bluuebunny/crossref_metadata_2025 huggingface dataset:
Can Access to Spirometry in Asthma Education Centres Influence the Referral Rate by Primary Physicians for Education?
Authors: Labrecque M , Lavallée M , Beauchesne MF , Cartier A , Boulet LP
Published: March 2016

BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators. The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners.

METHODS: A one‐year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second six‐month period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs’ services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period.

RESULTS: The group of AECs randomly selected for spirometry in the second six‐month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions.

CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.
Discharge Delay in Patients with Community‐Acquired Pneumonia Managed on a Critical Pathway
Authors: Moeller Jeremy J , Ma Martin , Hernandez Paul , Marrie Thomas , Touchie Claire , Patrick Ward
Published: March 2016

INTRODUCTION: It has previously been reported that a critical pathway for community‐acquired pneumonia (CAP) significantly reduces bed days per patient managed but results in no difference in average length of stay, suggesting that discharge criteria were not successfully implemented. The present study sought to identify factors in the timing of discharge not taken into account by discharge criteria.

METHODS: Patients admitted with CAP and placed on a pneumonia critical pathway were studied. Patients′ functional and cognitive status were evaluated using the Barthel Index, Hierarchical Assessment of Balance and Mobility (HABAM) and the Mini‐Mental Status Examination. Once discharge criteria were met, the patient, a family member and the treating physician were interviewed to identify other factors contributing to length of stay.

RESULTS: Thirty‐one patients were enrolled in the study; 12 were discharged when they met discharge criteria and 19 stayed in hospital longer. There were no differences between patients discharged at stability versus those with an increased length of stay in terms of demographics, pneumonia severity score, functional or cognitive status at discharge using the Barthel Index (87.3±11.1 versus 83.8±8.6, respectively; P=0.46) and MMSE (27.1±1.1 versus 27.3±1.1, respectively; P=0.64); however, there was a significant difference in HABAM score at the time clinical stability was reached (22.6±1.3 versus 17.4±3.5, respectively; P=0.03), which correlated with physician and family assessments of patients′ readiness for discharge.

CONCLUSIONS: HABAM may be a useful tool to identify patients at risk of remaining in hospital after objective discharge criteria are met. Additional resources may be targeted at these patients to reduce length of stay in CAP.
Eosinophilic Pancreatitis Mimicking Pancreatic Neoplasia
Authors: Cay Ali , Imamoglu Mustafa , Cobanoglu Umit
Published: March 2016

Eosinophilic pancreatitis (EP) is a rare disease. It typically occurs in the setting of either eosinophilic gastroenteritis or the hypereosinophilic syndrome. Isolated eosinophilic infiltration of the pancreas is less common. EP usually presents as a pancreatic tumour with abdominal pain and/or obstructive jaundice. The diagnosis is often not made until after pancreatic resection under suspicion of a pancreatic tumour.

The case of a 14-year-old boy whose initial presentation was suggestive of a pancreatic tumour is reported. Radiological evaluation revealed a pancreatic mass suggestive of a pancreatic tumour obstructing the duodenum and common bile duct. The patient underwent surgery and a gastrojejunal anostomosis, tube cholecystostomy and biopsy were performed with no postoperative complications. The diagnosis of EP was established after surgical biopsy. The biopsy specimen revealed prominent eosinophilic infiltration. Serum immunoglobulin E levels were elevated. The patient was treated with oral prednisolone (40 mg/day). After two months of oral steroid therapy, clinical manifestations rapidly improved and peripheral eosinophilia subsided. Computed tomography scan revealed remission of the pancreatic mass-like lesion.
Physical Plant Design and Engineering Controls to Reduce Hospital‐Acquired Infections
Authors: Conly JM , Johnston BL
Published: March 2016

The importance of the environment as a reservoir for microorganisms implicated in disease transmission in the hospital setting has been increasingly recognized, especially with respect to dialysis units, ventilation in specialized areas, and the proper use of disinfectants (1). Inherent within the environmental setting is the importance of physical plant design. Several studies have underscored the importance of optimizing design standards to maximize patient and health care worker (HCW) safety, including the prevention of hospital‐acquired infections in patients (2‐6). Ulrich et al (7) recently completed an evidence‐based review, entitled ′The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity′, for the Center for Health Design in California (USA), which was funded by the Robert Wood Johnson Foundation. Ulrich and colleagues identified over 600 studies that examined the hospital environment and its effects on staff effectiveness, patient safety, patient and family stress, quality and costs. They suggested that one of the important elements in improving patient safety is the reduction of the risk of hospital‐acquired infections through improved facility design.
Hypercalcemia in Patients with Newly Diagnosed Tuberculosis in Abuja, Nigeria
Authors: Dosumu EA , Momoh JA
Published: March 2016

BACKGROUND: The prevalence of hypercalcemia has not previously been determined in newly diagnosed tuberculosis (TB) patients in Nigeria.

OBJECTIVE: To determine the incidence of hypercalcemia in Nigerian patients with newly diagnosed TB before the commencement of anti‐TB treatment.

METHODS: The present study is a prospective examination of consecutive patients with newly diagnosed TB confirmed by bacteriological and/or histological methods at the National Hospital (Abuja, Nigeria) from January 2004 to December 2004.

