bluuebunny/crossref_metadata_2025 huggingface dataset:
Child Abuse and Dissociation in Patients with Complex Regional Pain Syndrome
Authors: Williams Michael , Read John , Large Robert
Published: March 2016

>OBJECTIVE: In the absence of a proven medical explanation for the chronic pain syndrome Complex Regional Pain Syndrome type I (CRPS I), this study explored a hypothetical link between childhood physical and sexual abuse, and the subsequent development of CRPS I. The hypothesis predicts the existence of a subpopulation of CRPS I patients with a high frequency of dissociative experiences corresponding to a history of childhood trauma.

DESIGN: To test this theory, CRPS I patients attending the Auckland Hospital Pain Clinic, Auckland, New Zealand were assessed by self‐report questionnaires for their frequency of dissociative experiences and for a history of childhood abuse. The data were compared with those of a low back pain control group and a healthy, pain‐free control group.

RESULTS: CRPS I patients were not unusually dissociative and had not experienced significantly higher rates of childhood abuse than the general population. Two of the 18 CRPS I patients were highly dissociative; both reported childhood sexual abuse.

CONCLUSIONS: A trauma‐dissociation pathway to CPRS I was not found. The desirability of screening for that subpopulation of CPRS I sufferers who may have been abused is discussed.
Asthma Education, Action Plans, Psychosocial Issues and Adherence
Authors: Kolbe John
Published: March 2016

This article deals with four separate but not disparate topics. The first section discusses asthma education, reviews the current literature and attempts to challenge some of the dogma that is associated with this area. Knowledge alone does not guarantee appropriate behaviour, due to a variety of adverse socioeconomic and psychological factors that need to be considered for each patient. Action plans and peak flow monitoring have both been disappointing in terms of reducing asthma morbidity; the former needs to be individualized, and the latter may be useful in specific situations. Space precludes an in‐depth discussion of psychological issues and adherence, but an attempt has been made to address salient issues, particularly related to the first two topics. Psychological factors, especially anxiety, play an important role in asthma outcome. Adherence to medication prescriptions and other management strategies need to be taken into account when an individual’s treatment program is planned.
Pain Evoked by Electrical Stimulation of the Prepyloric Region of the Stomach: Cutaneous Sensibility Changes in the Referred Pain Area
Authors: Drewes Asbjørn M , Krarup Henrik B , Hansen Jesper B , Tage-Jensen Ulrik , Arendt-Nielsen Lars
Published: March 2016

OBJECTIVE: To investigate the pain threshold and the referred pain areas to electrical stimulation of the prepyloric region of the stomach, and the cutaneous sensibility in the referred pain areas.

DESIGN: Eight healthy males volunteered for the study. To identify the area of referred pain, all subjects participated in a study using the same model four months previously. During gastroscopy, repeated electrical burst stimuli were delivered in four adjacent prepyloric sites of the stomach, and the pain detection thresholds (PDTs) together with the area of pain referral were determined. Before, during and after continuous electrical painful stimuli delivered in the prepyloric region, the cutaneous sensitivities in the referred pain area and a control area on the chest were characterized using electrical, heat, touch and pinprick stimuli.

RESULTS: The PDTs in the four prepyloric areas were not different and the location of the referred pain was reproducible. During the nociceptive visceral stimuli, hyperalgesia to heat stimulation was detected in the referred pain area compared with the control area, but the thresholds for electrical, touch and pinprick stimulations did not change.

CONCLUSIONS: The reproducible pain thresholds in adjacent prepyloric sites make future analysis in patient groups possible because the precise site of stimulation can vary without changing the sensibility. The modality‐specific somatosensory changes in the referred pain areas further indicate that visceral pain can cause differentiated sensory changes. Modality‐specific sensibility changes are also seen in referred areas to muscle pain. Thus, the model may increase the information on viscerocutaneous convergence phenomena in humans.
Canadian Pain Society Position Statement on Pain Relief
Authors: Watt-Watson Judith H , Clark A John , Finley G Allen , Watson C Peter N
Published: March 2016

The present report outlines key requirements that are central to helping patients manage pain effectively. Although current standards are available as guides for practice, the prevalence of pain suggests that many health professionals do not know and/or cannot relate to these standards. Therefore, a brief, pragmatic statement may be more useful initially for health professionals and patients learning about problematic pain outcomes. The principles in the brief statement produced by the Canadian Pain Society clarify and emphasize key underlying assumptions that have directed the development of many pain standards. The aim of the present paper is to increase awareness of ineffective pain practices and the importance of pain relief, and to stimulate further work in this area.
Acute Respiratory Distress Syndrome: 30 Years Later?
Authors: Lesur Olivier , Berthiaume Yves , Blaise Gilbert , Damas Pierre , Deland Éric , Guimond Jean-Gilles , Michel René P
Published: March 2016

Acute respiratory distress syndrome (ARDS) was first described about 30 years ago. Modern definitions and statements have recently been proposed to describe ARDS accurately, but none is perfect. Diffuse alveolar damage is the basic pathological pattern most commonly observed in ARDS, and the term includes permeability edema. The alveolar epithelium of the alveolar‐capillary barrier is clearly a key component requiring repair, given its multipotent functional activity. Lung inflammation and neutrophil accumulation are essential markers of disease in ARDS, and a wide variety of pro‐ and anti‐inflammatory cytokines have been described in the alveolar fluid and blood of patients. These molecules still have to prove their value as diagnostic or prognostic biomarkers of ARDS.

