bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of Norfloxacin Versus Nalidixic Acid in Therapy of Acute Urinary Tract Infections
Authors: Selin Liisa K , Harding Godfrey KM , Thomson Margaret J , Kennedy James K , Urias Barbara A , Ronald Allan R
Published: March 2016

Thirty‐seven adult patients with acute urinary tract infections (UTI) were randomized to receive either a seven day (lower UTI) or a 14 day (upper UTI) course of norfloxacin 400 mg orally twice daily, or nalidixic acid 1 g orally four times per day. Mean age, underlying disease and infecting organisms were similar in the two groups. Nine patients in the norfloxacin group and seven in the nalidixic acid group had presumptive evidence of upper UTI. Overall, 12 patients had antibody‐coated bacteria‐positive infections. The infecting organisms were: Escherichia coli (27), coagulase‐negative staphylococci (four), Citrobacter freundii (three), Klebsiella pneumoniae (three), and Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, Enterobacter agglomerans, Streptococcus agalactiae, Enterococcus faecalis (one of each). All of the organisms were susceptible to norfloxacin, while 81% were susceptible to nalidixic acid. The effects on the periurethral and anal canal flora were similar in both groups. Five patients in each group experienced adverse clinical effects. The cure rates for norfloxacin and nalidixic acid were 79 and 83%, respectively. There were two failures, two relapses and four reinfections in the norfloxacin group. In the nalidixic acid group, there were two failures, one relapse and four reinfections. One of the failure patients in the nalidixic acid group developed resistance to the drug, and two of the four reinfections were due to organisms resistant to nalidixic acid. In this patient population it was concluded that nalidixic acid may be as effective as norfloxacin in the treatment of acute, symptomatic UTI.
Infective Endocarditis Due to Eikenella corrodens: Case Report and Review of the Literature
Authors: Patrick Ward D , Brown Winston D , Ian Bowmer M , Sinave Christian P
Published: March 2016

Eikenella corrodens is an uncommon cause of bacterial endocarditis. In the 11 reported cases in the literature, the disease was associated with predisposing factors and was clinically indolent or subacute. A case is reported which in contrast to the reported literature was acute in onset with severe heart failure, requiring urgent valve replacement.
Survey of Neisseria gonorrhoeae Antimicrobial Susceptibility in Ontario
Authors: Loo Vivian G , Simor Andrew E , Jaeger Ruth , Low Donald E
Published: March 2016

The minimal inhibitory concentrations (MICs) of penicillin, tetracycline, erythromycin, cefoxitin, ceftriaxone and spectinomycin were determined for 300 consecutive strains of Neisseria gonorrhoeae collected from physicians’ offices in Ontario. Only four isolates were found to produce beta‐lactamase. Of the remaining 296 isolates, five (1.7%) had penicillin MICs greater than or equal to 1 mg/L, 78 (26.3%) had tetracycline MICs greater than or equal to 1 mg/L, 13 (4.4%) had cefoxitin MICs greater than or equal to 1 mg/L and 43 (14.5%) had erythromycin MICs greater than or equal to 1 mg/L. Two isolates (0.7%) had high level tetracycline resistance with MICs greater than or equal to 16 mg/L. All N gonorrhoeae isolates were susceptible to ceftriaxone and to spectinomycin.
Two Cases of Osteomyelitis Due to Group G Streptococcus
Authors: Joshi Nirmal , Goldman John N
Published: March 2016

Two cases of group G streptococcal osteomyelitis in adults are reported, one of the patients being an otherwise healthy individual. Both cases were successfully treated with parenteral aqueous penicillin G. Only one case of group G streptococcal osteomyelitis has been described previously in the literature; this was in an intravenous drug abuser.
A Review of Tuberculous Meningitis in a Canadian Pediatric Hospital
Authors: Navas Lissette , Wang Elaine
Published: March 2016

Tuberculous meningitis is a disease associated with high morbidity and mortality. Experience with this disease at the Hospital for Sick Children in Toronto was reviewed to determine whether changes in prognosis have occurred in the past decade. All patients from whom the organism was recovered from the cerebrospinal fluid, or who had a positive Mantoux test in association with a compatible history, were included. Thirteen patients were identified from 1978 to 1989. The median age was six years (range 11 months to 17.5 years). Nine patients were born in Canada, but all except one were members of recently immigrant families. History of close contact with an adult with tuberculosis, or travel to an endemic area in the preceding six months, was present in seven cases. All patients had clinical manifestations and mild pleocytosis with elevated protein content in the cerebrospinal fluid. Patients were all diagnosed within 20 days after admission (median one day). Computed tomography scan of the head was abnormal in all patients within three weeks of admission. No patient died, although long term sequelae developed in five. The prognosis of tuberculous meningitis has improved in the past decade. Although a specific reason for this improvement cannot be definitively stated, earlier diagnosis and better chemotherapy may contribute.
Pneumococcal Endometritis with Peritonitis: Case Report and Review of the Literature
Authors: Ostrowska KI , Rotstein C , Thornley JH , Mandell LA
Published: March 2016

The first case of pneumococcal endometritis with peritonitis in a woman using tampons is described. The patient responded to removal of the tampon and administration of broad spectrum antibiotics. The pathogenesis of pneumococcal endometritis and peritonitis and the potential significance of a tampon in situ are discussed.
Clinical Features Fail to Distinguish Respiratory Infections Caused by Branhamella catarrhalis from Those Caused by Haemophilus Influenzae
Authors: Forward Kevin Roy
Published: March 2016

