bluuebunny/crossref_metadata_2025 huggingface dataset:
Antidepressant Prophylaxis Reduces Depression Risk but Does Not Improve Sustained Virological Response in Hepatitis C Patients Receiving Interferon Without Depression at Baseline: A Systematic Review and Meta-Analysis
Authors: Al-Omari Awad , Cowan Juthaporn , Turner Lucy , Cooper Curtis
Published: March 2016

BACKGROUND: Depression complicates interferon-based hepatitis C virus (HCV) antiviral therapy in 10% to 40% of cases, and diminishes patient well-being and ability to complete a full course of therapy. As a consequence, the likelihood of achieving a sustained virological response (SVR [ie, permanent viral eradication]) is reduced.

OBJECTIVE: To systematically review the evidence of whether preemptive antidepressant prophylaxis started before HCV antiviral initiation is beneficial.

METHODS: Inclusion was restricted to randomized controlled trials in which prophylactic antidepressant therapy was started at least two weeks before the initiation of HCV antiviral treatment. Studies pertaining to patients with active or recent depressive symptoms before commencing HCV antiviral therapy were excluded. English language articles from 1946 to July 2012 were included. The MEDLINE, Embase and Cochrane Central databases were searched. Where possible, meta-analyses were conducted evaluating the effect of antidepressant prophylaxis on SVR and major depression as well as on Montgomery-Asberg Depression Rating Scale and Beck Depression Index scores at four, 12 and 24 weeks. The Cochrane Collaboration tool was used to assess bias risk.

RESULTS: Six randomized clinical trials involving 522 patients met the inclusion criteria. Although the frequency of on-treatment clinical depression was decreased with antidepressant prophylaxis (risk ratio 0.60 [95% CI 0.38 to 0.93]; P=0.02; I2=24%), no benefit to SVR was identified (risk ratio 1.08 [95% CI 0.74 to 1.57]; P=0.69; I2=58%).

CONCLUSION: This practice is not justified to improve SVR in populations free of active depressive symptoms leading up to HCV antiviral therapy.
Management of Malignant Pleural Effusions with Indwelling Pleural Catheters or Talc Pleurodesis
Authors: Srour Nadim , Amjadi Kayvan , Forster Alan John , Aaron Shawn David
Published: March 2016

BACKGROUND: Management of malignant pleural effusion typically involves insertion of an indwelling pleural catheter (IPC) or chemical pleurodesis with agents such as talc.

OBJECTIVES: To compare these management strategies with regard to success of pleural effusion management.

METHODS: A retrospective cohort study was designed comparing patients with malignant and paramalignant pleural effusions and Eastern Cooperative Oncology Group performance status <4 managed with IPC insertion or talc pleurodesis (TP) through tube thoracostomy during non‐contemporary three‐year periods at a single centre.

RESULTS: The IPC and TP groups comprised 193 and 167 patients, respectively. The pleural effusion control rate at six months was higher in the IPC group (52.7% versus 34.4% in the TP group; P<0.01), but the rate of freedom from catheter at 90 days and pleural effusion at 180 days was not significantly different (IPC 25.8% versus TP 34.4% [P=0.17]). Median effusion‐free survival from the date of catheter insertion was significantly longer in the IPC group (101 days versus 58 days in the TP group; log‐rank P=0.025). Both procedures were safe.

DISCUSSION: While the results suggest better pleural effusion control and longer effusion‐free survival with IPC insertion compared with TP, the present study had several limitations. Other recent studies have not shown one strategy to be clearly superior to the other.

CONCLUSION: Both IPC insertion and TP remain acceptable options for the management of malignant pleural effusions.
Natural History and Long-Term Outcome of Patients Treated for Early Stage Colorectal Cancer
Authors: Freeman Hugh James
Published: March 2016

BACKGROUND: The long-term natural history of early stage colon cancer and the outcome of long-term colonoscopic surveillance in routine specialist clinical practice after removal of the incident cancers have not been fully defined. In the present long-term evaluation up to 25 years, metachronous neoplasia, including both advanced adenomas and carcinomas, was defined.

METHODS: All early stage colorectal cancer patients evaluated consecutively from a single clinical practice underwent follow-up colonoscopic evaluations after removal of the incident cancer and clearing of neoplastic disease. Colonoscopic surveillance was planned for two phases – initially on an annual basis for five years, followed by continued surveillance every three years up to 25 years with removal of any metachronous neoplastic lesion.

RESULTS: A total of 128 patients (66 men and 62 women) with 129 incident early stage colorectal cancers were evaluated. Virtually all patients were symptomatic, usually with clinical evidence of blood loss. Incident early cancers were located throughout the colon, especially in the rectosigmoid, and showed no pathological evidence of nodal or other metastases. All patients evaluated during the first five years did not experience recurrent disease or have metachronous cancer detected. After five years, a total of 94 patients were evaluated up to 25 years; six of these patients were found to have seven metachronous colon cancers. All developed cancer more than seven years after removal of the incident colorectal cancer, including six asymptomatic adenocarcinomas, of which only one had evidence of single node involvement. Another patient in this cohort developed a poorly differentiated neuroendocrine carcinoma of the colon. In addition, 45% of patients had a total of 217 adenomas removed, including 11% of patients with 33 advanced adenomas. Among 14 patients with advanced adenomas, seven (50%) developed ≥1 late metachronous cancers.