Supportive therapy in ARDS improved in the past decade; mechanical ventilation with lung protective strategies and patient positioning are gaining interest, but the indications for corticosteroids for ARDS are still debated. Nitric oxide may have a place in the treatment of one‐third of patients. Novel approaches, such as surfactant replacement and liquid ventilation, may further improve supportive therapy. Innovative interventions may be on the horizon in treatments that help to resolve or modulate common pathways of ARDS, such as inflammation (eg, granulocyte‐colony stimulating factor) or epithelial repair (eg, keratinocyte growth factor).
Salmeterol and Fluticasone Propionate (50/250 μg) Administered via Combination Diskus Inhaler: As Effective as When Given via Separate Diskus Inhalers
Authors: Chapman Kenneth R , Ringdal Nils , Backer Vibeke , Palmqvist Mona , Saarelainen Seppo , Briggs Mark
Published: March 2016

OBJECTIVE: To compare the efficacy and safety of a new combination Diskus inhaler containing both salmeterol 50 μg and fluticasone propionate 250 μg (Seretide) with the two drugs delivered via separate Diskus inhalers.

DESIGN: A multicentre, double‐blind, double‐dummy study. Three hundred and seventy‐one symptomatic asthma patients (age range 13 to 75 years, mean 42 years) receiving inhaled corticosteroids were randomly assigned to two treatement groups: 28 weeks’ treatment with either salmeterol/fluticasone propionate (50/250 μg bid) via a single
Diskus inhaler (combination) and placebo bid via another Diskus inhaler, or salmeterol 50 μg bid via one Diskus inhaler and fluticasone propionate 250 μg bid via another (concurrent). Morning peak expiratory flow rate (PEFR) and symptoms were measured for the first 12 weeks and safety data were collected throughout the study.

RESULTS: Over weeks 1 to 12, adjusted mean improvements in morning PEFR were 43 and 36 L/min for combination and concurrent therapies, respectively. The difference between the two treatment arms was 6 L/min (90% CI –13 to 0 L/min; P=0.114), which was within the predefined criteria for clinical equivalence. Adjusted mean improvements in forced expiratory volume in 1 s from baseline for week 28 were also similar between the two therapies. Thirty‐five per cent of patients receiving combination inhaler and 31% of those receiving concurrent therapy had a mean daytime symptom score of zero over weeks 1 to 12 compared with 1% and 2%, respectively, at baseline. There was no difference in the incidence of adverse events between the two treatment arms. Mean serum cortisol levels were similar, and no differences in frequency of abnormal results were noted between the two groups.

CONCLUSIONS: This study shows that the combination of
salmeterol and fluticasone propionate in a single inhaler is as efficacious in achieving asthma control and as well tolerated over a 28‐week period as the two drugs administered individually.
Application of DNA Array Technology for Diagnostic Microbiology
Authors: Booth Stephanie A , Drebot Michael A , Tipples Graham A , Ng Lai King
Published: March 2016

Microarrays or DNA chips have been hailed as the ultimate experimental tool for research, drug discovery and diagnostics. They have the potential to perform a multitude of molecular tests simultaneously and to produce a wealth of information from a single clinical sample. Applications include genotyping, expression analysis and sequencing (1‐4). The aim of this review is to provide a brief summary of current microarray technology and highlight the many ways in which it is being developed for use in clinical microbiology laboratories.
Amiodarone Pulmonary, Neuromuscular and Ophthalmologic Toxicity
Authors: Burns Karen EA , Piliotis Eugenia , Garcia Bertha M , Ferguson Kathleen A
Published: March 2016

Amiodarone is an iodinated benzofuran derivative class III antiarrhythmic that is highly effective in suppressing ventricular and supraventricular arrhythmias. It is also associated with an imposing side effect profile, which often limits its use. Numerous adverse effects have been documented including skin discolouration, photosensitivity, hepatitis, thyroid dysfunction, corneal deposits, pulmonary fibrosis, bone marrow suppression and drug interactions. These side effects are thought to be correlated with the total cumulative dose of amiodarone, but idiopathic reactions have been reported. The majority of adverse reactions resolve with discontinuation of the drug; however, rapid progression may occur, which may be fatal. The present report documents a patient who had a combination of serious amiodarone toxicities that, once recognized, were treated and eventually resulted in a good outcome.
Hydroxyurea‐Induced Hypersensitivity Pneumonitis: A Case Report and Literature Review
Authors: Sandhu Harminder S , Barnes Penny J , Hernandez Paul
Published: March 2016