RESULTS: Of 120 patients (70 males and 50 females), 70 had pulmonary TB, 10 had pulmonary and pleural TB, 20 had pleural TB without radiographic evidence of lung involvement, 18 had various other forms of extrapulmonary TB and two had disseminated TB. The mean age of the patients was 38.3±12.0 years. The mean albumin‐adjusted serum calcium concentration was 2.53±0.22 mmol/L. Hypercalcemia was present in 27.5% of the patients, but only 12% of these patients showed symptoms of hypercalcemia. The type of TB and, in the case of pulmonary TB, the extent of lung involvement, had no effect on the serum calcium concentration.

CONCLUSION: Hypercalcemia is not uncommon among Nigerian patients with newly diagnosed TB, but it is rarely symptomatic.
Only a Train can Mask another Train
Authors: Salehian Behrouz , Yan Melvin
Published: March 2016

A 36‐year‐old man presented with fever, abdominal pain and diarrhea reportedly lasting for the past three months. Originally an immigrant from Mexico, he had been living in California for the past four years and made a recent trip back to Guerrero, Mexico. On admission, the patient was febrile (41°C), hypotensive (94/54 mmHg), tachycardic (118 beats/min) and tachypneic (36 breaths/min). Multiple bilateral cervical and axillary lymph nodes were palpated. Other findings included crackles in the bases of both lungs and a large mass in the left hypochondrium.
Gluten Intolerance: Sex- and Age-Related Features
Authors: Llorente-Alonso MJ , Fernández-Aceñero MJ , Sebastián M
Published: March 2016

OBJECTIVE: Gluten intolerance is an immune-mediated enteropathy associated with gluten-containing foods in genetically susceptible patients. The typical form mainly affecting children shows failure to thrive and/or gastrointestinal symptoms. The adult form is less typical, presenting vague gastrointestinal symptoms, iron deficiency (with or without anemia) or nonspecific serum chemistry abnormalities. The present study aims to analyze clinical and biochemical differences of celiac disease (CD) according to sex and age.

PATIENTS AND METHODS: The present study reviewed clinical and biochemical features of patients with suspected CD admitted to the Hospital General of Móstoles (Madrid, Spain) between July 2001 and June 2005. Two hundred fifty-two patients were analyzed, in whom intestinal biopsy was performed due to clinical and/or biochemical abnormalities suggestive of CD. One hundred seventy-eight asymptomatic relatives of the affected patients were also included. Overall, 125 patients showed diagnostic features of CD in the intestinal biopsy.

RESULTS: The results confirmed higher prevalence of typical forms of CD in children (67% in children compared with only 14.3% in adults). CD seemed to be more frequent in adult women than in men (ratio of women to men 4:1), but it is worth noting that men diagnosed were most often referred with a typical clinical picture, so atypical forms of the disease in men may have been underdiagnosed.

CONCLUSIONS: CD shows atypical features in adults, and physicians must include this disorder in the differential diagnosis of adults with iron deficiency or slight hypertransaminasemia. Increased awareness of the disease and extensive availability of accurate serological tests will lead to improved diagnosis of this disorder, both in children and adults.
Blastomycosis in a Young African Man Presenting with a Pleural Effusion
Authors: Alvarez GG , Burns BF , Desjardins M , Salahudeen SR , AlRashidi F , Cameron DW
Published: March 2016

Blastomyces dermatitidis is a dimorphic fungus endemic to northwestern Ontario, Manitoba and some parts of the United States. The fungus is also endemic to parts of Africa. Pulmonary and extrapulmonary findings of a 24‐year‐old African man who presented with weight loss, dry cough and chronic pneumonia not resolving with antibiotic treatment are presented. The unusual occurrence of pulmonary blastomycosis associated with skin lesions and a moderate pleural effusion is reported.
Innovative Approaches to Neuraxial Blockade in Children: The Introduction of Epidural Nerve Root Stimulation and Ultrasound Guidance for Epidural Catheter Placement
Authors: Tsui Ban CH
Published: March 2016

Continuous epidural blockade remains the cornerstone of pediatric regional anesthesia. However, the risk of catastrophic trauma to the spinal cord when inserting direct thoracic and high lumbar epidural needles in anesthetized or heavily sedated pediatric patients is a concern. To reduce this risk, research has focused on low lumbar or caudal blocks (ie, avoiding the spinal cord) and threading catheters from distal puncture sites in a cephalad direction. However, with conventional epidural techniques, including loss‐of‐resistance for localization of the needle, optimal catheter tip placement is difficult to assess because considerable distances are required during threading. Novel approaches include electrical epidural stimulation for physiological confirmation and segmental localization of epidural catheters, and ultrasound guidance for assessing related neuroanatomy and real‐time observation of the needle puncture and, potentially, catheter advancement. The present article provides a brief and focused review of these two advances, and outlines recent clinical experiences relevant to pediatric epidural anesthesia.
Liver Transplantation for Cirrhosis in Cystic Fibrosis
Authors: Lamireau T , Martin S , Lallier M , Marcotte JE , Alvarez F
Published: March 2016

BACKGROUND: Liver disease is the third most common cause of death in children with cystic fibrosis (CF). Liver transplantation is an effective treatment in children with hepatic failure.