Branhamella catarrhalis is being isolated with increasing frequency from patients with symptoms and signs of respiratory tract infection. Records of 77 patients were reviewed to define the spectrum of respiratory illness and to compare clinical and laboratory features with those of respiratory infection due to Haemophilus influenzae. Both B catarrhalis and H influenzae caused respiratory infection predominantly in elderly males with underlying heart or lung disease. There were no clinical or laboratory features aside from sputum Gram stain and culture which differentiated the two groups. Although fewer than one‐half of each group received antibiotics, no patient developed progressive respiratory disease.
Comparative Evaluation of Seven Commercial Tests for Detection of Heterophile Antibody in Infectious Mononucleosis
Authors: Skulnick Martin , Low Donald E , Simor Andrew E , Patel Mohan , George Pauline , Chua Robert
Published: March 2016

Detection of heterophile antibodies in infectious mononucleosis is the most rapid and cost‐effective method for confirming the clinical diagnosis of the disease. This study compared seven commercial test kits (the Oxoid Infectious Mononucleosis Kit [Oxoid Ltd], Immunoscan Im‐Latex [Baxter Travenol], Mono‐Latex [Wampole Laboratories], Monospot and Im Screen Test [Ortho Diagnostics], Immunoscan Im‐RBC Test [Baxter Travenol], and Infectious Mononucleosis Test [NCS Diagnostics]) to the Davidsohn differential test. All of the kits were shown to be acceptable for use, with specificities and sensitivities greater than 96.5% and 95.5%, respectively.
Initial Therapy of Bacterial Meningitis with Cefuroxime: Experience in 167 Children
Authors: Navas Lissette , King Susan M , Gold Ronald
Published: March 2016

The morbidity and mortality of patients with bacterial meningitis treated initially with cefuroxime were studied and compared with the results of a previous prospective study of patients treated initially with ampicillin plus chloramphenicol in the same institution from 1979 to 1983. A retrospective chart review was completed in all cases of microbiologically confirmed bacterial meningitis admitted to the Hospital for Sick Children in Toronto, Ontario between January 1, 1984 and August 1, 1988. During this period all patients were treated initially with intravenous cefuroxime. The 167 children reviewed ranged in age from six weeks to 17.1 years (median 11.6 months). The case fatality rate was 7.8% and the rate of hearing deficit 13%. There were no statistically significant differences in abnormal neurological outcome (20 versus 20%, respectively), hearing loss (12.9 versus 13%, respectively), and case fatality rate (6.4 versus 7.8%, respectively) between the cohort of 1979–83 and the present study. The rate of hearing loss following meningitis caused by Haemophilus influenzae type b increased from 7.3 to 11.7% (P=0.26).
Antibody to Hepatitis C Virus in Risk Groups in Canada
Authors: Chaudhary RK , Mo Theresa
Published: March 2016

The prevalence of antibodies against hepatitis C virus (HCV) was studied in hemophiliacs, hemodialysis patients, intravenous drug abusers, female prisoners, homosexuals, individuals with no markers of recent hepatitis A or B virus infections and normal individuals (federal public servants), by an enzyme immunoassay (Ortho Diagnostic Systems Inc). Repeat positive samples were further tested by recombinant immunoblot assay (RIBA) HCV (Chiron Corp, California). The number of samples positive for antibodies to HCV (anti‐HCV) was higher with enzyme immunoassay than by RIBA HCV in most cases. A high prevalence of anti‐HCV was detected in hemophiliacs by both enzyme immunoassay (68.8%) and RIBA HCV (53.7%). Among intravenous drug abusers and female prisoners the prevalence rates for anti‐HCV were 42.8% and 29.8%, respectively, by RIBA HCV; the results with enzyme immunoassay were only slightly higher. The prevalence rate was also high by both tests (54.2%) in hemodialysis patients’ sera taken during 1980–82, when many cases of non‐A,non‐B hepatitis were suspected in this group. In contrast, only 14.1% of sera taken during 1990 were positive by RIBA HCV. In individuals with no markers of recent hepatitis A or B infections, 13.4% were positive by enzyme immunoassay, whereas only 4.5% were reactive by RIBA HCV. The lowest prevalence was seen in homosexuals (2.3%) and normal individuals (1.2%) by RIBA HCV. These results indicate a high prevalence of anti‐HCV in high risk groups tested in Canada.
Neonatal Rectal Colonization with Malassezia furfur
Authors: Gross Gil J , MacDonald Noni E , Mackenzie Andrew MR
Published: March 2016

Malassezia furfur and Candida albicans are fungal pathogens which have been recognized with increasing frequency as agents of mortality and serious morbidity in neonatal intensive care unit patients. A longitudinal study of oral, rectal and umbilical colonization by these organisms of newborns admitted to a neonatal intensive care unit within 24 h of birth was undertaken. Of 71 infants followed for a minimum of 10 days, 24 were colonized with M furfur and 12 with C albicans during the first 10 days of life. The lower gastrointestinal tract was found to be the most common colonization site for both organisms. Statistically significant (P<0.05) inverse associations were demonstrated between gestational age and risk of colonization with either organism at any site, and between birthweight or gestational age and risk of rectal colonization with either organism. Antibiotics were associated with a relative risk colonization of 4.06 (P=0.06) with either organism at any site. It is concluded that M furfur and C albicans are common colonizing organisms in a neonatal intensive care unit setting and are most frequently harboured in the lower gastrointestinal tract. M furfur, recently implicated as a systemic pathogen in this population, has not been previously recognized as a gastrointestinal commensal organism. The relationship between colonization and invasive fungal disease, and potential roles for preventive strategies, remain to be elucidated.
Serological Investigation of Pneumonia as It Presents to the Physician’s Office
Authors: Langille DB , Yates L , Marrie TJ
Published: March 2016

