bluuebunny/crossref_metadata_2025 huggingface dataset:
Reconstruction of Low Speed Rear‐End collisions ‐ Technical Means of Assessing Cervical Spine Injuries
Authors: Hitzemann Martin
Published: March 2016

In recent years, an increasing number of cervical spine injuries sustained by vehicle occupants in collisions at comparatively low speeds have been reported to insurance companies and in civil litigation. The reported injuries occur in both rear‐end and side impact collisions. The paper describes how a detailed assessment of such cases requires interdisciplinary teamwork involving technical, biomechanical and medical experts.
Choice of Antibiotics in Late Neonatal Sepsis in the Extremely Low Birth Weight Infant
Authors: Allen Tara R , da Silva Orlando P
Published: March 2016

OBJECTIVE: To review the choice of antibiotics in treating suspected late neonatal sepsis in infants weighing 1000 g or less in a neonatal intensive care unit.

METHODS: Retrospective review of medical records.

RESULTS: Ninety‐six infants weighing 1000 g or less were admitted to the neonatal intensive care unit during the study period. Sixty‐two infants survived beyond four days of life and had at least one sepsis workup done to exclude late neonatal infection. Of the 62 study patients, 42 (68%) were started on ampicillin and netilmicin (A/N) and 20 (32%) were started on vancomycin and ceftizoxime (V/C) as the antibiotics of choice, pending culture results. Of the patients started on A/N, 17 of 42 had a positive blood culture compared with 11 of 20 on V/C (40% versus 55%, P=0.40). The mean (±SD) birth weight of infants started on A/N was 793±133 g compared with a mean of 728±153 g in the group that received V/C (P=0.09). Seven patients died in the A/N group compared with three in the V/C group (16.7% versus 15%, P=0.84). In addition to the sepsis episode studied, before they were discharged from hospital, 21 of 42 (50%) infants in the A/N group had further workups for suspected sepsis, compared with 16 of 20 (80%) (P=0.048) infants initially given V/C.

CONCLUSIONS: Ampicillin and netilmicin is a safe antibiotic combination for neonates suspected of late sepsis. This, in turn, may be important in reducing vancomycin overuse and the potential for bacterial resistance to this antimicrobial agent.
Mesenchymal Cystic Hamartoma Presenting with Spontaneous Pneumothorax
Authors: Glezos J , Toppin D , Cooney T
Published: March 2016

A 53-year-old woman presented with a spontaneous right-sided pneumothorax. Computed tomography chest scan demonstrated a large bulla involving the right middle lobe. Recurrence of the pneumothorax after initial closed chest tube drainage necessitated thoracotomy and wedge resection. Histopathological examination revealed features consistent with a benign mesenchymal cystic hamartoma. Pneumothorax is a recognized complication of mesenchymal cystic hamartoma, a lesion that also has malignant potential.
Cepacia‐Like Syndrome Caused by Burkholderia mutivorans
Authors: Zahariadis George , Levy Michelle H , Burns Jane L
Published: March 2016

The variable severity of Burkholderia cepacia complex infections in cystic fibrosis (CF) has recently been ascribed to differences in the virulence between genomovars. Specifically, genomovar III isolates have been associated with higher transmission rates and adverse outcomes compared to other B cepacia genomovars, and consequently further segregation between genomovar III and non‐genomovar III B cepacia infected patients is advocated in some centres. The important role of non‐genomovar III isolates is presented in the context of a clinical case whereby a patient with long‐standing pulmonary infection with B multiovorans developed bacteremic infection reminiscent of the fatal ′cepacia syndrome′.
A Cross‐Sectional Study of Intestinal Parasitic Infections in a Rural District of West China
Authors: Tang Ning , Luo Nian Ji
Published: March 2016

BACKGROUND: Parasitic infections are widespread in rural areas of West China. The remote and humid environment, traditional ways of life, contaminated potable water and limited health services all contribute to the transmission and persistence of fecal parasites.

OBJECTIVE: To describe the prevalence of intestinal parasitic infections in an area of West China, including its associations with demographic variables.

METHODS: Single fecal specimens were collected using a previously validated kit. Parasites were detected microscopically by iodine‐stained smear, modified Kato‐Katz thick smear, simple saline smear, test tube filter paper culture and adhesive cellophane tape anal swab.

RESULTS: The prevalence of enteric parasites in the population was 51.7%. The proportion of individuals infected with one parasite was 36.5%, two parasites 12.7%, three parasites 3.0% and four parasites 0.08%. Parasites identified included Ascaris lumbricoides in 41.4% of all individuals tested, Ancylostoma duodenale in 17.7%, Trichurias trichuria in 8.25%, Enterobius vermicularis in 0.43%, Blastocystis hominis in 1.37%, Entamoeba coli in 0.47%, Entamoeba histolytica in 0.16%, Giardia lamblia in 0.04%, Strongyloides stercoralis in 0.04% and Clonorchis sinensis in 0.04%. The prevalence was significantly increased in women, people aged 15 to 19 years and over 80 years, the rural farm population, farmers, preschool and primary school groups, residents of a hilly rather than mountainous or plains terrain, and in intermediate income groups. The prevalence was significantly negatively associated with educational level, but not with age or income.

