameen , Haider Shariq
Published: March 2016

A case of travel‐related, subacute, progressive disseminated histoplasmosis in a nonimmunocompromised individual is described. The present case highlights the environmental exposure to Histoplasma capsulatum in Costa Rica, the diagnostic approach and treatment options, as well as new alternatives for salvage therapy for histoplasmosis infection.
A Meta-Analysis of Adjuvant Therapy after Potentially Curative Treatment for Hepatocellular Carcinoma
Authors: Wang Jun , He Xiao Dong , Yao Nan , Liang Wen Jia , Zhang You Cheng
Published: March 2016

BACKGROUND: The high recurrence rate of hepatocellular carcinoma (HCC) after potentially curative treatment determines the long-term prognosis.

OBJECTIVE: To evaluate the efficacy and safety of adjuvant therapies in patients with HCC who have undergone hepatic resection, transplantation or locoregional ablation therapy.

METHODS: Several databases were searched to identify randomized controlled trials (RCTs) fulfilling the predefined selection criteria. Meta-analyses were performed to estimate the effects of adjuvant therapies of any modality on recurrence-free survival (RFS) and overall survival (OS).

RESULTS: Eight adjuvant modalities were identified from 27 eligible RCTs conducted predominantly in Asian populations comparing adjuvant with no adjuvant therapy. Adjuvant chemotherapy, internal radiation and heparanase inhibitor PI-88 therapy failed to improve RFS or OS, while interferon (IFN) therapy yielded significant survival results. The findings of adjuvant vitamin analogue therapy required further examination. Adjuvant adoptive immunotherapy conferred significant benefit for RFS but not for OS. Although cancer vaccine therapy and radioimmunotherapy may improve survival after radical surgery, the results were from single, small-scale trials. Severe side effects were observed in the studies of adjuvant chemotherapy and of IFN therapy.

CONCLUSIONS: Adjuvant IFN therapy can improve both RFS and OS; however, the benefits of using this agent should be weighed against its side effects. Combination of systemic and transhepatic arterial chemotherapy is not recommended for HCC after potentially curative treatment. Other adjuvant therapies produce limited success for survival. Additional RCTs with proper design are required to establish the role of adjuvant therapies for HCC.
Immunoglobulin G4‐related Lung Disease: A Disease with Many Different Faces
Authors: Hui Philip , Mattman André , Wilcox Pearce G , Wright Joanne L , Sin Don D
Published: March 2016

Immunoglobulin (Ig) G4‐related lung disease is a fibroinflammatory entity that presents in protean ways. Diagnostically, IgG4‐related lung disease requires a high clinical index of suspicion complemented by elevated serum IgG4 levels and/or biopsy that shows the characteristic pathological features. The disease is almost always responsive to systemic corticosteroids. However, relapse is common following their discontinuation. The authors present three cases to highlight the diverse clinical features, and to illustrate the diagnostic and therapeutic approaches to this disease.
Locus of Control Patterns in Headaches and Chronic Pain
Authors: Cano-García Francisco Javier , Rodríguez-Franco Luis , López-Jiménez Ana María
Published: March 2016

BACKGROUND: Locus of control (LOC) is related to the impact of headaches and chronic pain; however, literature evidence regarding LOC is not always consistent. Several authors consider this to be due, in part, to the separate interpretation of LOC factors, during which the interaction among them is ignored. In 1982, Wallston and Wallston proposed eight possible LOC health patterns depending on whether the individual scored high or low in each of three dimensions.

OBJECTIVE: To identify these LOC patterns in patients with headaches and chronic pain, and to validate them in terms of their association with a selection of the main pain indicators.

METHODS: A total of 228 individuals were recruited at three public centres in Seville, Spain. Participants completed a semistructured clinical interview and several questionnaires assessing psychological variables related to pain. The main statistical analyses used were two‐step cluster analysis and ANCOVA.

RESULTS: The six‐cluster solution was optimal. The patterns observed coincided with: the believer in control; the yea‐sayer; the pure chance; the pure internal; the pure professional; and the nay‐sayer clusters. The double external or type VI clusters were not observed. Clusters could be classified from the best to the worst adjustment to chronic pain.