Purpose: To define the etiology of pneumonia, using a battery of serological tests, among patients presenting to physicians’ offices in Cumberland County, Nova Scotia from July 2, 1989 to July 1, 1990.

Methods: Patients presenting to their physician’s office with symptoms suggestive of pneumonia were invited to participate in the study by completing a questionnaire, having a chest radiograph and providing acute and convalescent phase serum samples. These serum samples were tested for antibodies to Mycoplasma pneumoniae, Coxiella burnetii, Legionella pneumophila, adenovirus, and influenza viruses A and B. Some of the samples were tested for antibodies to Chlamydia pneumoniae.

Results: Seventy‐five of the inception cohort of 203 patients had a chest radiograph compatible with pneumonia, a completed questionnaire and acute and convalescent phase serum samples. There were 39 females and 36 males with a mean age of 41.7 years. Twenty‐six (35%) were admitted to hospital. The mortality rate was 3%. Forty‐five per cent had a diagnosis made by serology: M pneumoniae, 22 (29%); influenza A virus, five (7%); C burnetii, L pneumophila, adenovirus, two (3%) each.

Conclusions: While it is not possible to generalize about these findings because of ascertainment bias, the data suggest that M pneumoniae is a common cause of pneumonia presenting to a physician’s office and that mortality is low in this group of patients.
Tuberculosis Involving the Oral Cavity
Authors: Ferguson Kathleen A , McCormack David G
Published: March 2016

The oral cavity is a rare site for extrapulmonary tuberculosis. A case is reported of a young woman with dysphagia and oral ulceration. The original mucosal biopsy was negative on smear for acid‐fast bacilli, and the patient subsequently developed pulmonary symptoms. A diagnosis of Mycobacterium tuberculosis was ultimately made on open lung biopsy. Complete resolution of both mouth lesion and chest involvement occurred with standard antituberculous therapy.
High Prevalence of Occult Hepatitis B among Immigrant Students in Canada: A Case for Universal Immunization of Young Adults
Authors: Pennie Ross A , Kang C Yong
Published: March 2016

The prevalence and demographic characteristics of positive hepatitis B (HBV) serology were determined among post secondary health care students in Ottawa. Ontario. HBV seropositivity was defined as the presence of HBV surface antigen (HBsAg) or antibodies to HBV core or surface antigens by radioimmunoassay. HBsAg‐positive students were advised to visit their family doctors; the health measures that resulted were observed. Among 600 students born in North America, the proportion of HBV seropositive and HBsAg‐positive were 0.8 and 0.2%, respectively. Among the 63 students born outside Europe or North America. 22.2% were HBV seropositive (odds ratio 29.7. confidence interval 10.1 to 97.5) and 7.9% were HBsAg‐positive (odds ratio 54.2, confidence interval 5.9 to 2568.3). Of the seven HBsAg‐positive students, none had known their HBV status – five visited their doctors, two of whom sought and immunized susceptible household contacts. This survey supports the view that many sexually active young adults integrating into Canadian society from immigrant families are unknowingly HBsAg‐positive, and when their HBV status is identified to them and their doctors, appropriate measures for the protection of close contacts are often overlooked. Physician education about the management of HBV carriers should be improved and consideration given to the universal HBV immunization of young adults.
Streptococcus pneumoniae: A Cause of Primary Lung Abscess in a Child
Authors: MacDonald Kelly S , de Carvalho Volia M , Liebert Lawrence , Embree Joanne E
Published: March 2016

A case of primary pneumococcal lung abscess in a five‐year‐old child is described. Secondary anaerobic infection as a cause of cavitation was excluded by bronchoscopic culture of the cavity. Streptococcus pneumoniae is a rare but recognized cause of lung abscess in healthy children.
Thrombotic Thrombocytopenic Purpura Associated with Pneumococcal Sepsis
Authors: Schriber Jeffrey R , Freedman John J , Brandwein Joseph M
Published: March 2016

The first documented case of thrombotic thrombocytopenic purpura (TTP) associated with pneumococcal septicemia is reported. This association has been previously demonstrated with hemolytic uremic syndrome. The patient presented with recurrent seizures, oliguric renal failure, fever, thrombocytopenia and microangiopathic hemolytic anemia; coagulation studies were normal. Blood and sputum cultures were positive for Streptococcus pneumoniae. The patient responded to therapy with plasmapheresis and antiplatelet agents as well as antibiotics. Coincident infection should be searched for in all cases of TTP.
Brain Abscess in the Computed Tomography Era: A 10‐year Experience from Auckland, New Zealand
Authors: Holland DJ , Cooper B , Garner J , Ellis-Pegler R , Mee E
Published: March 2016