AIMS: The objective of the present study was to review the indications and postoperative course of hepatic transplantation in a cystic fibrosis population.

PATIENTS: Five children with CF, at a mean age of 16.5 years, underwent liver transplantation.

RESULTS: All patients showed cirrhosis, portal hypertension and hepatic failure. The main postoperative complication was ascites refractory to treatment in two patients. No significant deterioration of the pulmonary function was noted. Two patients died, one of Hodgkin lymphoma and the other of progressive pulmonary failure.

CONCLUSION: Liver transplantation was indicated in children with CF when hepatic failure and/or severe portal hypertension was present with well-preserved pulmonary function.
Combined Low-Volume Polyethylene Glycol Solution Plus Stimulant Laxatives versus Standard-Volume Polyethylene Glycol Solution: A Prospective, Randomized Study of Colon Cleansing before Colonoscopy
Authors: Hookey Lawrence C , Depew William T , Vanner Stephen J
Published: March 2016

INTRODUCTION: The effectiveness of polyethylene glycol solutions (PEG) for colon cleansing is often limited by the inability of patients to drink adequate portions of the 4 L solution. The aim of the present study was to determine whether a reduced volume of PEG combined with stimulant laxatives would be better tolerated and as or more effective than the standard dose.

METHODS: Patients undergoing outpatient colonoscopy were randomly assigned to receive either low-volume PEG plus sennosides (120 mg oral sennosides syrup followed by 2 L PEG) or the standard volume preparation (4 L PEG). The subjects rated the tolerability of the preparations and their symptoms. Colonoscopists were blind to the colonic cleansing preparation and graded the cleansing efficacy using a validated tool (the Ottawa scale).

RESULTS: The low-volume PEG plus sennosides preparation was significantly better tolerated than the standard large volume PEG (P<0.001) but was less efficacious (P=0.03). Thirty-eight per cent of patients in the large volume PEG group were unable to finish the preparation, compared with only 6% in the reduced volume group. There were no adverse events reported.

CONCLUSIONS: Although the low-volume PEG plus sennosides preparation was better tolerated, it was not as effective as standard large-volume PEG. However, in view of the significant difference in tolerance, further research investigating possible improvements in the reduced-volume regimen seems warranted.
Fatigue in Liver Disease: Pathophysiology and Clinical Management
Authors: Swain Mark G
Published: March 2016

Fatigue is the most commonly encountered symptom in patients with liver disease, and it has a significant impact on their quality of life. However, although some progress has been made with regard to the understanding of the processes which may generate fatigue in general, the underlying cause(s) of liver disease-associated fatigue remain incompletely understood. The present review describes recent advances which have been made in our ability to measure fatigue in patients with liver disease in the clinical setting, as well as in our understanding of potential pathways which are likely important in the pathogenesis of fatigue associated with liver disease. Specifically, experimental findings suggest that fatigue associated with liver disease likely occurs as a result of changes in neurotransmission within the brain. In conclusion, a reasonable approach to help guide in the management of the fatigued patient with liver disease is presented.
Acute Fatty Liver of Pregnancy
Authors: Ko Hin Hin , Yoshida Eric
Published: March 2016

Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal complication that occurs in the third trimester or early postpartum period. Although the exact pathogenesis is unknown, this disease has been linked to an abnormality in fetal fatty acid metabolism. Early diagnosis of AFLP sometimes can be difficult because it shares features with other common conditions such as pre-eclampsia, viral hepatitis and cholestasis of pregnancy. However, a careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. Supportive care and expeditious delivery are essential to optimal maternal-fetal outcomes and remain as the mainstay treatment for AFLP.
Ischemic Colitis During Pegylated Interferon-Alpha and Ribavirin Therapy for Chronic Hepatitis C
Authors: Leung Yvette , Urbanski Stefan J , Schindel Lynn , Myers Robert P
Published: March 2016

Rare cases of ischemic colitis associated with interferon-alpha (IFN-α) treatment for chronic hepatitis C (HCV) infection and metastatic cancer have been reported. The present study describes the first case of ischemic colitis attributable to pegylated IFN-α and ribavirin combination therapy in an HCV-infected patient after 34 weeks of treatment. The clinical presentation, endoscopic appearance and histopathology of the colon were consistent with ischemic colitis, and the patient’s symptoms rapidly resolved with cessation of therapy. The association between the therapy and the pathogenesis of ischemic colitis is unclear, but immunoregulatory, vasospastic and procoagulant mechanisms have been proposed. Physicians should be aware of this complication, and should consider it in any HCV-infected patient taking pegylated IFN-α and ribavirin who develops abdominal discomfort and gastrointestinal bleeding.
Rare Lung Diseases I – Lymphangioleiomyomatosis
Authors: Juvet Stephen C , Hwang David , Downey Gregory P
Published: March 2016

The present article is the first in a series that will review selected rare lung diseases. The objective of this series is to promote a greater understanding and awareness of these unusual conditions among respirologists. Each article will begin with a case that serves as a focal point for a discussion of the pathophysiology and management of the particular condition. The first article is on lymphangioleiomyomatosis (LAM); subsequent articles will focus on pulmonary alveolar proteinosis, alpha-1-antitrypsin deficiency and primary ciliary dyskinesia.