CONCLUSIONS: These results support the empirical validity of the theoretical model of LOC patterns proposed in 1982 by Wallston and Wallston among a chronic pain population. The analysis of patterns provides more accurate information regarding the adjustment to pain compared with analysis of the LOC factors separately.
Artemisinin Combination Therapy Can Result in Clinical Failure If Oral Therapy Is Not Directly Observed
Authors: Chan Wilson W , Virmani Divya , Pillai Dylan R
Published: March 2016

Intravenous artesunate therapy is the first‐line therapy for severe malaria, and is highly efficacious when used in combination with an oral partner drug such as doxycycline or atovaquone‐proguanil. However, treatment failure occurs routinely with artesunate monotherapy due to the very short half‐life of this drug. In North America, experience with artesunate is limited. With the pressure to discharge patients early, administration of the essential oral partner drug is often left to the discretion of the patient. Thus, treatment failure may be commonplace if nonadherence is a factor, as was observed in the case described in the present report.
Marked Disparity in the Epidemiology of Tuberculosis among Aboriginal Peoples on the Canadian Prairies: the Challenges and Opportunities
Authors: Long Richard , Hoeppner Vernon , Orr Pamela , Ainslie Martha , King Malcolm , Abonyi Sylvia , Mayan Maria , Kunimoto Dennis , Langlois-Klassen Deanne , Heffernan Courtney , Lau Angela , Menzies Dick
Published: March 2016

BACKGROUND: While it is established that Aboriginal peoples in the prairie provinces of Canada are disproportionately affected by tuberculosis (TB), little is known about the epidemiology of TB either within or across provincial borders.

METHODS: Provincial reporting systems for TB, Statistics Canada censuses and population estimates of Registered Indians provided by Aboriginal Affairs and Northern Development Canada were used to estimate the overall (2004 to 2008) and pulmonary (2007 to 2008) TB rates in the prairie provinces. The place of residence at diagnosis of pulmonary TB cases in 2007 to 2008 was also documented.

RESULTS: The age‐ and sex‐adjusted incidence of TB in Registered Indians was 52.6 per 100,000 person‐years, 38 times higher than in Canadian‐born ‘others’. Incidence rates in Registered Indians were highest in Manitoba and lowest in Alberta. In Alberta and Saskatchewan, on‐reserve rates were more than twice that of off‐reserve rates. Rates in the Métis and Registered Indians were similar in Saskatchewan (50.0 and 52.2 per 100,000 person‐years, respectively). In 2007 to 2008, approximately 90% of Canadian‐born pulmonary TB cases in the prairie provinces were Aboriginal. Outside of one metropolitan area (Winnipeg, Manitoba), most Registered Indian and Métis pulmonary TB cases were concentrated in a relatively small number of communities north of the 53rd parallel. Rates of pulmonary TB in 11 of these communities were >300 per 100,000 person‐years. In Manitoba, 49% of off‐reserve Registered Indian pulmonary cases were linked to high‐incidence reserve communities.

INTERPRETATION: The epidemiology of TB among Aboriginal peoples on the Canadian prairies is markedly disparate. Pulmonary TB is highly focal, which is both a concern and an opportunity.
Aerococcus viridans Native Valve Endocarditis
Authors: Zhou Wenwan , Nanci Vanessa , Jean Andreanne , Salehi Amir H , Altuwaijri Fahad , Cecere Renzo , Genest Jacques
Published: March 2016

Aerococcus viridans is an infrequent human pathogen and few cases of infective endocarditis have been reported. A case involving a 69‐year‐old man with colon cancer and hemicolectomy 14 years previously, without recurrence, is reported. A diagnosis of native mitral valve endocarditis was established on the basis of clinical presentation, characteristic echocardiographic findings and pathological specimen examination after urgent valve replacement. A viridans endocarditis appears to be particularly virulent, requiring a surgical approach in four of 10 cases reported and death in one of nine. Given the aggressive nature of A viridans endocarditis and the variable time to diagnosis (a few days to seven months), prompt recognition of symptoms and echocardiography, in addition to blood cultures, should be performed when symptoms persist.
HFEMutations in Caucasian Participants of the Hemochromatosis and Iron Overload Screening Study with Serum Ferritin Level <1000 μg/L
Authors: Adams Paul C , McLaren Christine E , Speechley Mark , McLaren Gordon D , Barton James C , Eckfeldt John H
Published: March 2016

BACKGROUND: Many patients referred for an elevated serum ferritin level <1000 μg/L are advised that they likely have iron overload and hemochromatosis.