Notes were reviewed for 68 patients with brain abscess diagnosed at Auckland Hospital, Auckland, New Zealand between 1978 and 1988. Mean age was 30 years (range one week to 74 years). There were 48 men and 40% were Maori or Pacific Island Polynesians. Seventy‐two per cent of patients had headache, 54% had fever and 72% had lateralizing neurological signs. Thirty‐one per cent of abscesses were associated with contiguous infection (otic, sinus, dental). Forty‐four per cent were in the frontal lobe. Two abscesses were sterile; 197 bacterial isolates were cultured from the remainder. Fifty‐four per cent contained obligate anaerobes, which were the only isolates in 22%. Streptococcus anginosus was the single most common isolate present in 22% of the abscesses. Amoxycillin plus metronidazole provided cover for approximately 95% of the total isolates on the basis of sensitivity testing. Treatment was with surgery and antibiotics in all but three patients, who were cured with antibiotics alone. Sixty per cent had a definitive regimen of penicillin (or ampicillin/amoxycillin) and/or metronidazole, always intravenous initially but subsequently often orally. Median duration of antibiotic treatment was 57 days (range 28 to 206). Seventy‐five per cent had initial aspiration, 9% open drainage and 7% were excised initially. Seventy‐one per cent had a good functional outcome. Mortality was 8.8%. Factors associated with a poor outcome were trauma as a cause, and delays after admission of more than seven days to diagnosis and/or operation.
Prevention of Perinatal Hepatitis B Virus Transmission in an Obstetric/Infant Population
Authors: Parker Paul J , Gyorkos Theresa W , Dylewski Joseph S , Joshi Arvind K , Franco Elaine D
Published: March 2016

Study Design: This retrospective study reviewed the screening practice and seroprevalence of hepatitis B surface antigen (HBsAg) among all mothers with live births at a teaching hospital in Montreal between November 1, 1990 and April 30, 1991.

Results: Most women (94%) were screened prenatally and 5.2% postnatally. Screening status could not be determined for 0.8% of women. One‐quarter of all postnatal screening results were available only at 48 h or more postdelivery. No infants born to women with postnatal screening or to women with unknown screening status were immunized expectantly. The maternal seroprevalence was 1.08% (95% confidence interval from 0.6, 1.4). All 22 infants born to HBsAg‐positive mothers had received hepatitis B immune globulin within 12 h of birth and the first dose of hepatitis B vaccine within 24 h. Follow‐up of infants revealed that only 50% had received the second and third doses according to the recommended protocol, with 83% completing the immunization series.

Conclusion: These results indicate that a program of prenatal HBsAg screening and neonatal prophylaxis against hepatitis B can be successfully instituted in a high volume obstetric hospital, and that better monitoring of infants is required to ensure completion of vaccination.
Evaluation of Immunization Coverage in the Adult Population of Canada
Authors: Duclos Philippe
Published: March 2016

The immunization coverage of the adult population, availability of records and knowledge of proper schedules were assessed using the Canada Omnibus Survey, a door to door survey of a modified probability sample conducted four times a year. In total, 8021 interviews were completed over four periods. Only 43% of individuals 65 years of age or older reported receiving a dose of influenza vaccine during the year preceding the interview. Twenty‐one per cent (38% of those under 25 and 9% of those 65 and older) reported having an immunization booklet at home. Twelve per cent believed that there were no vaccines that they should be receiving regularly. Only 61% of those who believed they should receive some shots regularly knew when the next one was due. Overall, 48% felt they had enough information about the vaccines they should receive. This information will help target immunization programs for the adult population.
A Nonselective Cation Channel in Adult Alveolar Epithelial Cells
Authors: Orser Beverley A , Edelson Jeffrey D
Published: March 2016

OBJECTIVE: Efficient gas exchange across the alveolar
membrane requires a dry air space. At birth, active Na+
transport provides the major driving force for absorption of
fetal lung liquid, and during adult life, similar transport
mechanisms balance fluid exchange across the alveolarcapillary
membrane. A cation channel, previously identified
in fetal alveolar epithe lium, may represent one of several
pathways which regulate apical‐basal transepithelial Na+
flux. The purpose of this study was to determine if cation
channels are also present in adult alveolar epithelial cells.

DESIGN: Standard inside‐out patch‐clamp recording techniques
were used to study channels present in patches of
membrane from adult rat alveolar epithelium.

POPULATION: Alveolar epithelial cells were obtained from
adult male Sprague‐Dawley rats and studied in primary cell
culture.

MAIN RESULTS: A 23 pS nonselective cation channel was
identified in 68% of patches voltage clamped to ‐60 mV.
The probability of channel opening was not influenced by
changes in membrane potential. Amiloride ( I05 M) applied
to the extracellular membrane induced channel flickering
and reduced the apparent mean channel open time
without affecting channel conductance.