CONCLUSIONS: This study supports the use of simple fecal examinations to monitor the parasite burden in rural areas of developing countries. Enteric parasites remain common in this population in rural China.
Necrotizing Lung Infection Caused by the Protozoan Balantidium coli
Authors: Sharma Sat , Harding Godfrey
Published: March 2016

Balantidium coli, a ciliated protozoan, is well known to cause intestinal infection in humans. Extraintestinal spread to the peritoneal cavity and genitourinary tract has rarely been reported. There have also been a few cases of lung involvement from this parasite. A case of B coli causing a thick‐walled right upper lobe cavity in an organic farmer who had contact with aerosolized pig manure is reported. Bronchoalveolar lavage fluid examined for ova and parasite revealed trophozoites of B coli in large numbers. Treatment with doxycycline hyclate led to marked improvement. Necrotizing lung infection caused by the protozoan B coli should be considered in individuals who report contact with pigs.
Neck Kinematics in Rear‐End Impacts
Authors: Yang King H , King Albert L
Published: March 2016

The purpose of this study was to document the kinematics of the neck during low‐speed rear‐end impacts. In a series of experiments reported by Deng et al (2000), a pneumatically driven mini‐sled was used to study cervical spine motion using six cadavers instrumented with metallic markers at each cervical level, a 9‐accelerometer mount on the head, and a tri‐axial accelerometers on the thorax. A 250‐Hz x‐ray system was used to record marker motion while acceleration data were digitized at 10,000 Hz. Results show that, in the global coordinate system, the head and all cervical vertebrae were primarily in extension during the entire period of x‐ray data collection. In local coordinate systems, upper cervical segments were initially in relative flexion while lower segments were in extension. Facet joint capsular stretch ranged from 17 to 97%. In the vertical direction, the head and T1 accelerated upward almost instantaneously after impact initiation while there was delay for the head in the horizontal direction. This combination was the result of a force vector which was pointed in the forward and upward direction to generate an extension moment. Upward ramping of the torso was larger in tests with a 20‐deg seatback angle. The study concluded that the kinematics of the neck is rather complicated and greatly influenced by the large rotations of the thoracic spine. Significant posterior shear deformation was found, as evidenced by the large facet capsular stretch. Although the neck forms a ′mild′ S‐shaped curve during whiplash, using its shape as an injury mechanism can be misleading because the source of pain is likely to be located in the facet capsules.
Mycobacterium neoaurum Bacteremia in a Hemodialysis Patient
Authors: Becker Marissa L , Suchak Amar A , Wolfe Joyce N , Zarychanski Ryan , Kabani Amin , Nicolle Lindsay E
Published: March 2016

Bacteremia due to Mycobacterium neoaurum, a rapidly growing mycobacterium, is described in a diabetic woman on hemodialysis. This is the first reported case of M neoaurum bacteremia in Canada. The organism initially grew on standard BacT/Alert SA aerobic blood cultures, and was subsequently positively identified using 16S rRNA sequence analysis. The present case serves to reinforce the need for a high index of clinical suspicion of infections caused by unusual microorganisms in the context of an immunocompromised host.
Noninvasive Investigations for the Early Detection of Chronic Airways Dysfunction Following Lung Transplantation
Authors: Cook Richard C , Fradet Guy , Muller Nestor L , Worsley Daniel F , Ostrow David , Levy Robert D
Published: March 2016

BACKGROUND: The diagnosis of chronic rejection after lung transplantation is limited by the lack of a reliable test to detect airways disease early.

OBJECTIVES: To determine whether maximum midexpiratory flow (MMEF), or changes on high resolution computed tomography (HRCT) or ventilation/perfusion lung (V/Q) scans are sensitive and specific for early detection of bronchiolitis obliterans syndrome (BOS; forced expiratory volume in 1 s [FEV1] less than 80% post‐transplant baseline) by evaluating long term survivors of lung transplantation at two sequential time points.

METHODS: Twenty‐two stable lung transplant recipients underwent spirometry, HRCT scanning and V/Q scanning 1.6±0.9 years and 3.1±1.1 years post‐transplant (time points 1 and 2, respectively; mean ± SD).

RESULTS: Although HRCT was sensitive for the detection of BOS, it lacked specificity, and hence, there were no significant relationships between the presence of BOS and any of the HRCT parameters evaluated at time 1 or time 2. Of the V/Q parameters studied, the presence of heterogeneous perfusion (P=0.04, sensitivity 100%, specificity 33%) and segmental perfusion defects (P=0.04, sensitivity 60%, specificity 83%) were significantly related to BOS, but only at time 2. MMEF less than or equal to 75% post‐transplant baseline was significantly related to the presence BOS at time 1 only (P=0.05, sensitivity 100%, specificity 47%). MMEF less than or equal to 75% post‐transplant baseline at time 1 was sensitive for the development of BOS at time 2, but was limited by low specificity.

CONCLUSIONS: In this group of lung transplant recipients, HRCT and V/Q scanning, as well as analysis of MMEF, did not add information that was clinically more useful than FEV1 for the early identification of chronic rejection.
Response to a Protease‐Inhibitor (Ritonavir)‐Containing Combination Antiretroviral Regimen in HIV‐Infected Children
Authors: Allen Upton D , Lapointe Normand , Read Stanley E , Forbes Jack C , King Susan M , Wasfy Samia , the Canadian Pediatric AIDS Research Group
Published: March 2016

INTRODUCTION: The number of antiretroviral agents available for children who are failing existing therapy is limited. Data are lacking on the use of various combination regimens and the resulting viral load dynamics in such children.