AIMS: To determine the prevalence ofHFEmutations in the hemochromatosis gene for 11 serum ferritin concentration intervals from 200 μg/L to 1000 μg/L in Caucasian participants in a primary care, population-based study.

METHODS: The Hemochromatosis and Iron Overload Screening study screened 99,711 participants for serum ferritin levels, transferrin saturation and genetic testing for the C282Y and H63D mutations of theHFEgene. This analysis was confined to 17,160 male and 27,465 female Caucasian participants because theHFEC282Y mutation is rare in other races. Post-test likelihood was calculated for prediction of C282Y homozygosity from a ferritin interval. A subgroup analysis was performed in participants with both an elevated serum ferritin level and transferrin saturation.

RESULTS: There were 3359 male and 2416 female participants with an elevated serum ferritin level (200 μg/L to 1000 μg/L for women, 300 μg/L to 1000 μg/L for men). There were 69 male (2.1%) and 87 female (3.6%) C282Y homozygotes, and the probability of being a homozygote increased as the ferritin level increased. Post-test likelihood values were 0.3% to 16% in men and 0.3% to 30.4% in women.

CONCLUSIONS: Iron loadingHFEmutations are unlikely to be the most common cause of an elevated serum ferritin level in patients with mild hyperferritinemia. Patients should be advised that there are many causes of an elevated serum ferritin level including iron overload.
Self‐Reported Practices in Opioid Management of Chronic Noncancer Pain: A Survey of Canadian Family Physicians
Authors: Allen Michael JM , Asbridge Mark M , MacDougall Peter C , Furlan Andrea D , Tugalev Oleg
Published: March 2016

BACKGROUND: In May 2010, a new Canadian guideline on prescribing opioids for chronic noncancer pain (CNCP) was released. To assess changes in family physicians’ (FPs) prescribing of opioids following the release of the guideline, it is necessary to know their practices before the guideline was widely disseminated.

OBJECTIVES: To determine FPs’ practices and knowledge in prescribing opioids for CNCP in relation to the Canadian guideline, and to determine factors that hinder or enable FPs in prescribing opioids for CNCP.

METHODS: An online survey was developed and FPs who manage CNCP were electronically contacted through the College of Family Physicians of Canada, university continuing medical education offices and provincial regulatory colleges.

RESULTS: A total of 710 responses were received. FPs followed a precautionary approach to prescribing opioids and already practiced in accordance with Canadian guideline recommendations by discussing adverse effects, monitoring for aberrant drug‐related behaviour and advising caution when driving. However, FPs seldom discontinued opioids even if they were ineffective and were unaware of the ‘watchful dose’ of opioids, the daily dose at which patients may need reassessment or closer monitoring. Only two of nine knowledge questions were answered correctly by more than 40% of FPs. The main enabler to optimal opioid prescribing was having access to a patient’s opioid history from a provincial prescription monitoring program. The main barriers to optimal prescribing were concerns about addiction and misuse.

CONCLUSIONS: While FPs follow a precautionary approach to prescribing opioids for CNCP, there are substantial practice and knowledge gaps, with implications for patient safety and costs.
Assessment of Linezolid Efficacy, Safety and Tolerability in the Treatment of Tuberculosis: A Retrospective Case Review
Authors: Tse-Chang Alena , Kunimoto Dennis , Der Evelina , Ahmed Rabia
Published: March 2016