Hydroxyurea is a cytotoxic agent indicated in the treatment of a variety of malignant and nonmalignant conditions. Apart from dose‐related bone marrow suppression, this antineoplastic agent is generally well tolerated. This report describes a patient with chronic myeloid leukemia who developed severe pneumonitis within four weeks of beginning therapy with hydroxyurea. Pathological examination of a lung specimen obtained by video‐assisted thoracoscopic lung biopsy revealed extensive active alveolar and interstitial inflammation, and poorly formed granulomas. After the cessation of hydroxyurea and treatment with systemic corticosteroids, both clinical and radiological resolution of pneumonitis occurred. Physicians using hydroxyurea must be aware of its potentially life‐threatening pulmonary toxicity.
Postherpetic Nneuralgia: Review of Treatment Modalities
Authors: Chan Philip SL , Clark Alexander J
Published: March 2016

BACKGROUND: Varicella zoster virus (VZV) is the etiological agent for both varicella (chickenpox) and herpes zoster (HZ) (shingles). HZ results from the reactivation of VZV acquired during childhood. Postherpetic neuralgia (PHN) is the most common complication of HZ infection in immunocompetent patients. There is no universally accepted definition of PHN. While the mechanisms producing pain associated with PHN are not fully understood, peripheral and central processes are thought to be important.

METHODS: The literature on the pathophysiology and the treatment of postherpetic neuralgia was reviewed for the past 30 years by using Index Medicus.

CONCLUSIONS: Many modalities to treat PHN are available; none of them are very effective. The most commonly used modalities are tricyclic antidepressants, anticonvulsants, opioid analgesics, topical medications, physical modalities such as acupuncture and transcutaneous nerve stimulation, and nerve blocks. The tricyclic antidepressants have the most evidence supporting their role in treating PHN, although only half of the patients with PHN benefit. Recent studies support the use of opioid analgesics in PHN. There is a growing body of evidence in support of the use of gabapentin for PHN. Physical modalities and topical medications are probably most useful as adjuncts to centrally acting agents, not as a primary treatment modality. Injections (nerve blocks) are effective in relieving PHN anecdotally, although there are no controlled clinical trials showing efficacy.
Summary of Canadian Guidelines for the Initial Management of Community-Acquired Pneumonia: An Evidence-Based Update by the Canadian Infectious Diseases Society and the Canadian Thoracic Society
Authors: Mandell Lionel A , Marrie Thomas J , Grossman Ronald F , Chow Anthony W , Hyland Robert H , the Canadian CAP Working Group
Published: March 2016

Community-acquired pneumonia (CAP) is a serious illness with a significant impact on individual patients and society as a whole. Over the past several years, there have been significant advances in our knowledge and understanding of the etiology of the disease, and an appreciation of problems such as mixed infections and increasing antimicrobial resistance. The development of additional fluoroquinolone agents with enhanced activity against Streptococcus pneumoniae has been important as well. It was decided that the time had come to update and modify the previous CAP guidelines, which were published in 1993. The current guidelines represent a joint effort by the Canadian Infectious Disease Society and the Canadian Thoracic Society, and they address the etiology, diagnosis and initial management of CAP. The diagnostic section is based on the site of care, and the treatment section is organized according to whether one is dealing with outpatients, inpatients or nursing home patients.
Is Methicillin‐Resistant Staphylococcus aureus an Emerging Community Pathogen? A Review of the Literature
Authors: Gardam Michael A
Published: March 2016

OBJECTIVES: To discuss the historical epidemiology of methicillin‐resistant Staphylococcus aureus (MRSA) and review the literature suggesting that MRSA has become a community pathogen.

DATA SOURCES: A search of the MEDLINE database was performed, encompassing all English or French language citations  from 1966 to 1999 and containing the subjects and/or text words: ′Staphylococcus aureus′, ′methicillin resistance′, ′endocarditis′, ′cellulites′, ′pneumonia′ and ′community‐acquired′. Articles published in other languages that provided English or French abstracts were included. All relevant references cited in articles obtained from the MEDLINE database and book chapters were also included.

DATA EXTRACTION: All articles obtained from the above sources were examined and were included in the review if a laboratory or epidemiological study of community‐acquired MRSA was presented.

DATA SYNTHESIS AND CONCLUSIONS: MRSA has emerged over the past 30 years to become a worldwide nosocomial pathogen and has recently been reported as a cause of community‐acquired infections. The changing epidemiology of MRSA is likely because of two mechanisms: the movement of nosocomial MRSA strains into the community and the de novo appearance of community strains resulting from the transfer of genetic material from methicillin‐resistant Gram‐positive organisms to sensitive S aureus strains. The emergence of MRSA as a community pathogen has occurred at a slower rate than it did for penicillin‐resistant S aureus (PRSA) in the 1950s and 1960s, possibly because the mechanism of methicillin resistance does not exhibit the same ease of transferability as that of penicillin resistance. Four case reports, seven case series, 10 case‐control studies and two cohort studies on community‐acquired MRSA were analyzed. Determining whether these reports involve new community‐acquired strains rather than previously acquired nosocomial strains can be problematic. It appears, however, that MRSA strains of both nosocomial and community origin are now endemic in certain communities in different parts of the world. Few surveillance studies of nonhospitalized patient populations have been performed to date; thus, the true prevalence of MRSA in the community at large is essentially unknown, although it appears to be low. At present, the empirical treatment of community‐acquired S aureus infections with a beta‐lactamase‐stable beta‐lactam antibiotic is appropriate for most populations. However, empirical vancomycin therapy for serious S aureus infections should be strongly considered for patients with significant risk factors for previously‐acquired nosocomial MRSA or for patients belonging to outpatient populations with a proven high prevalence of MRSA. Increasing vancomycin use will likely have a significant impact on the development of resistance in Gram‐positive organisms.
Common Mechanisms Underlying Opioid Tolerance and Dependence and Neuropathic Pain: Role of Metabotropic Glutamate Receptors
Authors: Fundytus Marian E
Published: March 2016