CONCLUSIONS: These results provide direct evidence for a
cation channel in the apical membrane of adult alveolar
epithelial cells. The channel is similar to a nonselective
cation channel in fetal alveolar epithelial cells and may play
an important role in Na+‐coupled fluid absorption and/or K+
secretion.
Reduction in Surgical Wound Infection Rates Associated with Reporting Data to Surgeons
Authors: Taylor GD , Buchanan-Chell M , Kirkland T , McKenzie M , Sutherland B , Wiens R
Published: March 2016

Several studies have shown that wound infection (surgical site infection [ ssi ]) rates fall when surgeons are provided with data on their performance. Since 1987, the authors have been performing concurrent surveillance of surgical patients and confidentially reporting surgeon‐specific ssi rates to individual surgeons and their clinical directors, and providing surgeons with the mean rates of their peers. The program has been gradually refined and expanded. Data are now collected on wound infection risk and report risk adjusted rates compared with the mean for hospitals in the United States National Nosocomial Infections Surveillance (nnis) data bank. Since inception through to December 1993, ssi rates have fallen 68% in clean contaminated general surgery cases (relative risk [rr] 0.36, 95% ci 0.2 to 0.6, P=0.0001), 64% in clean plastic surgery cases (rr 0.35, 95% ci 0.06 to 1.8), 72% in caesarean section cases (rr 0.23, 95% ci 0.03 to 1.96) and 42% in clean cardiovascular surgery cases (rr 0.59, 95% ci 0.34 to 1.0). In clean orthopedic surgery the ssi rate remained stable from 1987 through 1992. In 1993 a marked increase was experienced. Reasons for this are being explored. Overall there was a 32% decrease in ssi rate between the index year and 1993 or, in percentage terms, 2.8% to 1.9% (rr 0.65, 95% ci 0.51 to 0.86, P=0.002). ssi surveillance should become standard in Canadian hospitals interested in improving the quality of surgical care and reducing the clinical impact and cost associated with nosocomial infection.
Persistent Cough in Nonsmokers
Authors: Hoffstein Victor
Published: March 2016

OBJECTIVE: The purpose of this study was to test the
hypothesis that, using Irwin′s protocol, the majority of
nonsmokers with persistent cough can be diagnosed and
treated successfully.

DESIGN: Retrospective review of patients referred for the
investigation of chronic cough.

SETTING: Referral out‐patient practice of a hospital‐based
pulmonary physician.

PATIBNTS: There were 228 patients who satisfied the following
entry criteria for inclusion in the data analysis:
cough longer than four weeks; nonsmoker; normal chest
radiograph; and completion of the required investigations.
A total of 198 patients completed the required investigations
and returned for the final follow‐up visit.

INTERVENTIONS: Diagnostic tests included chest radiographs,
pulmonary function tests, radiographs of the sinuses,
barium swallow and fibreoptic bronchoscopy.

MAIN OUTCOME MEASURES: Status of cough at the time
of final follow‐up visit, classified according to four levels:
resolved, improved, unchanged or worse.

RESULTS: The diagnosis was established in 91 % of patients.
The most common diagnoses (alone or in combination)
were postnasal drip (26% ), asthma (25% ), gastroesophageal
reflux (24%), postinfectious cough (21 %), and
cough due to angiotensin‐converting enzyme inhibitors
(6%); none had an occult malignancy and one patient had
endobronchial tuberculosis. The initial diagnostic impression
was best in patients with postinfectious cough (100%)
and worst in patients with asthma (25%). The outcome of
specific therapy was successful in 91 % of patients.

CONCLUSIONS: In the majority of nonsmoking adults
cough can be diagnosed and treated successfully. most
causes are relatively ′benign′ and the initial clinical impression
may be quite misleading, particularly in cough‐variant
asthma.
Throat Colonization of Neonatal Nursery Staff by Ureaplasma urealyticum: an Infection Control or Occupational Health Consideration?
Authors: Embree Joanne E , Alfa Michelle , Lertzman Joy , Gray Gloria , Fajardo Carlos , Yassi Annalee
Published: March 2016

Very low birth weight infants often have protracted respiratory tract colonization with Ureaplasma urealyticum. To determine whether prolonged contact with very low birth weight infants resulted in higher rates of upper respiratory tract colonization with this organism for caregivers, throat swabs for U urealyticum culture were obtained from medical, nursing and other support staff working in the neonatal intensive care and level II nurseries at the Health Sciences Centre and the St Boniface Hospital in Winnipeg, Manitoba. Throat colonization by U urealyticum was demonstrated in 7.3% (95% ci 0 to 15.6%) of 41 nurses working in the intensive care nurseries but in none of the 48 nurses working in other locations or the 66 other individuals tested (P=0.02). However, throat colonization was not significantly higher among the neonatal intensive care nurses than among the women delivering at one of the study institutions. Close contact with very low birth weight infants appears to constitute a minimal risk for increased throat colonization with U urealyticum among hospital staff members.
Asbestos Related Disorders
Authors: Bégin Raymond , Dufresne André , Plante François , Massé Serge
Published: March 2016

An updated summary of current understanding of asbestos
related disorders is presented, along with a review of the
history of the disorders, and the mineralogy, biological
tissue burden, pathogenesis, pathology and clinical aspects
of the asbestos related disorders, with particular emphasis
on important information for the clinician.
Bacteremia in a Long Term Care Facility
Authors: Nicolle Le , McIntyre M , Hoban D , Murray D
Published: March 2016