METHODS: Between March 1998 and March 2000, HIV‐infected children younger than 18 years of age were studied in an open trial. The study regimen included ritonavir, with at least two drugs to which the virus was known or presumed to be sensitive. subjects were ritonavir‐naive and were included if they had high viral loads while receiving antiretroviral therapy. Patients had clinical assessments, CD4 counts and viral load monitoring.

RESULTS: Fifteen antiretroviral‐experienced HIV‐infected children were enrolled. Approximately 87% (13 of 15) had perinatally‐acquired HIV; median age was 7.9 years (range 1.6 to 14.8). At enrolment, the median CD4 count was 557 cells/mm3 (range 57 to 1702) and the median viral load was 72,600 copies/mL (range 3626 to 796,440). The majority of children (73.3%) had increases in CD4 counts within 12 weeks. During this period, the median increase in CD4 counts over baseline was 30.0%. Approximately 73% (eight of 11) of subjects with initial improvements in CD4 counts had sustained increases at 32 to 48 weeks. Over the first 12 weeks, 60% (nine of 15) had greater than 0.5 log10 decreases in viral load. The improvement was sustained in 88.9% (eight of nine) of these patients at 32 to 48 weeks. Three patients discontinued therapy due to taste aversion.

CONCLUSIONS: Among pediatric patients with high viral loads while on existing therapy, the ritonavir‐containing regimen was generally well tolerated. In a significant proportion of patients, modification of therapy was associated with sustained improvements in viral loads and CD4 counts over 32 to 48 weeks.
Case report: Acute Hepatitis E Infection with Co‐Existent Glucose‐6‐Phosphate Dehydrogenase Deficiency
Authors: Monga Amitabh , Makkar Ravinder PS , Arora Anju , Mukhopadhyay Surabhi , Gupta Ajay K
Published: March 2016

Hepatitis E virus is one of the leading causes of acute viral hepatitis in India but usually manifests as a mild self‐limiting illness. Viral hepatitis in the presence of glucose‐6‐phosphate dehydrogenase (G6PD) deficiency may be associated with complications such as severe anemia, hemolysis, renal failure, hepatic encephalopathy and even death. The incidence of G6PD deficiency in the general population of northern India is reported to be between 2.2% and 14%. Despite both hepatitis E infection and G6PD deficiency being common, their impact on patient illness has only recently been reported. The present study reports a case of severe hemolysis in a patient with G6PD deficiency and hepatitis E infection.
Longitudinal Decline in Lung Function Measurements among Saskatchewan Grain Workers
Authors: Pahwa Punam , Senthilselvan Ambikaipakan , McDuffie Helen H , Dosman James A
Published: March 2016

OBJECTIVE: To evaluate the relationship between the long term effects of grain dust and decline in lung function among grain elevator workers in Saskatchewan, studied over a 15‐year period.

METHODS: The Grain Dust Medical Surveillance Program was started by Labour Canada in 1978 and longitudinally studied the respiratory health of Canadian grain elevator workers over a 15‐year period (1978 to 1993). Data on respiratory symptoms and pulmonary function tests (forced expiratory volume in 1 s [FEV1], forced vital capacity [FVC]) were collected once every three years; each three‐year interval was called a ′cycle′. Data from Saskatchewan were analyzed for this report. A transitional model using the generalized estimating equations approach was fitted using a SAS macro to predict the annual decline in FEV1 and FVC.

RESULTS: Previous lung function, as one of the covariates in the transitional model, played an important role. Significant predictors of FEV1 were previous FEV1, base height, weight, years in the grain industry, current smoking status, cycle II, cycle III and cycle V. Significant predictors of FVC were previous FVC, base height, weight, years in the grain industry, cycle II, cycle III and cycle IV.

CONCLUSIONS: The estimated annual decline in FEV1 and FVC increased according to length of time in the grain industry among nonsmoking, ex‐smoking and smoking grain elevator workers. Lung function values improved after dust control, and yearly declines in FEV1 and FVC after dust control were smaller compared with yearly losses before dust control.
A Descriptive Study of Human Salmonella Serotype Typhimurium Infections Reported in Ontario from 1990 to 1997
Authors: Ford Michael W , Odoi Agricola , Majowicz Shannon E , Michel Pascal , Middleton Dean , Ciebin Bruce , Doré Kathryn , McEwen Scott A , Aramini Jeffery A , Deeks Shelley , Jamieson Frances , Ahmed Rafiq , Rodgers Frank G , Wilson Jeff B
Published: March 2016

BACKGROUND: Salmonella infections cause gastrointestinal and systemic diseases worldwide and are the leading causes of food‐borne illnesses in North America (1‐4). Salmonella serotype typhimurium (ST), in particular, is increasingly becoming a major public health concern because of its ability to acquire multiple resistant genes (5,6).

OBJECTIVE: To describe demographic, temporal and geographical distributions, and reported risk factors of nonoutbreak cases of ST reported to a surveillance system in Ontario.

METHODOLOGY: Descriptive analyses were performed on data on salmonellosiscases reported in Ontario between 1990 and 1998. Direct age‐ and sex‐standardized rates were computed, and temporal trend analyses were performed using simple linear regression and a general additive model with alocally weighted regression (LOESS) smoother.

RESULTS: The mean annual rates of infections with all Salmonella serotypes and with ST were 27 cases per 100,000 persons and 3.7 cases per 100,000 persons, respectively. Males and children under five years of age had significantly higher rates of both ST and ST definitive type 104 (DT104) infections. There was also evidence of temporal clustering of all strains of Salmonella, with significantly more cases being reported during the summer. Significantly higher rates of ST DT104 were observed in urban areas compared with rural areas, suggesting potential differences in the geographical distribution of risk factors.