It has been suggested that opioid tolerance and dependence share common mechanisms with neuropathic pain. This short review deals with the role of glutamate and glutamate receptors in opioid tolerance and dependence, and neuropathic pain. Particular attention is given to the role of metabotropic glutamate receptors (mGluRs). First, the different types of glutamate receptors, which include N‐methyl‐D‐aspartate, alpha‐amino‐3‐hydroxyl‐5‐methyl‐ isoxazole‐4‐propionic acid, kainate and mGluRs, are described. Following this, evidence suggesting that these receptors are involved in opioid tolerance and dependence are summarized. At the end of this section, a model that has been previously proposed to explain mechanisms by which mGluRs may be involved in opioid tolerance and dependence are described. Next is a discussion of the evidence suggesting that glutamate receptors are similarly involved in neuropathic pain, and also in opioid sensitivity associated with neuropathic pain. Again, a hypothetical model used to explain mechanisms by which mGluRs may be involved in neuropathic pain is briefly described. The relevance of the data is discussed in terms of some of the clinical implications of the material presented in the article.
Neuralgias of the Trigeminal Nerve
Authors: Gordon Allan S
Published: March 2016

Practitioners are often presented with patients who complain bitterly of facial pain. The trigeminal nerve is involved in four conditions that are sometimes mixed up. The four conditions ‐ trigeminal neuralgia, trigeminal neuropathic pain, postherpetic neuralgia and atypical facial pain ‐ are discussed under the headings of clinical features, differential diagnosis, cause and treatment. This article should help practitioners to differentiate one from the other and to manage their care.
Physician Asthma Management Practices in Canada
Authors: Jin Robert , Choi Bernard CK , Chan Benjamin TB , McRae Louise , Li Felix , Cicutto Lisa , Boulet Louis-Philippe , Mitchell Ian , Beveridge Robert , Leith Eric
Published: March 2016

OBJECTIVES: To establish national baseline information on asthma management practices of physicians, to compare the reported practices with the Canadian Consensus recommendations and to identify results potentially useful for interventions that improve physician asthma management practices.

DESIGN: National, stratified cross‐sectional survey.

SETTINGS: The 10 provinces and two territories of Canada, from 1996 to 1997.

PARTICIPANTS: Questionnaires were sent to 4489 physicians stratified by province/territory and specialty group (family/general practice, respirology, internal medicine, pediatrics and allergy/immunology); 2605 responses were received.

OUTCOME MEASURES: Methods for the diagnosis, treatment, education and follow‐up of patients with asthma (′asthma management practices′).

RESULTS: Significant variations existed among the five specialty groups in asthma management practices. A low use of objective measures of airflow limitation to assist with diagnosis was found among some respondents (mostly family physicians). Up to 40% of physicians regarded the daily fixed dosing (three or four times a day) of inhaled, short acting beta2‐agonist as ′first‐line therapy′ for moderate to severe asthma. A minority of physicians reported using written action plans for patients or referring them to other health professionals for asthma education. Insufficient time during appointments and a perceived lack of appropriate educational materials were frequently cited as reasons for not providing asthma education. The perceived knowledge of the Canadian Consensus recommendations varied among physicians but was lowest among nonspecialists.

CONCLUSIONS: The survey showed variations in certain aspects of the management of asthma by physicians. The findings will help to target specific areas for future physician education programs and other behavioural change strategies.
Support for a Common Metric for Pediatric Pain Intensity Scales
Authors: von Baeyer Carl L , Hicks Carrie L
Published: March 2016

Institutional adoption of routine measurement of pediatric pain has been impeded partly by the profusion of different metrics (eg, 0 to 5, 0 to 6, 0 to 10, 0 to 100) for reporting pain intensity on various instruments.  The present paper discusses the importance of adopting a common metric, that is, a single numbering system on which estimates of pain intensity from various sources can be recorded. To explore both support and reservations concerning the adoption of a common metric, a survey questionnaire was sent in 1999 to an estimated 600 subscribers to the Pediatric Pain Internet Mailing List. Individuals working in pediatric institutions where children′s pain is routinely measured, or where adoption of such measures is planned, were requested to respond by e‐mail or mail. Responses (n=37) were from nurses (49%), physicians (24%), psychologists (7%) and others/unlisted (20%) on four continents. Adoption of a common metric was endorsed by 81% of respondents. Among the possible numbering systems, the 0 to 10 system was strongly favoured (70%) over other options. Respondents commented that adoption of a common metric would improve communication and consistency in measurement both within and among institutions.  Some disadvantages, such as staff resistance to altering existing systems, were also suggested. The majority of respondents thought that it would be desirable to adopt a common metric. Among the possible numbering systems, the 0 to 10 system is by far the most favoured. Adopting a common 0 to 10 standard, and adapting existing tools to that metric, would be positive steps toward identifying and relieving children′s pain.
The Montreal General Hospital Pain Centre (1974‐2000): The Contributions of Ronald Melzack
Authors: Jeans Mary Ellen , Stratford Joseph , Taenzer Paul , Lefort Sandra , Rowat Kathleen
Published: March 2016