Linezolid is a potentially effective drug for the treatment of patients with drug‐resistant tuberculosis. Among 13 patients treated for tuberculosis with linezolid in the present study, nine had treatment success and four remain on treatment. Adverse effects occurred in 11 (85%) patients, of whom three discontinued treatment because of adverse effects. The present study adds to the growing evidence supporting the efficacy of linezolid for tuberculosis, although treatment remains complicated by adverse effects.
Patient and Parent Satisfaction with a Dietitian-and Nurse-Led Celiac Disease Clinic for Children at the Stollery Children’S Hospital, Edmonton, Alberta
Authors: Rajani Seema , Sawyer-Bennett Jessica , Shirton Leanne , DeHaan Gail , Kluthe Cheryl , Persad Rabindranath , Huynh Hien Q , Turner Justine
Published: March 2016

OBJECTIVE: To assess patient and parent satisfaction with a primarily nurse- and dietitian-led celiac disease clinic in a tertiary pediatric centre.

METHODS: An online survey was sent to families and patients attending the Stollery Children’s Hospital’s Multidisciplinary Pediatric Celiac Clinic (Edmonton, Alberta) since 2007. The survey focused on clinic attendance, satisfaction with clinic structure, processes, and education and preference for alternatives to the current process. Respondents were asked to rank satisfaction or preference on a five-point Likert scale, with 1 being lowest and 5 being highest.

RESULTS: Most satisfaction related to follow-up with serology (4.6) and with a dietitian (4.3). The most preferred changes included either meeting the entire multidisciplinary team after the biopsy (4.7), or meeting with only the dietitian and nurse after the biopsy (4.4). The preferred education resources were the Internet (4.3) and the dietitian (4.2). The mean overall satisfaction score of the Multidisciplinary Pediatric Celiac Clinic was 4.0.

CONCLUSIONS: Results of the present survey suggested that patients and families value a multidisciplinary follow-up clinic for children with celiac disease. In particular, feedback based on repeat blood work and regular contact with a dietitian were highly valued. The present survey, outlining the most valued aspects of the clinic, may be useful for service delivery in other regions. In addition, it provides information on how to better support pediatric patients with celiac disease.
Immunization History of Children with Inflammatory Bowel Disease
Authors: Soon Ing Shian , deBruy Jennifer CC , Wrobel Iwona
Published: March 2016

BACKGROUND: Protection against vaccine-preventable diseases is important in children with inflammatory bowel disease (IBD) due to frequent immunosuppressive therapy use. The chronic relapsing nature and treatment regimen of IBD may necessitate modified timing of immunizations.

OBJECTIVE: To evaluate the completeness of immunizations in children with IBD.

METHODS: Immunization records of all children with IBD followed at the Alberta Children’s Hospital (Calgary, Alberta) were reviewed. For children with incomplete immunization according to the province of Alberta schedule, the reasons for such were clarified. Demographic data and age at diagnosis were also collected.

RESULTS: Immunization records were obtained from 145 (79%) children with IBD. Fifteen children had incomplete routine childhood immunizations, including two with no previous immunizations. The most common incomplete immunizations included hepatitis B (n=9), diphtheria, tetanus, acellular pertussis at 14 to 16 years of age (n=7), and diphtheria, tetanus, acellular pertussis, inactivated polio at four to six years of age (n=6). The reasons for incomplete immunization included use of immunosuppressive therapy at time of scheduled immunization; IBD-related symptoms at time of scheduled immunization; parental refusal; recent move from elsewhere with different immunization schedule; unawareness of routine immunization; and needle phobia.

CONCLUSIONS: Although the majority of children with IBD had complete childhood immunizations, suboptimal immunizations were present in 10%. With increasing use of immunosuppressive therapy in IBD, physicians caring for children with IBD must periodically evaluate immunization status and ensure the completeness of childhood immunizations.
Minimal Hepatic Encephalopathy
Authors: Stinton Laura M , Jayakumar Saumya
Published: March 2016