CONCLUSIONS: Information on demographic, temporal and geographical distributions, and risk factors is critical in planning disease control strategies. Further prospective analytical observation studies are needed to gain a better understanding of the epidemiology of ST and ST DT104 in Ontario, which will better guide disease control decisions.
Impact of Attending a Healthcare Conference in Toronto During the Severe Acute Respiratory Syndrome Crisis: Survey of Delegates
Authors: Stinson Jennifer , McCartney Colin JL , Leung Andrea , Katz Joel
Published: March 2016

OBJECTIVE: To describe the impact on delegates of attending the Canadian Pain Society′s annual meeting in Toronto during the severe acute respiratory syndrome (SARS) crisis in May 2003.

METHODS: A prospective survey design was used. Surveys were sent to all delegates (n=432) who attended the conference, and 294 delegates responded (68% response rate). The survey was developed to determine the level of concern about travelling to Toronto; the adequacy of screening measures; the level of stress about attending; and the occupational consequences of attending.

RESULTS: Fifty per cent of the participants were not concerned about travelling to Toronto, while the other 50% expressed some concern ranging from mild to serious. Concerns included being exposed to SARS and fear of transmitting it to others upon return. Reasons for attending the conference despite concern included a desire for continuing education, decrease in the number of reported SARS cases, and perceived minimal risk. Almost one‐half (n=140) felt the screening measures at the conference were adequate, while 4% felt they were inadequate and 9% somewhat adequate. Delegates (n=99) suggested that temperature‐taking (32.2%), improved screening vigilance (14.4%), SARS screening forms checked daily (9.1%), strictly controlled entry (8.1%) and adopting hospital screening procedures (7.1%) should have been instituted.

CONCLUSION: Health care professionals planning conferences in this era of new respiratory diseases can benefit from understanding the responses of delegates who attended conferences during outbreaks. Clear communication about the potential risks and benefits, as well as instituting full screening precautions, will help to allay concerns.
Alpha‐1 Adrenoceptor Hyperresponsiveness in Three Neuropathic Pain States: Complex Regional Pain Syndrome 1, Diabetic Peripheral Neuropathic Pain and Central Pain States Following Spinal Cord Injury
Authors: Teasell Robert W , Arnold J Malcolm O
Published: March 2016

The pathophysiology of the pain associated with complex regional pain syndrome, spinal cord injury and diabetic peripheral neuropathy is not known. The pain of complex regional pain syndrome has often been attributed to abnormal sympathetic nervous system activity based on the presence of vasomotor instability and a frequently reported positive response, albeit a temporary response, to sympathetic blockade. In contrast, the pain below the level of spinal cord injury and diabetic peripheral neuropathy are generally seen as deafferentation phenomena. Each of these pain states has been associated with abnormal sympathetic nervous system function and increased peripheral alpha‐1 adrenoceptor activity. This increased responsiveness may be a consequence of alpha‐1 adrenoceptor postsynaptic hypersensitivity, or alpha‐2 adrenoceptor presynaptic dysfunction with diminished noradrenaline reuptake, increased concentrations of noradrenaline in the synaptic cleft and increased stimulation of otherwise normal alpha‐1 adrenoceptors. Plausible mechanisms based on animal research by which alpha‐1 adrenoceptor hyperresponsiveness can lead to chronic neuropathic‐like pain have been reported. This raises the intriguing possibility that sympathetic nervous system dysfunction may be an important factor in the generation of pain in many neuropathic pain states. Although results to date have been mixed, there may be a greater role for new drugs which target peripheral alpha‐2 adrenoceptors (agonists) or alpha‐1 adrenoceptors (antagonists).
Massive Pulmonary Hemorrhage from Dual Circulation Pulmonary Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia
Authors: Sharma Krishna B , Forkert Lutz
Published: March 2016

Pulmonary arteriovenous malformations (AVMs) are commonly supplied by the pulmonary arterial system and rarely by the systemic bronchial circulation. The authors outline the case of a young woman with pulmonary AVMs as part of hereditary hemorrhagic telangiectasia with the uncommon presentation of massive hemoptysis. Management of her recurrent, life‐threatening pulmonary hemorrhage was complicated by pulmonary AVMs that were supplied by both the pulmonary and systemic bronchial arterial circulatory systems. Transcatheter embolotherapy of the higher pressure bronchial systemic circuit was necessary for acute hemostasis.
Patterns of Forensic Practice
Authors: Merskey Harold
Published: March 2016

Forensic pain medicine has provided an interesting survey of medico‐legal practice patterns among pain specialists (1). Members of the New England Pain Association responded to a 20‐item questionnaire addressing specific areas of practice including the completion of disability forms, letters, reports to lawyers, depositions, testimony in court, record reviews and return‐to‐work forms. Respondents were asked to distinguish the medico‐legal activities for their patients from those that occurred for third parties. The participants who responded included pain specialists from a range of disciplines represented by the membership of this regional pain society. The response rate was 67% with a total of 144 surveys returned.
Overdiagnosis of Asthma in the Community
Authors: Lindensmith Jorin , Morrison Debra , Deveau Carole , Hernandez Paul
Published: March 2016

BACKGROUND: Overdiagnosis of asthma may be an emerging problem after years of attention to the rising prevalence and reported underdiagnosis of the disease.