This paper chronicles the development of the Montreal General Hospital Pain Centre from its inception in 1974 to the present. Highlighted in particular are the contributions of Ronald Melzack to this history. Data for the article arose, in the main, from an interview with Dr Melzack carried out earlier in the year. Discussions with former and present members of the pain centre team, including former graduate students, provided additional information. The article begins with a recounting of those individuals and events that inspired Ron early in his ′pain career′ to pursue his dream of a multidisciplinary pain centre, the first of its kind in Canada. The forces that helped shape the development of this centre and the challenges that had to be overcome are described.
Microbiologic Surveillance and Parenteral Antibiotic Use in a Critical Care Unit
Authors: Yamashita Sharon K , Louie Marie , Simor Andrew E , Rachlis Anita
Published: March 2016

OBJECTIVE: To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU).

DESIGN: Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay.

SETTING: A 17‐bed medical‐surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto.

PATIENTS: Two hundred and fifty‐eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy.

RESULTS: The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other Gram‐negative bacilli (19%). Only 9% of Gram‐negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended‐spectrum beta‐lactamases or imipenem‐resistance were detected. No vancomycin‐resistant enterococci and only two methicillin‐resistant Staphylococcus aureus isolates were identified.

CONCLUSIONS: Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.
Neurosurgery for Chronic Neuropathic Pain
Authors: Park Jung Y , Lozano Andres M
Published: March 2016

Neurosurgery can play a role in the management of patients with refractory chronic neuropathic pain. However, selecting patients as candidates for surgery and choosing the most appropriate surgical procedure is challenging, and surgical interventions often have limited efficacy. When considering surgery, neuroaugmentative or neuromodulative procedures (eg, peripheral, spinal, motor cortex or deep brain stimulation) are generally preferred over ablative procedures as initial modalities. With better understanding of specific pain mechanisms, surgery will have more to offer patients with chronic neuropathic pain.
Accuracy of Children′s and Parents′ Memory for a Novel Painful Experience
Authors: Badali Melanie A , Pillai Rebecca R , Craig Kenneth D , Giesbrecht Kelly , Chambers Christine T
Published: March 2016

BACKGROUND: Despite recent progress in understanding memory of pain in adults, the validity of the assumption that these findings extend to children has not been established. Because treatment often is evaluated on the basis of pain recall, it is crucial that the accuracy of pain memories in children be established.

OBJECTIVES: To examine children′s ability to recall pain intensity and contextual details associated with a novel painful experience. Furthermore, children′s memories were compared with those of their parents.

SUBJECTS AND METHODS: Twenty‐three parent‐child dyads were recruited from a sample participating in an earlier study investigating children′s responses to the cold pressor test and parents′ characterization of the children′s responses. Children (age five to 12 years) and parents independently had rated the child′s pain using a seven‐point Faces Pain Scale. Approximately one year later, they were asked to recall the experience and rate the pain again. Memory for contextual details associated with the event also was assessed through a series of open‐ended questions.

RESULTS: A 2 (rater) × 2 (time period) repeated measures ANOVA examined the reliability of ratings and differences between parent and child ratings of pain, both recorded at the time of the cold pressor and recalled one year later. There were no significant differences in ratings over time or between parent and child.

CONCLUSIONS: The findings indicate that children′s memories of a novel painful experience can be consistent over a long interval. Moreover, parents′ ratings also reflect good recall and can be in agreement with those of their children.
Electrical Nerve Stimulation Can Be Used as a Tool in fMRI Studies of Pain‐ and Tingling‐Evoked Activations
Authors: Davis Karen D , Kwan Chun L , Crawley Adrian P , Mikulis David J
Published: March 2016

OBJECTIVES/HYPOTHESES: To determine whether transcutaneous electrical nerve stimulation (TENS) provides adequate, inexpensive and simple means to image innocuous and pain‐related activations in the thalamus and cortex.

SUBJECTS AND METHODS: High resolution functional magnetic resonance imaging (fMRI) was used to obtain functional data sets on a 1.5T General Electric echospeed scanner (General Electric, Milwaukee) from six axial slices during interleaved periods of rest and TENS at either nonpainful tingling or painful intensities. The volume of brain imaged allowed inspection of stimulation‐related activations in the thalamus, insula and second somatosensory cortex (S2).