Episodes of bacteremia identified in a long term care facility over a seven and a half‐year period from July 1984 to December 1991 were reviewed. Twenty‐nine episodes of bacteremia were identified, a rate of 4.35/100,000 patient‐days. The most common infecting organisms were Escherichia coli (11 episodes), Streptococcus pneumoniae (four), Proteus mirabilis (three), Staphylococcus aureus (three) and Bacteroides species (two). The source of bacteremia was urinary in 45% of patients, gastrointestinal in 17%, pneumonia in 14%, skin in 14% and unknown in 10%. The overall case fatality rate was 24%, but for the final six years of the review the case fatality rate was only 9.5%. These observations report a rate of bacteremia 10‐fold lower than reported from other North American long term care facilities and, potentially, a lower case fatality rate. The primary site of bacteremia, however, in long term care facilities is the urinary tract.
Gnathostomiasis: Report of a Case and Brief Review
Authors: Houston Stan
Published: March 2016

Nematodes of the genus Gnathostoma can cause a spectrum of disease in humans. This includes a distinctive syndrome of intermittent migratory subcutaneous swellings, central nervous system involvement with high morbidity and mortality and occasionally, involvement of other organs. Gnathostomiasis is endemic in southern and eastern Asia, particularly Thailand, but has recently been reported from Ecuador and Mexico. Diagnosis is usually based on clinical, epidemiological and serological findings. A recent study suggests that treatment with albendazole is effective. This report describes a patient diagnosed in Canada in whom evidence of pericarditis was associated with gnathostomiasis and in whom treatment with albendazole appears to have been effective.
Diaphragm Structure and Function in Emphysematous Hamsters
Authors: Reid WD , Wilton RK
Published: March 2016

OBJECTIVE: To determine if muscle fibre injury, reduced
force output and fatigue of the diaphragm accompanied
hyperinflation induced by experimental emphysema.

DESIGN: Controlled and randomized.

ANIMALS: Adult male golden Syrian hamsters: seven control
and seven experimental emphysema hamsters were
studied.

INTERVENTIONS: Following anesthesia, experimental emphysema
hamsters received a transtracheal injection of elastase.
They also received injections of β‐aminopropionitrile
every other day for five weeks. After five weeks, all hamsters we re anesthetized , and their diaphragm and lungs were
excised.

MAIN RESULTS: Measurements of the excised lungs
showed an increased residual volume. functional residual
capacity and total lung capacity in experimental emphysema hamsters. In vitro physiological study of diaphragm
strips showed no difference in force output but a greater
fatiguability during repetitive stimulation for 5 mins in
experimental emphysema hamsters than in control hamsters. Histological examination did not show significant
muscle injury in the diaphragm of experimental emphysema
hamsters.

CONCLUSION: The greater fatiguability and absence of
muscle injury in the diaphragm of emphysematous hamsters
may result from hyperinflation decreasing diaphragmatic
load. Alternatively, muscle damage not detectable at the
light microscopic level may have contributed to increased
fatiguability of the diaphragm of experimental emphysematous
hamsters.
National Workshop on Asthma and the Environment
Authors: Wood Tom , Ernst Pierre
Published: March 2016

A national workshop on asthma and the environment was
held October 23 and 24, 1992. in Montreal, Quebec.
Twenty‐nine speakers presented data on asthma from a
Canadian perspective. A nun1hcr of recommendations were
produced which will influence future asthma research and
management in Canada.
Group A Streptococcal Endometritis: Report of an Outbreak and Review of the Literature
Authors: Memish Ziad A , Gravel-Tropper Denise , Oxley Catherine , Toye Baldwin , Garber Gary E
Published: March 2016

Two cases of group A streptococcus (gas) postpartum endometritis were diagnosed within 24 h following uncomplicated vaginal delivery. Investigation by the infection control service identified all 10 obstetric personnel who performed any invasive procedure on both cases. These personnel were questioned about a recent history of sore throat, skin lesions, vaginal or rectal symptoms. Throat and rectal cultures were obtained for gas from all 10 personnel. A carrier was identified among the personnel screened. This nurse was removed from direct patient care and treated with a two‐week course of oral clindamycin and rifampin with documentation of carrier eradication of gas at the end of therapy, 30 days, 60 days and six months post‐treatment. All three isolated strains were identical by restriction endonuclease analysis and by M and T typing. Rapid implementation of infection control measures were successful in arresting this outbreak, with no further cases of gas occurring in the subsequent year.
Passive Protection of Diabetic Rats with Antisera Specific for the Polysaccharide Portion of the Lipopolysaccharide Isolated from Pseudomonas pseudomallei
Authors: Bryan Larry E , Wong Sallene , Woods Don E , Dance David AB , Chaowagul W
Published: March 2016

Polyclonal and monoclonal antisera raised to tetanus toxoid‐conjugated polysaccharide of lipopolysaccharide (lps) and purified lps of Pseudomonas pseudomallei that reacted with a collection of 41 strains of this bacterium from 23 patients are described. The common antigen recognized by these sera was within the polysaccharide component of the lps of the cells. The sera were specific for P pseudomallei in that none of 37 strains of other bacteria, including 20 Gram‐negative and three Gram‐positive species, were recognized, although cross‐reaction occurred using the anticonjugate serum with some strains of Pseudomonas cepacia serotype A, a closely related bacterium. Passive protection studies using a diabetic rat model of P pseudomallei infection showed that partially purified rabbit polyclonal and mouse monoclonal antisera were protective when the median lethal dose was raised by four to five orders of magnitude. The wide distribution of the polysaccharide antigen among isolates of P pseudomallei used in this study and the protective role of antibody to the conjugated polysaccharide antigen suggest potential as a vaccine.
Death or Taxes? An Examination of Recent Changes in Tobacco Taxation Policy in Canada
Authors: Goodyear Michael DE
Published: March 2016