LAM is a rare, progressive and (without intervention) often fatal interstitial lung disease that predominantly affects women of childbearing age. LAM is characterized by progressive interstitial infiltration of the lung by smooth muscle cells, resulting in diffuse cystic changes of the lung parenchyma. The molecular basis of this disorder has been delineated over the past five years and LAM is now known to be a consequence of mutations in the tuberous sclerosis genes. This knowledge, combined with advances in our understanding of the signalling pathways regulated by these genes, has given rise to potential molecular therapies that hold great promise for treating this devastating disease.
Le Rôle de l’Omalizumab dans le Traitement de l’Asthme Allergique Grave
Authors: Chapman Kenneth R , Cartier André , Hébert Jacques , McIvor R Andrew , Schellenberg R Robert
Published: March 2016

CONTEXTE : Un nouveau traitement anti‐immunoglobuline E (anti‐IgE) contre l’asthme, l’omalizumab, a été approuvé au Canada.

OBJECTIF : Passer en revue les données fondamentales et cliniques sur l’omalizumab et examiner le rôle possible de ce médicament dans la prise en charge de l’asthme au Canada.

MÉTHODOLOGIE : Une recherche documentaire a été effectuée dans MEDLINE afin de repérer les études menées de 1960 à 2006 sur l’omalizumab. La recherche a également porté sur les résumés de réunions scientifiques récentes dans le domaine des maladies respiratoires et des allergies; par ailleurs, toute donnée non publiée a été demandée au fabricant. Après avoir revu et résumé les données, un comité mixte constitué de spécialistes des maladies respiratoires et des allergies a rédigé un ensemble de recommandations relatives à l’utilisation de l’omalizumab.

RÉSULTATS : L’omalizumab est un anticorps monoclonal humanisé qui se lie au domaine C epsilon 3 de la molécule d’IgE pour former des complexes immuns solubles qui sont éliminés par le système réticulo‐endothélial. L’administration d’injections sous‐cutanées espacées de deux ou de quatre semaines à la dose recommandée entraîne une diminution rapide des taux d’IgE circulantes libres. Lors de deux essais cliniques de phase III menés auprès de 1 405 adultes et adolescents atteints d’asthme modéré à grave qui recevaient des doses moyennes stables de corticostéroïdes en inhalation (CSI), l’omalizumab a diminué les taux d’exacerbation par rapport au placebo et a été associé à une amélioration des symptômes ainsi qu’à une épargne plus importante des corticostéroïdes. Dans un essai mené auprès de 419 patients atteints d’asthme grave non maîtrisé malgré l’utilisation de doses élevées de CSI et de la prise concomitante d’agonistes bêta‐2 à action prolongée, les exacerbations graves étaient de 50 % moins fréquentes chez les patients traités par l’omalizumab que chez les sujets témoins. Des analyses rétrospectives ont permis d’identifier les caractéristiques des patients les plus susceptibles de répondre au traitement par l’omalizumab.

RECOMMANDATIONS : L’omalizumab pourrait être envisagé comme traitement d’appoint dans les cas atopiques d’asthme grave non maîtrisé avec des traitements classiques par des doses optimales de CSI et un traitement d’appoint approprié (p. ex. : agonistes bêta‐2 à action prolongée). En général, les patients sont classés en fonction de leur recours – traitement court et fréquent ou continu et oral – aux corticostéroïdes. Il ne faut amorcer le traitement qu’après avoir consulté un spécialiste pour confirmer le diagnostic et s’assurer que le traitement classique est optimal.
Introduction of Leukotriene Receptor Antagonists in Manitoba
Authors: Macie C , Wooldrage K , Manfreda J , Anthonisen NR
Published: March 2016

Patient characteristics and prescribing patterns during the introduction of leukotriene receptor antagonists (LTRA) in Manitoba are described using the provincial health database. Residents of Manitoba with asthma, chronic obstructive pulmonary disease, bronchitis or claims for respiratory medications were identified. Six thousand forty‐one of 160,626 (3.8%) patients received LTRA; the likelihood of receiving LTRA increased if a patient was younger than 15 years, lived in a rural locale, had asthma, had frequent physician visits or used inhaled corticosteroids. Subsequent prescriptions (68%) were associated with the number of physician visits and inhaled corticosteroid use, which were thought to be indexes of severity. Patients, especially children, who received more than five prescriptions showed evidence of increased asthma control, but there was little evidence of benefit in less selected patient groups due, at least in part, to poor compliance with all respiratory drugs.
A Randomized Trial of Yoga for Adolescents with Irritable Bowel Syndrome
Authors: Kuttner Leora , Chambers Christine T , Hardial Janine , Israel David M , Jacobson Kevan , Evans Kathy
Published: March 2016

BACKGROUND: Adolescents with irritable bowel syndrome (IBS) frequently experience interference with everyday activities. Mind‐body approaches such as yoga have been recommended as interventions for patients with IBS. Despite promising results among adult samples, there have been limited studies exploring the efficacy of yoga with pediatric patients.

OBJECTIVE: To conduct a preliminary randomized study of yoga as treatment for adolescents with IBS.