OBJECTIVES: A sample of adult asthmatics from the community was investigated to determine whether they met the current diagnostic criteria for asthma.

METHODS: Ninety participants were studied from a self‐referred sample of physician‐labelled, adult asthmatics from the community. The setting was a tertiary care, university‐affiliated teaching hospital in Halifax, Nova Scotia. Three diagnostic criteria from the Canadian Thoracic Society Asthma Guidelines were used to demonstrate the presence of asthma: first, positive symptom history, and either, second, reversible airflow obstruction demonstrable on spirometry or documented peak expiratory flow rate diurnal variability, or, third, bronchial hyperreactivity to methacholine.

RESULTS: At the time of the study, 41% of a sample of physician‐labelled asthmatics showed no evidence of reversible airflow obstruction and had a negative methacholine challenge. By backward logistical regression analysis, a higher mean number of medications used (P<0.01), a lower forced expiratory volume in 1 s (P<0.05) and using inhaled steroids (P<0.05) were predictive of meeting the diagnostic criteria for asthma. Sixty‐two per cent of subjects who did not meet the criteria for asthma were currently taking medications for ′asthma′. Only 52.2% of the subjects reported ever having undergone pulmonary function testing.

CONCLUSIONS: Overdiagnosis of asthma is a potential problem, which may result in unnecessary or inappropriate medication use, increased health care costs and mislabelling of patients. The authors recommend greater use of objective diagnostic tests such as spirometry, peak flow diaries and bronchial provocation to establish a clinical diagnosis of asthma.
Translocation of Clostridium difficile Toxin B across Polarized Caco‐2 Cell Monolayers Is Enhanced by Toxin A
Authors: Du Tim , Alfa Michelle J
Published: March 2016

Clostridium difficile is the etiological agent of antibiotic‐associated diarrhea; the most common form of nosocomial infectious diarrhea. The basis for the shock‐like systemic symptoms observed in severe cases of this infection are not known. It is hypothesized that the invasion of C difficile toxins A and/or B from the gut mucosa may contribute to these symptoms.

A polarized tissue culture model employing Caco‐2 cells grown on transwell inserts was established to study the translocation of purified C difficile toxins A and B. C difficile toxins were 125I labelled and inoculated onto confluent polarized Caco‐2 cell monolayers to study translocation dynamics. Electrical resistance measurements were used to monitor monolayer confluence and tight junction integrity. Samples were taken from the apical and basal sides of the insert, as well as the insert itself, and tested using the human foreskin fibroblasts cell cytotoxicity assay to monitor partitioning of the radiolabelled toxins.

Toxin A produced a 50% reduction in electrical resistance in 3 h whereas the same concentration of toxin B required at least 7 h to achieve the same effect. Both toxins A and B were able to translocate across confluent monolayers of Caco‐2 cells. The combination of toxin A and B together was synergistic with respect to promoting the translocation of toxin B. Although the addition of toxin A resulted in a 100% increase in the amount of toxin B able to translocate, no increases in toxin A translocation were observed. These findings suggest a model of pathogenesis in which C difficile toxin A facilitates the translocation of toxin B from the gut into submucosal areas where it may play a role in inflammatory damage.
High Dose Intravenous Methylprednisone in the Treatment of Severe Acute Respiratory Syndrome
Authors: Mishra Sharmistha , Lee Winnie M , Bressler Brian , Juvet Stephen C , Hadjiliadis Denis
Published: March 2016

The case of a 72‐year‐old woman with probable severe acute respiratory syndrome is reported. While on treatment with ribavirin and antibiotics (for community‐acquired pneumonia), the patient continued to have progressive clinical deterioration and chest radiographic evidence of respiratory deterioration. Pulse dose intravenous corticosteroids were used in an unsuccessful attempt to treat the inflammatory component of this respiratory illness.
Risk and Prevention of Meningococcal Disease among Education Workers: A Review
Authors: De Wals Philippe , Deshaies Pierre , De Serres Gaston , Duval Bernard , Goulet Lise , Pouliot Bernard , Ricard Sylvie , Poulin Maurice
Published: March 2016

The aims of the present study were to review the risk of invasive meningococcal disease (IMD) among education workers, particularly pregnant women, and to evaluate preventive measures, in a context of endemicity, outbreak or epidemic as observed in the province of Quebec. The literature was reviewed and persons in charge of IMD surveillance in France, Quebec, the United Kingdom and the United States were interviewed. Surveys of asymptomatic carriage of Neisseria meningitidis show that transmission among students is higher than transmission between students and teachers. IMD incidence among education workers was analyzed in Cheshire (United Kingdom) in the period from 1997 to 1999, and the results indicated a risk six times higher than that in the general population. Overestimation of the magnitude of the risk is possible because the analysis focused on a cluster. None of the population‐based studies of IMD mentioned a risk of secondary cases among education workers. Six IMD cases in education workers were identified in five clusters in schools in the United Kingdom, but not in the other countries. There is no epidemiological study on IMD risk among pregnant women, and this factor was not mentioned in any published review of IMD. Immunization of education workers at the beginning of their employment, using serogroup C glycoconjugate vaccine or a combined A, C, W‐135, and Y conjugate vaccine (still under development), could reduce IMD risk, but the cost effectiveness of this measure should be evaluated. The societal benefit of excluding pregnant women from the work place during an outbreak seems to be very low, even if disease risk could be decreased for this specific group. When chemoprophylaxis is indicated for the control of an outbreak in an educational setting, treatment should be offered both to students and teachers in the group at risk.
Musings of a Political Neophyte
Authors: Bowie Dennis
Published: March 2016