Manipulation of the price of tobacco products has proven to
be one of the most effective tools in tobacco control. However,
a strategy relying predominantly on tampering with
free‐market conditions by raising prices independently of
the quantity available is unlikely to be successful over the
long term, unless balanced by equal efforts to reduce demand.
Canada has a number of unique factors which combined
to create a contraband market that eventually led to
political pressure for action at a national level. Although
presented with a number of policy alternatives, the federal
government based its strategy on reducing tobacco taxes to
compete with the contraband product. Provision of an effective
comprehensive national strategy to combat tobacco has
yet to be realized. Econometric models predict significant
changes in consumption from drastic tax reductions that
effectively halved the retail price in a large part of Canada.
The medical profession and public health authorities will
need to combat these effects, not only by working for
restoration of fiscal pressures but also for sweeping measures
to restrict overall demand if increases in long term
morbidity and mortality are to be prevented.
Multiple Pyarthrosis in Human Immunodeficiency Virus‐Infected Hemophiliacs
Authors: Ingram Alistair , Inwood Martin J , Gregson Dan , Coppolino Michael
Published: March 2016

Classically, a swollen, painful joint in a patient with hemophilia has been considered to be due to a hemarthrosis until otherwise proven, and treated immediately with appropriate coagulation factor replacement. Two cases of human immunodeficiency virus (hiv)‐infected hemophiliacs presenting with an initial apparent hemarthrosis, complicated subsequently by numerous pyarthroses and sepsis are described. In light of the prevalence of hiv infection in the adult hemophiliac population with arthropathy, a reappraisal of the clinical caveat of immediate infusion without joint aspiration is required.
In Search of the Genes of Asthma on the Island of Tristan da Cunha
Authors: Zamel Noe
Published: March 2016

Asthma, like several common diseases such as diabetes and atherosclerosis, occurs in families and thus probably has a complex polygenic basis, in which environmental factors also play a role. In trying to elucidate the genetic mechanism, studies of communities characterized by a high level of interbreeding and a high prevalence of asthma should be helpful. One such community has been described in the medical literature, the island of Tristan da Cunha. The University of Toronto Genetics of Asthma Project decided to study this community. It sent a team to the island to construct a geneology, obtain a history of respiratory and allergy symptoms by questionnaire, perform allergy skin testing and methocholine challenge, and obtain blood for white cell genetic studies. The initial results of this study are presented here, together with a historical perspective on the people of Tristan da Cunha.
Sequential Antibiotic Therapy: Effective Cost Management and Patient Care
Authors: Mandell Lionel A , Bergeron Michel G , Gribble Marie J , Jewesson Peter J , Low Donald E , Marrie Thomas J , Nicolle Lindsay E
Published: March 2016

The escalating costs associated with antimicrobial chemotherapy have become of increasing concern to physicians, pharmacists and patients alike. A number of strategies have been developed to address this problem. This article focuses specifically on sequential antibiotic therapy (sat), which is the strategy of converting patients from intravenous to oral medication regardless of whether the same or a different class of drug is used. Advantages of sat include economic benefits, patient benefits and benefits to the health care provider. Potential disadvantages are cost to the consumer and the risk of therapeutic failure. A critical review of the published literature shows that evidence from randomized controlled trials supports the role of sat. However, it is also clear that further studies are necessary to determine the optimal time for intravenous to oral changeover and to identify the variables that may interfere with the use of oral drugs. Procedures necessary for the implementation of a sat program in the hospital setting are also discussed.
Sleep Apnea and Aortic Dissection
Authors: Hanly Patrick J , Ford David
Published: March 2016

A 62‐year‐old man presented with obstructive sleep apnea, congestive heart failure and Cheyne‐Stokes respiration. Further evaluation revealed a chronic dissecting aneurysm of the aorta causing vena caval obstruction. Surgical correction or the aneurysm dramatically improved ventricular function with resolution of Cheyne‐Stokes respiration. Nasal continuous positive airway pressure corrected the obstructive sleep apnea and associated clinical features. The cardiopulmonary interactions between sleep apnea and aortic dissection are discussed.
Comparative Activity of Several Antimicrobial Agents against Nosocomial Gram‐Negative Rods Isolated across Canada
Authors: Scriver Shelley R , Canadian Antimicrobial Resistance Study Group  , Low Donald E
Published: March 2016

In 1992, a surveillance study was performed in Canada to determine the susceptibility of nosocomial Gram‐negative rods to several wide spectrum antimicrobials. Consecutive isolates from 10 institutions, as well as additional strains of selected species of Enterobacteriaceae that are known to possess the Bush group 1 beta‐lactamase, were tested for susceptibility to 12 antimicrobials. Third‐generation cephalosporin resistance was found to be as high as 29% in Enterobacter cloacae that possesses the Bush group 1 beta‐lactamase and less than 4% in those isolates not possessing this enzyme. Cefepime equalled or exceeded the activity of the third‐generation cephalosporins against the species of Enterobacteriaceae that demonstrated resistance to the third‐generation cephalosporins.
Management of Recurrent Lung Infections in a Case of Hyperimmunoglobulinemia E (or Job’s) Syndrome
Authors: Arsenault M , Echave V , Fish C , Praud J-P
Published: March 2016