METHODS: Twenty‐five adolescents aged 11 to 18 years with IBS were randomly assigned to either a yoga or wait list control group. Before the intervention, both groups completed questionnaires assessing gastrointestinal symptoms, pain, functional disability, coping, anxiety and depression. The yoga intervention consisted of a 1 h instructional session, demonstration and practice, followed by four weeks of daily home practice guided by a video. After four weeks, adolescents repeated the baseline questionnaires. The wait list control group then received the yoga intervention and four weeks later completed an additional set of questionnaires.

RESULTS: Adolescents in the yoga group reported lower levels of functional disability, less use of emotion‐focused avoidance and lower anxiety following the intervention than adolescents in the control group. When the pre‐ and postintervention data for the two groups were combined, adolescents had significantly lower scores for gastrointestinal symptoms and emotion‐focused avoidance following the yoga intervention. Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS.

CONCLUSIONS: Yoga holds promise as an intervention for adolescents with IBS.
An Open‐Label, Multicentre Pilot Study of Bosentan in Pulmonary Arterial Hypertension Related to Congenital Heart Disease
Authors: Ibrahim Reda , Granton John T , Mehta Sanjay
Published: March 2016

BACKGROUND: Bosentan has been shown to be a safe and efficacious treatment for idiopathic pulmonary arterial hypertension (PAH) and PAH associated with connective tissue disease. However, there are limited studies examining the benefits of bosentan in PAH associated with congenital heart disease (CHD).

OBJECTIVE: The aim of the present pilot study was to explore the safety and efficacy of bosentan in patients with PAH associated with CHD.

PATIENTS AND METHODS: In the present study, 11 patients with PAH associated with CHD were enrolled to receive bosentan for a minimum of 16 weeks (62.5 mg twice a day for four weeks; thereafter 125 mg twice a day). Safety was assessed by monitoring adverse events, oxygen saturation, systemic blood pressure, pulse, complete blood count and liver function tests. Efficacy was assessed by the World Health Organization functional class, 6 min walk test (6‐MWT), modified Borg dyspnea index, echocardiography and the 36‐item short form health survey.

RESULTS: Ten patients completed the 16‐week treatment period (one patient withdrew). Bosentan was not associated with a deterioration in resting oxygen saturation (83.0±4.6% at week 16 versus 81.9±6.1% at baseline; P=0.402), or a deterioration in post‐6‐MWT oxygen saturation (70.1±10.9% at week 16 versus 68.7±15.1% at baseline; P=0.747). Two patients experienced three serious adverse events. The distance walked in 6 min improved significantly by 28 m (P=0.005) at week 16 compared with baseline, and the modified Borg dyspnea index also improved at week 16 compared with baseline (P=0.050). The World Health Organization functional class improved from class III to class II for five of 10 patients (50%). Patients’ self‐rated quality of life (36‐item short form health survey) demonstrated a non‐significant improvement in each of the eight domains. Obtaining reliable echocardiographic measurements was difficult. Most echocardiographic parameters were only measurable on few patients, and none were measured on all patients, questioning the usefulness of echocardiography as a measuring tool for patients with complex CHD.

CONCLUSION: Bosentan was not associated with worsening of resting oxygen saturation or exercise systemic oxygen saturation, suggesting its potential as a safe treatment option for patients with PAH associated with CHD. Improved 6‐MWT and the modified Borg dyspnea index also suggested the possibility of bosentan as an efficacious treatment option for these patients. The results of the present study provide evidence for the need and feasibility of a large randomized, placebo‐controlled clinical trial.
Asthma Control in Canada Remains Suboptimal: The Reality of Asthma Control (TRAC) Study
Authors: FitzGerald J Mark , Boulet Louis-Philippe , McIvor R Andrew , Zimmerman Sabrina , Chapman Kenneth R
Published: March 2016

BACKGROUND: Two Canadian studies showed that 55% of patients with asthma had daily symptoms (in 1996) and that 57% of patients suffered from poorly controlled asthma (in 1999).

OBJECTIVES: To assess the state of asthma control of adult Canadians, and asthma knowledge and practices of Canadian physicians actively involved in the care of patients with asthma.

METHODS: Telephone interviews were conducted with adults 18 to 54 years of age who had been diagnosed with asthma at least six months before the survey, who did not have chronic obstructive pulmonary disease and who had a smoking history of fewer than 20 pack‐years. Physicians were surveyed by telephone and mail. The surveys took place between April and August 2004.

RESULTS: Almost all (97%) of the 893 patients believed that they had controlled asthma; however, only 47% had controlled disease according to symptom‐based guideline criteria. Just 39% of 463 physicians based their treatment recommendations on the Canadian asthma guidelines most or all of the time, despite having a high awareness of them. Only 11% of patients had written action plans, and one‐half of patients with action plans did not use them regularly. Almost three‐quarters of patients expressed concerns about taking inhaled corticosteroids.