Health care is now evolving faster than ever with a tremendous proliferation of knowledge and technology. We hope this will lead to better patient care, which is the major interest of us all, whether a true clinician or a bench researcher. As I stand outside the political realm, trying to make changes, whether in our local hospital, or at the provincial or national level, I am truly aware that there is a need for dialogue with governments and administrators to alter the system.
The Life Adjustment Process in Chronic Pain: Psychosocial Assessment and Clinical Implications
Authors: Gullacksen Ann-Christine , Lidbeck Jan
Published: March 2016

Previously, the subjective dimension of suffering from chronic pain has only infrequently been reported in the literature. However, in recent years qualitative psychosocial research has added new perspectives that describe how suffering from chronic pain affects life. The present paper refers to a qualitative study on the subjective experience of women diagnosed with chronic musculoskeletal pain. In a model for life adjustment, turning points and passages are described in three stages. In Stage I, there was increasing pain, disability, and physical and mental exhaustion. Alongside frustration and chaos there was a struggle to restore daily life; therefore, the picture of a healthy future was still intact. Acknowledging that pain may not be temporary marked the transition into Stage II, which was characterized by sorrow and loss, and the picture of the future faded. Once given an explanation of pain (a ′pain diagnosis′), a new understanding developed, with gradual improvement of coping skills. Adjustment eventually progressed into Stage III with the constructive use of past experiences, and competence and control increased. A new picture of the future emerged that could be handled. However, living with pain still required regular maintenance work. The outcome of qualitative investigations, including the one presented here, is discussed along with certain clinical implications. The following clinical implications are reviewed in the present study: distrust from health professionals may obstruct the adjustment process, prolong sick leave and hinder rehabilitation; providing the patient with a diagnosis (eg, an explanation of pain mechanisms) will facilitate life adjustment; acknowledging the individual experience of suffering from chronic pain will make concepts related to pain behaviour, secondary gain and sick role liable to question; and vocational rehabilitation measures should be harmonized with the actual stage of life adjustment.
The Costs and Consequences of Methicillin‐Resistant Staphylococcus aureus Infection Treatments in Canada
Authors: Rosner Andrew J , Becker Debbie L , Wong Angelina H , Miller Elizabeth , Conly John M
Published: March 2016

BACKGROUND: A multinational randomized controlled trial has shown a trend toward early discharge of patients taking oral linezolid versus intravenous vancomycin (IV) in the treatment of methicillin‐resistant Staphylococcus aureus (MRSA) infections. Infection treatments resulting in shorter hospitalization durations are associated with cost savings from the hospital perspective.

OBJECTIVE: To determine whether similar economic advantages are associated with oral linezolid, the costs and consequences of linezolid use following vancomycin IV versus the existing practice in the treatment of infections caused by MRSA were compared.

METHODS: The charts of all patients admitted to one of three tertiary care teaching hospitals between January 1, 1997 and August 31, 2000 and treated with vancomycin IV for an active MRSA infection (skin and soft tissue only) were reviewed. Based on the vancomycin IV chart review data set and a simulated linezolid data set, the clinical consequences and the associated costs of MRSA treatment with vancomycin IV, and oral and IV forms of linezolid were quantified and compared within the framework of a cost‐consequence analysis.

RESULTS: Patients treated with oral and IV forms of linezolid compared with the existing practice had a shorter length of stay and required fewer home IV care services, which resulted in a cost savings of $750 (2001 values) to the Canadian health care perspective.

CONCLUSIONS: The estimated cost savings associated with linezolid use not only offset the higher acquisition cost of the anti‐infective, but may be substantial to health care systems across Canada, especially as the incidence of MRSA continues to rise.
Mycophenolic Acid Inhibits Replication of Type 2 Winnipeg, a Cerebrospinal Fluid‐Derived Reovirus Isolate
Authors: Hermann Laura L , Coombs Kevin M
Published: March 2016

BACKGROUND: The role of reoviruses in human disease is uncertain. Most identified cases are sporadic and asymptomatic or produce minor upper respiratory or gastrointestinal symptoms. In November 1997, a reovirus was isolated from the cerebrospinal fluid of a severe combined immune deficient infant in Winnipeg, Manitoba. RNA characterization and sequencing studies demonstrated this reovirus isolate to be unique. Thus, the virus was named Type 2 Winnipeg (T2W).

OBJECTIVES: Mycophenolic acid (MPA), a drug primarily used as an immunosuppressive agent, was assessed in the capacity to inhibit T2W viral growth.

METHODS: The effects of MPA on viral growth were determined by plaque reduction assays. Cells were treated with different MPA concentrations, infected with T2W and incubated at 37°C for 0 h to 72 h. Virus titres were determined and compared with untreated controls.

RESULTS: Production of infectious T2W progeny decreased more than 99% at 3 µg/mL MPA compared with untreated controls. Inhibition was not caused by cell toxicity because there was no difference in cell viability. The 50% cell toxic dose was 30 µg/mL MPA.