The diagnosis of hyperimmunoglobulinemia E (hyper IgE) or Job’s syndrome was made in a five‐month‐old girl with chronic staphylococcal mastitis, elevated serum IgE and abnormal neutrophil chemotaxis. After multiple hospitalizations for severe skin in functions, right upper lobe bullae were found and treated by lobectomy when the patient was three years of age. Thereafter, the patient was repeatedly hospitalized for pneumonia while on cloxacillin prophylaxis and receiving regular chest physiotherapy. When she was 12 years old, pulmonary deterioration (increased frequency of pulmonary infections, hemoptysis, radiological destruction or the right middle lobe) led 10 a right middle lobectomy. Since this intervention, the patient has had an improved quality nf life, takes part in regular sports activities, without recurrence of severe pulmonary infections, and has had near normal pulmonary function studies. A concerted medicosurgical therapeutic regimen can control severe pulmonary complications in patients with this rare syndrome.
Effect of Cigarette Smoke on Bronchial Reactivity
Authors: Wright JL , Sun J-P , Vedal S , Churg A
Published: March 2016

OBJECTIVE: To compare the effects of a brief low level exposure to cigarette smoke in rats with known low (Sprague‐Dawley) and high (Fisher) airway responsiveness, to test the hypothesis that airways reactivity influences the severity or duration of pulmonary function alterations after cigarette smoke exposure.

METHODS: Baseline pulmonary function tests and methacholine dose response tests were conducted in 10 Sprague‐Dawley and 10 Fisher rats. On the following day, the animals were reanaesthetized, and breathed for 1 min from a 2 L chamber into which 25 mL of fresh cigarette smoke had been injected, followed by a second set of pulmonary function and methacholine response tests; a final set was performed two weeks later.

RESULTS: Sprague‐Dawley rats were larger, with larger lung volumes, compliance and flow rates, but Fisher rats showed a fourfold higher airway reactivity. Although neither resistance nor response to methacholine changed in either strain of animal, Sprague‐Dawley rats showed an increase in residual volume post smoke, which was not sustained over two weeks, and sustained small increases in vital capacity, total lung capacity and static lung compliance, with a sustained decrease in forced expiratory volume in 0.1 s, while Fisher rats showed only a small sustained increase in functional residual capacity.

CONCLUSIONS: Although there are marked differences in pulmonary function between the two different strains of rats, increased airways responsiveness per se does not make the animal more sensitive to the acute effects of cigarette smoke, and the effects of cigarette smoke on pulmonary function are not necessarily related to increased airway resistance. Pulmonary function alterations seen after brief cigarette smoke exposure may be sustained for a relatively long period of time.
Trends in Mortality from Chronic Obstructive Pulmonary Disease in Alberta: Back to the Future?
Authors: Guidotti Tee L
Published: March 2016

Trends in mortality from chronic obstructive pulmonary disease (COPD) in Alberta over 60 years, from 1927 to 1987, for ages 15 and above or both sexes, were examined. There was a striking decline in mortality among older adults in the 1930s and 1940s. a nadir that lasted almost 10 years in the 1950s, and a striking increase thereafter. By 1970, most age groups had returned to levels of the 1930s. This overall trend was observed in both the younger age groups (aged 15 to 50) and older adults, although mortality from COPD in the former disproportionately reflected asthma‐related deaths. Subsequently, mortality climbed still higher in older age groups, but not in the younger age groups. The sustained rise in mortality in older age groups after the Second World War is presumably related to smoking habits. Historical trends in Alberta were then compared with Canada as a whole for both sexes over 50 years of age. Although Alberta had a much lower mortality from COPD than Canada as a whole, this difference disappeared by 1980. There is no obvious explanation that would explain all of the observed trends, but they appear more likely to be a consequence of social and environmental conditions, including changes in health‐related behaviour, than of major changes in medical management at the time.
Molecular Basis for Mucolytic Therapy
Authors: Dasgupta Bonnie , King Malcolm
Published: March 2016

Airway mucus is a complex, viscoelastic gel that has a three‐dimensional structure. It is composed of water, mucous glycoproteins, low molecular weight ions, proteins and lipids. The three‐dimensional structure of the mucous gel depends on a number of forms of bonding, such as ionic bonds and disulphide bridges. Airway obstruction in cystic fibrosis (CF) lung disease is accompanied by the accumulation of thick and viscous secretions resulting from chronic infection and inflammation, promoting recurrent exacerbations. The normal, free‐flow ing airway mucus becomes thick and purulent in patients suffering from CF lung disease. Therefore, current approaches to the treatment of CF include strategics for changing the physical properties of pulmonary secretions with the goal of improving airway clearance. Some of the same strategies may be applicable in the larger group of patients with chronic obstructive airway diseases, including bronchiectasis and chronic obstructive pulmonary disease. This paper reviews various approaches to mucolysis based on the molecular nature of crosslinking and bonding in mucin gels. A brief review of the structure and biochemistry of airway mucus is followed by a discussion of the various physical and biochemical approaches to mucolysis. Seven representative mucotropic modalities are presented: N‐acetylcysteine; urea; hypertonic saline; recombinant human DNase; gelsolin; oscillation; and surfactants. Each of these mucotropic modalities acts on a different component within the mucous gel. Finally, the possibilities of mucolytic synergism among these various agents are conside red.