CONCLUSIONS: Since the last major national survey, guideline implementation has not resulted in significant changes in asthma‐related morbidity. Effective means of knowledge transfer should be developed and implemented to improve the translation of guideline recommendations into care.
Reasons for Coming to Hospital after Treatment for Community‐Acquired Pneumonia on an Ambulatory Basis
Authors: Shariatzadeh Mohammedreza , Marrie Thomas J
Published: March 2016

BACKGROUND: Most patients with community‐acquired pneumonia (CAP) are treated on an ambulatory basis. OBJECTIVE: To evaluate the reasons for presentation to hospital after treatment for CAP on an ambulatory basis.

METHODS: The study, conducted in five hospitals in the Capital Health Region (Edmonton, Alberta), enrolled adult patients aged 17 years or older who presented with a history of having been diagnosed and treated for pneumonia within the previous month. A current diagnosis of pneumonia was based on two or more symptoms or signs of CAP, plus radiographic evidence of pneumonia.

RESULTS: Seventy‐five (77.3%) of the 97 patients who met the inclusion criteria had CAP, and 22 (22.7%) patients presented with a noninfectious illness. Of the patients with CAP, 25 (33.3%) met the study criteria for worsening of a comorbid illness, 23 (30.7%) had clinical failure, 16 (21.3%) had microbiological failure, six (8.0%) were noncompliant, four (5.3%) had failure of expectations and one (1.3%) had adverse effects of antimicrobial therapy.

CONCLUSIONS: Underlying diseases, exacerbations of comorbidities and complications of CAP, as well as confounders such as unusual infections and noninfectious conditions that mimic CAP, are all reasons for presenting to hospital after treatment for CAP in an ambulatory setting.
Implementing Practice Guidelines: A Workshop on Guidelines Dissemination and Implementation with a Focus on Asthma and COPD
Authors: Boulet Louis-Philippe , Becker Allan , Bowie Dennis , Hernandez Paul , McIvor Andrew , Rouleau Michel , Bourbeau Jean , Graham Ian D , Logan Jo , Légaré France , Ward Thomas F , Cowie Robert L , Drouin Denis , Harris Stewart B , Tamblyn Robyn , Ernst Pierre , Tan Wan C , Partridge Martyn R , Godard Philippe , Herrerias Carla T , Wilson John W , Stirling Liz , Rozitis Emily-Brynn , Garvey Nancy , Lougheed Diane , Labrecque Manon , Rea Renata , Holroyde Martin C , Fagnan Danielle , Dorval Eileen , Pogany Lisa , Kaplan Alan , Cicutto Lisa , Allen Mary L , Moraca Serge , FitzGerald J Mark , Borduas Francine
Published: March 2016

The present supplement summarizes the proceedings of the symposium “Implementing practice guidelines: A workshop on guidelines dissemination and implementation with a focus on asthma and COPD”, which took place in Quebec City, Quebec, from April 14 to 16, 2005. This international symposium was a joint initiative of the Laval University Office of Continuing Medical Education (Bureau de la Formation Médicale Continue), the Canadian Thoracic Society and the Canadian Network for Asthma Care, and was supported by many other organizations and by industrial partners. The objectives of this meeting were to examine the optimal implementation of practice guidelines, review current initiatives for the implementation of asthma and chronic obstructive pulmonary disease (COPD) guidelines in Canada and in the rest of the world, and develop an optimal strategy for future guideline implementation. An impressive group of scientists, physicians and other health care providers, as well as policy makers and representatives of patients’ associations, the pharmaceutical industry, research and health networks, and communications specialists, conveyed their perspectives on how to achieve these goals.

This important event provided a unique opportunity for all participants to discuss key issues in improving the care of patients with asthma and COPD. These two diseases are responsible for an enormous human and socioeconomic burden around the world. Many reports have indicated that current evidence‐based guidelines are underused by physicians and others, and that there are many barriers to an effective translation of recommendations into day‐to‐day care. There is therefore a need to develop more effective ways to communicate key information to both caregivers and patients, and to promote appropriate health behaviours. This symposium contributed to the initiation of what could become the “Canadian Asthma and COPD Campaign”, aimed at improving care and, hence, the quality of life of those suffering from these diseases.

It is hoped that this event will be followed by other meetings that focus on how to improve the transfer of key recommendations from evidence‐based guidelines into current care, and how to stimulate research to accomplish this.
An Assessment of Linezolid Utilization in Selected Canadian Provinces
Authors: Walker Sandra , Dresser Linda , Becker Debbie , Scalera Alissa
Published: March 2016

BACKGROUND: Linezolid is approved for the treatment of designated infections caused by methicillin‐resistant and ‐susceptible Staphylococcus aureus and vancomycin‐resistant Enterococcus faecium.

OBJECTIVE: To characterize linezolid utilization since its launch in Canada in 2001.

METHODS: Demographics, antimicrobial regimens, and clinical and resource utilization data for linezolid‐treated patients were collected retrospectively by hospital pharmacists at nine tertiary care hospitals in four provinces. Statistics describing linezolid utilization were calculated and the appropriateness of use was assessed according to a treatment algorithm based on recommendations of the Infectious Diseases Pharmacy Specialty Network in 2001.