CONCLUSIONS: MPA was able to inhibit viral growth of the novel reovirus T2W. Although MPA is usually used as an immunosuppressive agent, and despite the fact that T2W was isolated from an immunocompromised patient, these results suggest that MPA could have been used as a possible treatment at subimmunosuppressive doses. Animal studies to better define the antiviral and immunosuppressive activities of MPA (and its prodrug mycophenolate mofetil) appear warranted.
A Case of Primary Lung Cancer Producing Alpha‐Fetoprotein
Authors: Yamagata Toshiyuki , Yamagata Yuko , Nakanishi Masanori , Matsunaga Kazuto , Minakata Yoshiaki , Ichinose Masakazu
Published: March 2016

A case of lung carcinoid showing elevated plasma alpha‐fetoprotein (AFP) level is reported. A 44‐year‐old man who complained of the development of bloody sputum had a left hilar lung mass on chest radiograph. The serum level of AFP was markedly increased to 8438 ng/mL. After resection, it was diagnosed as an atypical carcinoid, and the tumour cells were positive for cytoplasmic AFP. AFP is one of the most useful tumour markers for the diagnosis of hepatic cell carcinoma or germ cell tumours. It has also been reported that some primary lung tumours produce AFP. However, these tumours are mainly poorly differentiated adenocarcinomas or large cell carcinomas. A lung carcinoid that produces AFP is extremely rare.
The Management of Infection and Colonization due to Methicillin‐Resistant Staphylococcus aureus: A CIDS/CAMM Position Paper
Authors: Simor Andrew E , Loeb Mark , the CIDS/CAMM Guidelines Committee
Published: March 2016

Methicillin‐resistant Staphylococcus aureus (MRSA) is being seen with greater frequency in most hospitals and other health care facilities across Canada. The organism may cause life‐threatening infections and has been associated with institutional outbreaks. Several studies have confirmed that MRSA infection is associated with increased morbidity and mortality compared with infections caused by susceptible strains, even when the presence of comorbidities is accounted for. Treatment of MRSA infection is complicated by the fact that these organisms are resistant to multiple antimicrobial agents, so treatment options are limited. The effectiveness of decolonization therapy (attempting to eradicate MRSA carriage) is also uncertain. This paper reviews the medical management of MRSA infections, discusses the potential role of decolonization and provides an overview of evidence to support recommended infection control practices.
Steroids and/or Cytotoxic Agents Should Be Used Early in the Management of Patients with IPF ‐‐ The Pro Argument
Authors: Sharma Sat
Published: March 2016

Idiopathic interstitial pneumonias comprise a heterogenous group of acute and chronic respiratory conditions. Katzenstein and Myers (1) classified these disorders according to several pathologically distinct categories: usual interstitial pneumonitis (UIP), desquamative interstitial pneumonitis ? respiratory bronchiolitis interstitial lung disease, acute interstitial pneumonitis, nonspecific interstitial pneumonitis and cryptogenic organizing pneumonitis or bronchiolitis obliterans organizing pneumonia (1). These disorders present with similar clinical features of shortness of breath, diffuse pulmonary infiltrates on chest radiograph, and histologically, a varying combination of inflammation and fibrosis. However, the natural history and response to therapy differs substantially, as some categories have more favourable prognoses than others (2). Idiopathic pulmonary fibrosis (IPF) or fibrosing alveolitis is the clinical terminology for a specific interstitial pneumonia for which the pathological process is UIP. A disorder of unknown etiology, IPF is the most common and most lethal of all interstitial pneumonias.
Tuberculosis Control in Ecuador: Unforeseen Problems, Unanticipated Strengths
Authors: Houston Stan
Published: March 2016

Ecuador is among the eight countries with the highest tuberculosis (TB) prevalences in the Americas (the World Health Organization estimates 141 new cases/100,000 population in 2002) and has had a poorly functioning TB control program. As described in an earlier editorial (1), the Canadian Lung Association, with funding from the Canadian International Development Agency, has been involved for four years in supporting Ecuador?s National TB Program. The initial phase of the project has just been completed, but the experience has already provided many valuable lessons, some quite unexpected.
Pain Disorder, Hysteria or Somatization?
Authors: Merskey Harold
Published: March 2016

Pain used to be a simple issue. It was caused by physical injury or disease and the sufferer had to rest and take opium. That was about two hundred years ago. A few scattered commentators from Jeremiah (Lamentations I:12‐13) to Montaigne (1) had the idea that emotion could cause pain or influence it. The development of anatomical knowledge, closely followed by physiology and then pathology, produced a dilemma. There were many pains that could not be explained by the most modern physical methods of the nineteenth century. Hodgkiss (2) has tersely labelled the problem as "pain without lesion". The nineteenth century solution lay in a diagnosis of hysteria.
Pulmonary Rehabilitation Improves Functional Capacity in Patients 80 Years of Age or Older
Authors: Baltzan Marcel A , Kamel Hany , Alter Arlene , Rotaple Michael , Wolkove Norman
Published: March 2016

OBJECTIVES: There is limited evidence that pulmonary rehabilitation improves exercise capacity in older patients with chronic respiratory disease. The objective of the present study was to determine whether patients 80 years of age or older gain similar benefits from pulmonary rehabilitation as do younger patients.

DESIGN: Outcomes were compared in 230 consecutive inpatients with moderate to severe lung disease who participated in a comprehensive pulmonary rehabilitation program during a one‐year period. Outcomes included 6 min walk test distance (6MWT), the number of stairs completed in 2 min (2MST), Borg dyspnea scores after exertion and objective functional scores.