Minimal hepatic encephalopathy (MHE) is the earliest form of hepatic encephalopathy and can affect up to 80% of cirrhotic patients. By definition, it has no obvious clinical manifestation and is characterized by neurocognitive impairment in attention, vigilance and integrative function. Although often not considered to be clinically relevant and, therefore, not diagnosed or treated, MHE has been shown to affect daily functioning, quality of life, driving and overall mortality. The diagnosis of MHE has traditionally been achieved through neuropsychological examination, psychometric tests or the newer critical flicker frequency test. A new smartphone application (EncephalApp Stroop Test) may serve to function as a screening tool for patients requiring further testing. In addition to physician reporting and driving restrictions, medical treatment for MHE includes non-absorbable disaccharides (eg, lactulose), probiotics or rifaximin. Liver transplantation may not result in reversal of the cognitive deficits associated with MHE.
Development of a Web‐Based, Work‐Related Asthma Educational Tool for Patients with Asthma
Authors: Ghajar-Khosravi Shadi , Tarlo Susan M , Liss Gary M , Chignell Mark , Ribeiro Marcos , Levinson Anthony J , Gupta Samir
Published: March 2016

BACKGROUND: Asthma is a common chronic condition. Work‐related asthma (WRA) has a large socioeconomic impact and is increasing in prevalence but remains under‐recognized. Although international guidelines recommend patient education, no widely available educational tool exists.

OBJECTIVE: To develop a WRA educational website for adults with asthma.

METHODS: An evidence‐based database for website content was developed, which applied evidence‐based website design principles to create a website prototype. This was subsequently tested and serially revised according to patient feedback in three moderated phases (one focus group and two interview phases), followed by face validation by asthma educators.

RESULTS: Patients (n=10) were 20 to 28 years of age; seven (70%) were female, three (30%) were in university, two (20%) were in college and five (50%) were currently employed. Key format preferences included: well‐spaced, bulleted text; movies (as opposed to animations); photos (as opposed to cartoons); an explicit listing of website aims on the home page; and an exploding tab structure. Participants disliked integrated games and knowledge quizzes. Desired informational content included a list of triggers, prevention/control methods, currently available tools and resources, a self‐test for WRA, real‐life scenario presentations, compensation information, information for colleagues on how to react during an asthma attack and a WRA discussion forum.

CONCLUSIONS: The website met the perceived needs of young asthmatic patients. This resource could be disseminated widely and should be tested for its effects on patient behaviour, including job choice, workplace irritant/allergen avoidance and/or protective equipment, asthma medication use and physician prompting for management of WRA symptoms.
Using a Virtual Game System to Innovate Pulmonary Rehabilitation: Safety, Adherence and Enjoyment in Severe Chronic Obstructive Pulmonary Disease
Authors: Wardini Rima , Dajczman Esther , Yang Nathan , Baltzan Marcel , Préfontaine David , Stathatos Maria , Marciano Haguit , Watson Shawn , Wolkove Norman
Published: March 2016

OBJECTIVE: The present pilot study tested the use of a virtual game system (VGS) for exercise training in patients with moderate to very severe chronic obstructive pulmonary disease undergoing pulmonary rehabilitation (PR). Safety, feasibility, enjoyment and adherence were assessed.

METHODS: VGS (Wii [2006], Nintendo, USA) games were prescreened and categorized into lower‐ and upper‐body workouts. Patients admitted for a three‐ to four‐week inpatient PR program exercised daily. They were provided an opportunity to individually engage in VGS sessions three times weekly, varying with length of stay. Dyspnea, oxygen saturation and heart rate were measured before, during and after game sessions. Patients were considered to be adherent if they attended at least 50% of VGS sessions. Adverse events and enjoyment were evaluated.

RESULTS: Thirty‐two patients with a mean (± SD) age of 66±9 years and a mean forced expiratory volume in 1 s of 0.72±0.40 L participated. Among the 25 patients completing the program, adherence was 76%, with a mean attendance rate of 64±35%. Mean dyspnea score was 1.5±1.1 before and 3.2±1.2 after exercise. Mean oxygen saturation changed from 94±3% to 91±5% (P<0.001), while heart rate increased from 88±15 beats/min to 102±18 beats/min (P<0.001). One patient reported chest pain requiring nitroglycerin spray and five experienced transient desaturation below 85% with play. Patients enjoyed the program (visual analogue score 8±2.6/10) and most would highly recommend it to others.

CONCLUSIONS: Moderate exercise using a VGS was safe, feasible and enjoyed as an adjunct to inpatient PR. This modality may encourage patients to maintain physical activity after PR.