RESULTS: Tingling TENS activations were identified primarily in the contralateral posterolateral thalamus. Painful TENS activations were found in the contralateral posterolateral thalamus, medial and/or anterior thalamus. The insula and S2 were activated in four of the subjects with tingling TENS and in all subjects with painful TENS. Tingling TENS activations were located in the posterior insula, whereas pain‐related activations were located in the anterior insula. Painful TENS activations found in S2 overlapped with tingling TENS activations.

CONCLUSIONS: These findings demonstrate that TENS is a simple mode of stimulation that produces fairly consistent cortical activations, especially at painful levels, and thus may be useful in carefully designed and controlled clinical fMRI studies of pain and touch.
Opioid Analgesics in the Management of Neuropathic Pain
Authors: Moulin Dwight
Published: March 2016

The role of antidepressants and anticonvulsants in the management of neuropathic pain has been well established. However, up to 50% of patients obtain inadequate pain relief with the use of either or both of these agents; in this subpopulation, an opioid analgesic may be beneficial. There is clear evidence that opioid analgesics are efficacious in the management of neuropathic pain, but there is controversy as to the balance between analgesia and adverse effects. Opioid treatment may require higher doses than other kinds of drug therapies, thereby increasing the risk of opioid‐related side effects. Psychological dependence or addiction, however, is not usually an issue in pain management with opioid analgesics. The extant literature strongly suggests the trial of an opioid analgesic in the management of neuropathic pain if adjuvant analgesics fail to provide adequate pain control. Failure of one opioid warrants a trial of another opioid because their effectiveness can vary among patients; the results are based on physiochemical properties of the drug and idiosyncratic reactions of the patient. Neuropathic pain can be a difficult problem to manage, and sometimes the use of an opioid analgesic can make the difference between bearable and unbearable pain so that patients can get on with their lives.
The First Smallpox Epidemic on the Canadian Plains: In the Fur‐traders′ Words
Authors: Houston C Stuart , Houston Stan
Published: March 2016

William Tomison, in charge of the Hudson′s Bay Company′s Cumberland House on the Saskatchewan River, described the devastating smallpox epidemic of 1781 and 1782. He understood contagion, practised isolation and disinfection, and provided mortality statistics during a ′virgin soil′ epidemic. Above all, he showed remarkable compassion. He and his men took dying Indians into their already crowded quarters, and provided them with food, shelter and 24 h care. This article describes the epidemic and its aftermath.
Foodborne Pread of Hepatitis A: Recent Studies on Virus Survival, Transfer and Inactivation
Authors: Sattar Syed A , Tetro Jason , Bidawid Sabah , Farber Jeff
Published: March 2016

Hepatitis A virus (HAV) is responsible for considerable morbidity and economic losses worldwide, and is the only reportable, foodborne viral pathogen in Canada. Outbreaks caused by it occur more frequently in settings such as hospitals, daycare centres, schools, and in association with foods and food service establishments. In recent years, the incidence of hepatitis A has increased in Canada. Many factors, including changing lifestyles and demographics, faster and more frequent travel, and enhanced importation of foods from hepatitis A‐endemic regions, may be behind this increase. Despite its increasing significance as a human pathogen, not much was known until recently about the survival and inactivation of HAV, and even less was understood about the effectiveness of measures to prevent and control its foodborne spread. Studies conducted in the past decade have shown that HAV can survive for several hours on human hands and for several days on environmental surfaces indoors. The virus can also retain its infectivity for several days on fruits and vegetables which are often consumed raw, and such imported items have already been incriminated in disease outbreaks. Casual contact between contaminated hands and clean food items can readily lead to a transfer of as much as 10% of the infectious virus. HAV is also relatively resistant to inactivation by heat, gamma irradiation and chemical germicides. In view of these findings, better approaches to prevent the contamination of foods with HAV and more effective methods for its inactivation in foods, on environmental surfaces and on the hands of food handlers are needed.
Beyond Reflexive Measures to Examine Higher Order Pain Processing in Rats
Authors: Fuchs Perry N
Published: March 2016

In 1968, Melzack and Casey published a pivotal paper in which they described a model of the sensory, motivational and cognitive determinants of pain. Much of Ronald Melzack′s career has been dedicated to exploring this complex relationship. Of primary importance is the influence that Ron has had on the development of some of the current research interests of the present author. For instance, Ron′s theoretical approach provided the underpinnings for the development of an additional behavioural testing technique in rat models of nociception that has been recently developed in the author′s laboratory. The test is based on the assumption that escape and avoidance of a stimulus are clear indications that the stimulus is aversive. It is proposed that behavioural test paradigms based on this approach provide additional information beyond the traditional measures of stimulus‐evoked reflexive responses. With these tests, the underlying assumption that different aspects of pain are processed by different neural substrates can be tested.
Outcome of Tuberculosis Treatment: A Comparison between Alberta and Nicaragua
Authors: Kassam Narmin , Fanning Anne , Cruz Jose Ramon , Tardencilla Alejandro
Published: March 2016

OBJECTIVE: To measure the outcome of tuberculosis treatment in a low incidence, high income region, Alberta, and compare with an intermediate incidence, low income country with a model national tuberculosis program, Nicaragua.