RESULTS: Ninety‐nine linezolid courses were prescribed for 103 infections in 95 patients (mean age 57.8 years, 52.6% male) with an average length of hospital stay of 40.6 days. Fifty‐three per cent of patients had an allergy to at least one antibiotic other than linezolid. The major use of linezolid was for treatment of skin and soft tissue infections (32.0%), followed by bacteremia (15.5%). The most prevalent pathogen was methicillin‐resistant S aureus, identified in 44.7% of infections. Linezolid was primarily prescribed as the oral form following other intravenous anti‐infectives (55.6% of courses) for an average duration of 14.4 days. The rate of appropriate utilization was 53% (range 25% to 75% by site). In 93.5% of courses deemed inappropriate, recommended first‐line therapies were not attempted before linezolid.

CONCLUSIONS: Linezolid was prescribed appropriately in approximately one‐half of cases reviewed. The rate of appropriate utilization is similar to those rates reported in other Canadian antibiotic reviews.
Pain Prevalence in Nine‐ to 13‐Year‐Old School Children
Authors: van Dijk Adam , McGrath Patricia A , Pickett William , VanDenKerkhof Elizabeth G
Published: March 2016

BACKGROUND: Despite significant progress in the epidemiology of chronic pain in adults, major gaps remain in our understanding of the epidemiology of chronic pain in children. In particular, the incidence, prevalence and sensory characteristics of many types of pain in Canadian children are unknown.

OBJECTIVES: A study to obtain the lifetime and point prevalence of common acute pains, recurrent pain syndromes and chronic pains was conducted in a cohort of 495 school children, nine to 13 years of age, in eastern Ontario.

METHODS: Children reported their pain experiences and described the intensity, affect and duration of the pains experienced over the previous month by completing the Pain Experience Interview –Short Form.

RESULTS: The majority of children (96%) experienced some acute pain over the previous month, with headache (78%) being most frequently reported. Lifetime prevalence for certain acute pains differed significantly by sex (P<0.05). Fifty‐seven per cent of children reported experiencing at least one recurrent pain, while 6% were identified as having had or currently having chronic pain.

DISCUSSION: The prevalence of acute pain in this Canadian cohort is consistent with international estimates of acute pain experiences (ie, headache) and recurrent pain problems (ie, recurring headache, abdominal pain and growing pains). However, 6% of children reported chronic pain. The self‐completed Pain Experience Interview – Short Form provides a feasible administration technique for obtaining population estimates of childhood pain, and for conducting longitudinal studies to identify risk and prognostic factors for chronic pain.
Risk of Ruling out Severe Acute Respiratory Syndrome by Ruling in another Diagnosis: Variable Incidence of Atypical Bacteria Coinfection Based on Diagnostic Assays
Authors: Zahariadis George , Gooley Ted A , Ryall Phyllis , Hutchinson Christine , Latchford Mary I , Fearon Margaret A , Jamieson Frances B , Richardson Susan , Kuschak Theodore , Mederski Barbara
Published: March 2016

BACKGROUND: Severe acute respiratory syndrome (SARS) caused the first epidemic of the 21st century and continues to threaten the global community.

OBJECTIVE: To assess the incidence of coinfection in patients confirmed to have SARS‐associated coronavirus (SARS‐CoV) infection, and thus, to determine the risk of ruling out SARS by ruling in another diagnosis. METHODS: The present report is a retrospective study evaluating the incidence and impact of laboratory‐confirmed SARS‐CoV and other pulmonary pathogens in 117 patients. These patients were evaluated in a Toronto, Ontario, community hospital identified as the epicentre for the second SARS outbreak.

RESULTS: Coinfection with other pulmonary pathogens occured in patients with SARS. Seventy‐three per cent of the patient population evaluated had laboratory‐confirmed SARS‐CoV infection. Serology showing acute or recent Chlamydophila pneumoniae or Mycoplasma pneumoniae infection revealed an incidence of 30% and 9%, respectively, in those with SARS. These rates are similar to previously published studies on coinfection in pneumonia. All nucleic acid diagnostic assays were negative for C pneumoniae and M pneumoniae in respiratory samples from patients with SARS having serological evidence for these atypical pathogens.

CONCLUSIONS: Diagnostic assays for well‐recognized pulmonary pathogens have limitations, and ruling out SARS‐CoV by ruling in another pulmonary pathogen carries significant risk. Despite positive serology for atypical pathogens, in a setting where clinical suspicion for SARS is high, specific tests for SARS should be performed to confirm or exclude a diagnosis.
Ondansetron Treatment in a Child Presenting with Chronic Intractable Pruritus
Authors: Frigon Chantal , Desparmet Joëlle
Published: March 2016

The case of a seven‐year‐old boy with chronic pruritus secondary to a giant congenital melanocytic nevus is presented. The pruritus did not respond to conventional antipruritic drug treatment, but responded to ondansetron, a selective antagonist of 5‐hydroxytryptamine type 3 receptors.
Resolution of Paraneoplastic Collagenous Enterocolitis after Resection of Colon Cancer
Authors: Freeman Hugh J , Berean Ken W
Published: March 2016

A 52-year-old woman developed severe watery diarrhea, weight loss, anemia and hypoalbuminemia. A localized colon cancer was detected. Subsequently, extensive collagenous mucosal involvement of the small and large intestine was discovered. After resection of the colon cancer, her symptoms resolved. In addition, resolution of the inflammatory process occurred, including the subepithelial collagen deposits. Despite extensive small and large intestinal involvement, both clinical and histological resolution of collagenous inflammatory disease was evident. Collagenous enterocolitis is an inflammatory process that may represent a distinctive and reversible paraneoplastic phenomenon.
Pneumonitis after Inhalation of Mercury Vapours
Authors: Glezos JD , Albrecht JE , Gair RD
Published: March 2016