RESULTS: There were no differences between older (80 to 91 years, n=43) and younger patients (n=187) with respect to sex, forced expiratory volume in 1 s (mean 0.77 L versus 0.72 L) or number of chronic medical diagnoses (2.4 versus 2.7). Older patients were less frequently survivors of mechanical ventilation (2.3% versus 16%). Baseline 6MWT (133 m versus 144 m; P=0.48) and 2MST (5.2 laps versus 6.5 laps; P=0.067) were similar but global function was lower (85 versus 89; P=0.040) in older patients than in younger patients, respectively. After pulmonary rehabilitation, all outcomes improved significantly regardless of age (all before‐after comparisons P<0.0001). Younger patients improved with a higher discharge 6MWT (231 m versus 185 m; P=0.004) and similar discharge 2MST (9.3 laps versus 7.9 laps; P=0.070) compared with older patients. Global function at discharge remained lower in older patients than younger patients (91 versus 94; P=0.002). The duration of rehabilitation and length of stay were similar between the two groups.

CONCLUSION: A comprehensive inpatient pulmonary rehabilitation program is beneficial in selected patients 80 years of age or older.
User Perspectives on Issues that Influence the Quality of Daily life of Ventilator‐Assisted Individuals with Neuromuscular Disorders
Authors: Brooks Dina , King Audrey , Tonack Mark , Simson Helen , Gould Maria , Goldstein Roger
Published: March 2016

OBJECTIVES: To identify user perspectives on the issues that impact the quality of the daily lives of ventilator‐assisted individuals living in the community.

METHODS: Semistructured interviews were held with 26 Canadian ventilator‐assisted individuals (mean age 44±14 [SD] years, range 23 to 60 years; mean ventilator experience 18±13 years, range three to 53 years) whose disability from neuromuscular conditions necessitated assistance with activities of daily living. Participants described their daily life experiences and perceptions of the factors that limited or enhanced their quality. Interviews were tape‐recorded, transcribed and analyzed for emergent codes and themes.

RESULTS: Ventilator users characterized important issues in terms of personal successes and limitations, as well as dependencies on others for daily living. Personal support services, income security, health care and transportation were important positive contributors to their quality of life. Dependency on others was clearly a negative contributor. The ventilator was regarded as a form of assistive technology, similar to a wheelchair. Ventilator users perceived that ventilation was associated with a stigma and negative assumptions about disability, particularly if suctioning was required.

CONCLUSIONS: The majority of participants considered home mechanical ventilation to be a positive benefit for independent living, enhancing their overall health. They were clear as to the issues of importance to them, and formulated recommendations for health care providers and policy makers that could improve the quality of their daily lives. Many of the issues identified in the present report are faced by the growing community of ventilator users.
Microscopy and Polymerase Chain Reaction Detection of Leishmania chagasi in the Pleural and Ascitic Fluid of a Patient with AIDS: Case Report and Review of Diagnosis and Therapy of Visceral Leishmaniasis
Authors: Diehl Ada RS , dos Santos Rodrigo P , Zimmerman Ricardo , Luz Letícia P , Weiss Tanara , Jacobson Pedro , Goldani Luciano Z
Published: March 2016

Atypical visceral leishmaniasis is increasingly reported in immunocompromised patients, including patients with AIDS. A case of visceral leishmaniasis in an HIV‐infected Brazilian patient with pulmonary and peritoneal involvement is reported. Histological evaluation of pleural fluid and ascites aspirate revealed macrophages with intracellular Leishmania. Polymerase chain reaction analysis was positive for Leishmania in the pleural and ascitic fluid with use of primers specific for Leishmania chagasi. In addition to classical methods for diagnosing leishmaniasis, such as microscopy and culture, polymerase chain reaction detection and identification of Leishmania species in pleural effusions and ascites are important diagnostic tools that should be considered by clinicians evaluating HIV‐infected patients from endemic areas of visceral leishmaniasis. The authors review the clinical manifestations, diagnostic and therapeutic aspects of visceral leishmaniasis in immunocompetent and HIV‐infected patients.
The Effect of Breathing and Skin Stimulation Techniques on Labour Pain Perception of Turkish Women
Authors: Yildirim Gulay , Sahin Nevin Hotun
Published: March 2016

OBJECTIVE: To determine the effect of breathing techniques and
nurse‐administered massage on the pain perception of pregnant
woman during labour.

SETTING AND PARTICIPANTS: The present study was conducted
among pregnant women (75% primiparous) admitted to the
SSK Bakirkoy Women and Children’s Hospital (Istanbul, Turkey)
between January 1, and September 1, 2000. The patients were in their
38th to 42nd week of pregnancy, not at high risk and expected to
have normal vaginal delivery. They were selected from volunteers by
nonrandom sampling.

STUDY DESIGN: The present study involved 40 cases, with 20 in
the experimental group and 20 in the control group. Data were
obtained through the visual analogue scale, inspection form, observation
form and postnatal interview form. The study investigators provided
information about labour, breathing techniques and massage to
the pregnant women assigned to the experimental group at the beginning
of labour (latent phase). A study investigator also accompanied
them during labour. These women received nurse‐administered massage
and were encouraged to breathe and perform self‐administered
massage. They were also instructed to change their positions and to
relax.

RESULTS AND CONCLUSION: Study results demonstrated that
nursing support and patient‐directed education concerning labour
and nonpharmacological pain control methods (eg, breathing and
cutaneous stimulation techniques) were effective in reducing the perception
of pain by pregnant women (when provided in the latent
labour phase before delivery), leading to a more satisfactory birth
experience.