DESIGN: All 1992 sputum smear‐positive pulmonary cases from both regions were included. Treatment outcome was assigned retrospectively to Alberta cases according to the International Union Against Tuberculosis and Lung Diseases′ (IUATLD) criteria of cure, failure, transfer, absconder and death.

SETTING: Alberta laboratories are required to report all Mycobacterium tuberculosis cultures to Alberta provincial tuberculosis services. Nicaragua cases are reported centrally to the Programa de control de tuberculosis in Managua using the IUATLD criteria.

MAIN RESULTS: In Alberta, 222 tuberculosis cases were identified, of which 61 were smear positive. Nicaragua had 1552 smear positive cases of 2885 tuberculosis cases. Alberta′s outcomes were 82% cured, no failed treatment, 5% absconded, 2% transferred and 11% died; Nicaragua′s outcomes were 77% cured, 2% failed, 13% absconded, 5% transferred and 4% died. There was no significant difference in cure rates between Alberta and Nicaragua, P=0.33.

CONCLUSIONS: Treatment outcomes can be measured effectively and reported in high income, low incidence settings. Alberta is achieving comparable cure rates with the Nicaraguan national tuberculosis program.
Tolerance to Morphine Analgesia: Influence of Pain and Method of Morphine Delivery
Authors: Chen Scott A , Vaccarino Anthony L
Published: March 2016

Whether some kinds of pain can modify the development of tolerance to morphine analgesia is a controversial issue. Clinically, the development of tolerance is often difficult to establish because many factors can contribute to a decline in analgesic coverage, including disease progression. Basic animal research designed to examine tolerance provides the experimental control necessary to differentiate ′real′ tolerance from other variables that can influence morphine analgesia. The present study examines the effects of inflammation induced by complete Freund′s adjuvant (CFA) on the development of tolerance to morphine analgesia produced by two different methods of morphine delivery ‐ repeated bolus injections and continuous infusion. Male Long‐Evans hooded rats were injected with CFA (0.2 mL) into the right hind paw under sodium pentobarbital anesthesia or were given anesthesia alone. Starting 24 h later, rats either received an injection of morphine (20 mg/kg, intraperitoneal) on four consecutive days or were implanted with a 72 h osmotic minipump that delivered 80 mg/kg morphine over a similar time period. Control animals received saline injections or were implanted with empty minipumps. After 24 h, sensitivity to morphine‐induced analgesia was measured by the tail‐immersion test (water maintained at 52°C) using a cumulative dosing procedure. It was found that CFA attenuated tolerance to the morphine analgesia that was induced by intraperitoneal injections of morphine. In contrast, when morphine was delivered via osmotic minipumps, significant analgesic tolerance was observed in animals that received morphine in the presence of CFA but not in those that received morphine in the absence of CFA. These results show the importance of the method used to deliver morphine in determining the effects of pain on the development of tolerance to morphine analgesia.
Tic Douloureux
Authors: Loeser John D
Published: March 2016

Tic douloureux is an excruciatingly painful condition that primarily affects elderly people. It consists of unilateral electric shock‐like facial pains triggered by non‐noxious stimulation with clear‐cut pain‐free intervals. It should be discriminated from all other types of facial pain by the history and physical examination. Primary treatment includes anticonvulsant drugs if these fail or side effects prevent their use, a surgical procedure is warranted. Almost every patient with tic douloureux can be relieved of his or her pain with anticonvulsant medications or surgery. Stereotactic radiosurgery, percutaneous gangliolysis and suboccipital craniectomy with microvascular decompression are the primary surgical options. The common aspects of tic douloureux and some of the rarer variations are reviewed, and treatment options are presented.
An Unusual Example of Asperigillus Species Lung Disease
Authors: Pardy Richard L , Grymaloski Martha , Walker Blair AM
Published: March 2016

A 37‐year‐old man developed persistent hemoptysis after sustaining a gunshot wound to the right shoulder and lung. A right upper lobectomy was performed, in which Aspergillus species microorganisms were identified within retained bullet fragments. The role of infected bullet fragments in the pathogenesis of hemoptysis in this patient is discussed.
Is Video‐Assited Thoracoscopic Surgery Superior to Limited Axillary Thoracotomy in the Management of Spontaneous Pneumothorax?
Authors: Hyland Meaghen J , Ashrafi Ahmad S , Crépeau André , Mehran Reza J
Published: March 2016

OBJECTIVE: To evaluate bullectomy and pleurectomy in the treatment of spontaneous pneumothorax (PNO) using video‐assisted thoracoscopic surgery (VATS), and to compare the outcome with that of the same procedure performed using limited axillary thoracotomy (LAT).

DESIGN: A retrospective case series with patient follow‐up.

SETTING: A Canadian tertiary care hospital.

PATIENTS: The medical records of all patients with a spontaneous PNO treated by either VATS or LAT at the Ottawa Hospital ‐ General Campus, Ottawa, Ontario, between April 1993 and August 1999 were reviewed, and the patients were subsequently interviewed.