A 43‐year‐old man presented to hospital with pneumonia but only after discharge from hospital did he admit to deliberate prior inhalation of mercury. His pulmonary involvement appeared to resolve almost completely with antibiotics and supportive care. Nevertheless, persisting elevated urinary excretion of mercury required two courses of chelation therapy. No serious systemic sequelae were observed.
Mucin Overproduction in Chronic Inflammatory Lung Disease
Authors: Hauber Hans-Peter , Foley Susan C , Hamid Qutayba
Published: March 2016

Mucus overproduction and hypersecretion are commonly observed in chronic inflammatory lung disease. Mucins are gel‐forming glycoproteins that can be stimulated by a variety of mediators. The present review addresses the mechanisms involved in the upregulation of secreted mucins. Mucin induction by neutrophil elastase, bacteria, cytokines, growth factors, smoke and cystic fibrosis transmembrane conductance regulator malfunction are also discussed.
A Diagnostic Approach to Hemochromatosis
Authors: Tavill Anthony S , Adams Paul C
Published: March 2016

In the present clinical review, a diagnostic approach to hemochromatosis is discussed from the perspective of two clinicians with extensive experience in this area. The introduction of genetic testing and large-scale population screening studies have broadened our understanding of the clinical expression of disease and the utility of biochemical iron tests for the detection of disease and for the assessment of disease severity. Liver biopsy has become more of a prognostic test than a diagnostic test. The authors offer a stepwise, diagnostic algorithm based on current evidence-based data, that they regard as most cost-effective. An early diagnosis can lead to phlebotomy therapy to prevent the development of cirrhosis.
Photodynamic Therapy in Barrett’s Esophagus: Results of Treatment of 17 Patients
Authors: Weiss Alan A , Wiesinger Holly AR , Owen David
Published: March 2016

BACKGROUND: Barrett’s esophagus (BE) with dysplasia may progress to esophageal adenocarcinoma. Photodynamic therapy is a promising treatment for BE.

OBJECTIVE: To determine if photodynamic therapy is an acceptable alternative to esophagectomy in BE patients with high-grade dysplasia or early adenocarcinoma.

METHODS: Seventeen patients were treated with photodynamic therapy for BE and high-grade dysplasia or early esophageal adenocarcinoma. Patients with residual Barrett’s epithelium were treated with supplemental argon plasma coagulation or potassium titanyl phosphate laser. Patients underwent follow-up endoscopy three, six, nine and 12 months post-treatment, then every six to 12 months. Mean follow-up was 21 months.

RESULTS: High-grade dysplasia or early adenocarcinoma was completely eliminated in nine of 15 (60%) patients. High-grade dysplasia was downgraded in one patient, persisted in one patient and progressed in four patients. Two patients with early esophageal adenocarcinoma were nonresponders. Complications included stricture, sunburn, urticaria, small pleural effusions, esophageal spasm and transient atrial fibrillation.

CONCLUSIONS: Photodynamic therapy with supplemental ablation is a good, noninvasive therapy for elimination of high-grade dysplasia and early adenocarcinoma in BE. Failure to eliminate dysplastic epithelium occurred in 40% of the patients, thereby necessitating careful follow-up.
Two Cases of Miliary Tuberculosis and Increasing Level of CA‐125
Authors: Alimagham M , Aminiafshar S , Moghaddam SMM H , Shokuhi S
Published: March 2016

Two cases of miliary tuberculosis and elevated levels of cancer antigen 125 Ovarian carcinoma is one of the most dangerous malignancies in women. The serum level of cancer antigen (CA) 125, as a tumour marker, is useful in the diagnosis of ovarian cancer. CA 125 serum level is also elevated in ascites (1), ovarian tube abscess (2,3), biliary duct cancer and periampullary tumours (4), cholangitis (5), cancer of pancreas (6) and cervical adenocarcinoma (7). Additionally, sometimes the serum level of CA 125 increases spontaneously during the menstrual cycle (8,9). In bone marrow transplantation, this marker is a sensitive index in the diagnosis of veno‐occlusive disease (10). We describe an elevated serum level of CA 125 in two cases of tuberculosis (TB): one with cryptogenic miliary TB, and the other with miliary TB and meningitis.
Pylephlebitis and Pyogenic Liver Abscesses: A Complication of Hemorrhoidal Banding
Authors: Chau Nicole G , Bhatia Sacha , Raman Maitreyi
Published: March 2016

Hemorrhoidal banding is a well-established and safe outpatient procedure. Septic complications of hemorrhoidal banding are rare but can be fatal. The first case of pylephlebitis (septic portal vein thrombosis) and pyogenic liver abscess following hemorrhoidal banding in a 49-year-old man with diabetes is reported in the present study. Risk factors, management and the role of prophylaxis in immunocompromised patients are discussed. Caution against hemorrhoidal banding in immunosuppressed patients, including patients with diabetes, is warranted.