MAIN OUTCOME MEASURES: Operative details (length of operation, operative complications); postoperative details (duration of chest tube, length of hospital stay, duration of analgesia, pain, time missed from work, complications, recurrence rate); and cost (hospital and operative, socioeconomic [time missed from work]).

RESULTS: Fifty patients were identified who had had surgical treatment of a spontaneous PNO. Twenty‐eight patients were treated by LAT and 22 underwent VATS. The median length of follow‐up was 44.6 months (range four to 81.5 months). Three patients developed a recurrent PNO ‐ two patients after LAT and one patient after VATS. No difference was found between the two groups in the operating time or in the amount of pain experienced immediately after surgery. However, patients who underwent VATS had a shorter length of stay (P=0.002) and a shorter requirement for analgesics postoperatively (P=0.03). Overall, the total cost of VATS was no different than that for LAT; however, in terms of socioeconomic costs, patients in the VATS group missed significantly less time from work postoperatively (P=0.02).

CONCLUSIONS: VATS offers a cost effective and better tolerated procedure for the management of spontaneous PNO than the time‐honoured open technique.
Of Microsoft and Mycobacteria
Authors: Pasterkamp Hans
Published: March 2016

Bill Gates should have run for President of the United States. Not only would he have been a candidate with some legitimate claim to the Internet, but his call for a major increase in funding for new defence systems would have been supported by the general public, both at home and abroad. The founder of Microsoft himself spent US$1.44 billion last year to support the fight against global health threats from infectious diseases such as AIDS, malaria and tuberculosis (TB). This contribution from the Bill and Melinda Gates Foundation was more than one‐quarter of the total amount that all industrialized nations together raised for this cause.
Children’s Pain: A Mandate for Change
Authors: Brennan-Hunter Andrea L
Published: March 2016

There have been tremendous research advances in the past 15 years in knowledge about children′s pain, and strategies for recognizing and managing that pain. However, the clinical care of children in pain remains a challenge. Children′s pain continues to be frequently unrecognized , dismissed or ineffectively managed. A loud call for change is being voiced by physicians, nurses, children and their families. A review of the literature was conducted to document this issue. Starting with a Medline search of the key word ′child* + pain′ and continuing with a snowball technique, articles and resources addressing children′s pain were collected. Resources presented or published after 1990 were particularly sought because they theoretically reflect both current knowledge about children′s pain and the implementation of this knowledge in practice. Unfortunately, although information on pain is available to help children, in many instances, it is not being used. The purpose of the present paper is twofold ‐‐ to present an overview of current knowledge of children′s pain, and factors that hinder its effective assessment and management; and to present a mandate for change. Children′s postoperative pain is highlighted in this paper as an example of the gap between pain knowledge and clinical practice. Although treatment strategies differ across different types of pain, children′s conditions and ages, the principles and mandate for change discussed in this paper are directly relevant to all categories of children′s pain.
Evaluation of Potential Factors Contributing to Microbiological Treatment Failure in Streptococcus Pyogenes Pharyngitis
Authors: Kuhn Susan M , Preiksaitis Jutta , Tyrrell Gregory J , Jadavji Taj , Church Deirdre , Davies H Dele
Published: March 2016

BACKGROUND: A cohort study of children with pharyngitis aged two to 16 years was conducted to assess the role of microbial and host factors in group A beta‐hemolytic streptococcus (GABHS) microbiological treatment failure. METHODS: GABHS‐infected children had pharyngeal swabs repeated two to five days after completing a 10‐day course of penicillin V. M and T typing, and pulsed field gel electrophoresis were performed on the isolates, and the isolates were evaluated for tolerance. Patient characteristics and clinical features were noted and nasopharyngeal swabs for respiratory viruses were taken at enrolment. RESULTS AND CONCLUSIONS: Of 286 patients enrolled, 248 (87%) could be evaluated. GABHS was cultured from 104 patients (41.9%), of whom 33 (33.7%) had microbiological treatment failures on follow‐up. Although there was a trend toward failure for younger children (mean 6.5±2.4 years versus 7.3±2.4 years, P=0.07) and M type 12 (24% versus 10%, P=0.08), no factors were associated with treatment failure.
Mechanisms of Sucrose and Non‐Nutritive Sucking in Procedural Pain Management in Infants
Authors: Gibbins Sharyn , Stevens Bonnie
Published: March 2016

The administration of sucrose with and without non‐nutritive sucking (NNS) has been examined for relieving procedural pain in newborn infants. The calming and pain‐relieving effects of sucrose are thought to be mediated by endogenous opioid pathways activated by sweet taste. The orogustatory effects of sucrose have been demonstrated in animal newborns, and in preterm and full term human infants during painful procedures. In contrast to sucrose, the analgesic effects of NNS are hypothesized to be activated through nonopioid pathways by stimulation of orotactile and mechanoreceptor mechanisms. Although there is uncertainty as to whether the effects of sucrose and NNS are synergistic or additive, there is sufficient evidence to support the efficacy of combining the two interventions for procedural pain relief in infants. In this review article, the underlying mechanisms of sucrose and NNS, separately and in combination for relieving procedural pain in preterm and full term infants, are examined. Clinical and research implications are addressed.