CONCLUSIONS: Following removal of an incident symptomatic early stage colorectal cancer, the risk of later metachronous neoplasia persists for an extended period more than five years after removal of the incident colorectal cancer. Moreover, risk for late metachronous cancer appears to be predicted by the presence of multiple adenomas or advanced adenomas; most metachronous cancers in this cohort were detected using colonoscopy before onset of symptoms and at an early stage.
Hepatitis C as a Prognostic Indicator among Noncirrhotic Patients Hospitalized with Alcoholic Hepatitis
Authors: Thuluvath Paul J , Ahn Eric , Nguyen Geoffrey C
Published: March 2016

OBJECTIVE: A nationwide analysis of alcoholic hepatitis (AH) admissions was conducted to determine the impact of hepatitis C virus (HCV) infection on short-term survival and hospital resource utilization.

METHODS: Using the Nationwide Inpatient Sample, noncirrhotic patients admitted with AH throughout the United States between 1998 and 2006 were identified with diagnostic codes from theInternational Classification of Diseases, Ninth Revision. The in-hospital mortality rate (primary end point) of AH patients with and without co-existent HCV infection was determined. Hospital resource utilization was assessed as a secondary end point through linear regression analysis.

RESULTS: From 1998 to 2006, there were 112,351 admissions for AH. In-hospital mortality was higher among patients with coexistent HCV infection (41.1% versus 3.2%; P=0.07). The adjusted odds of in-hospital mortality in the presence of HCV was 1.48 (95% CI 1.10 to 1.98). Noncirrhotic patients with AH and HCV also had longer length of stay (5.8 days versus 5.3 days; P<0.007) as well as greater hospital charges (US$25,990 versus US$21,030; P=0.0002).

CONCLUSIONS: Among noncirrhotic patients admitted with AH, HCV infection was associated with higher in-hospital mortality and resource utilization.
Treatment of Chronic Hepatitis C in a Canadian Aboriginal Population: Results from the Prairie Study
Authors: Minuk Gerald Yosel , O’Brien Meaghan , Hawkins Kim , Emokpare Didi , McHattie James , Harris Paul , Worobetz Lawrence , Doucette Karen , Kaita Kelly , Wong Stephen , Pinette Gilles , Uhanova Julia
Published: March 2016

BACKGROUND: The Aboriginal population of Canada is at increased risk of exposure to the hepatitis C virus (HCV). Previous data indicate that spontaneous clearance of HCV occurs more often in Aboriginals than Caucasians. Whether this enhanced response extends to antiviral therapy for chronic HCV remains to be determined.

OBJECTIVES: To document and compare the biochemical and virological responses to antiviral therapy in HCV-infected Canadian Aboriginals and Caucasians.

METHODS: A total of 101 treatment-naive adult patients (46 Aboriginal, 55 Caucasian) with chronic HCV genotype 1 infections were prospectively treated with pegylated-interferon and ribavirin and followed as per national guidelines.

RESULTS: Aboriginals had higher HCV-RNA loads at baseline (6.42log10versus 5.98log10; P<0.03). Although normalization of serum aminotransferase levels, decreases in viral loads, and rapid, early and end-of-treatment virological responses were similar in the two cohorts, sustained virological responses were significantly lower in Aboriginals (35% versus 55%; P=0.047). Premature discontinuation of treatment and/or loss of patients to follow-up was common (Aboriginals 37%, Caucasians 27%). Treatment-related side effects were similar in the two cohorts.

CONCLUSION: Despite higher rates of spontaneous HCV clearance, the response to antiviral therapy was similar, if not lower, in Aboriginals compared with Caucasians with chronic HCV genotype 1 infections. Compliance with treatment is an issue that needs to be addressed in the management of these patients.
Evaluation of Funding Gastroenterology Research in Canada Illustrates the Beneficial Role of Partnerships
Authors: Sherman Philip M , Hart Kimberly Banks , Rose Keeley , Bosompra Kwadwo , Manuel Christopher , Belanger Paul , Daniels Sandra , Sinclair Paul , Vanner Stephen , Buret André G
Published: March 2016

BACKGROUND: Funders of health research in Canada seek to determine how their funding programs impact research capacity and knowledge creation.

OBJECTIVE: To evaluate the impact of a focused grants and award program that was cofunded by the Canadian Institutes of Health Research Institute of Nutrition, Metabolism and Diabetes, and the Canadian Association of Gastroenterology; and to measure the impact of the Program on the career paths of funded researchers and assess the outcomes of research supported through the Program.

METHODS: A survey of the recipients of grants and awards from 2000 to 2008 was conducted in 2012. The CIHR Funding Decisions database was searched to determine subsequent funding; a bibliometric citation analysis of publications arising from the Program was performed.

RESULTS: Of 160 grant and award recipients, 147 (92%) completed the survey. With >$17.4 million in research funding, support was provided for 131 fellowship awards, seven career transition awards, and 22 operating grants. More than three-quarters of grant and award recipients continue to work or train in a research-related position. Combined research outputs included 545 research articles, 130 review articles, 33 book chapters and 11 patents. Comparative analyses indicate that publications supported by the funding program had a greater impact than other Canadian and international comparators.

CONCLUSIONS: Continuity in support of a long-term health research funding partnership strengthened the career development of gastroenterology researchers in Canada, and enhanced the creation and dissemination of new knowledge in the discipline.
Transitioning to Highly Effective Therapies for the Treatment of Chronic Hepatitis C Virus Infection: A Policy Statement and Implementation Guideline
Authors: Smyth Daniel J , Webster Duncan , Barrett Lisa , MacMillan Mark , McKnight Lisa , Schweiger Frank
Published: March 2016

Chronic hepatitis C virus (HCV) infection increases all-cause mortality, rates of cirrhosis, hepatocellular carcinoma, liver transplantation and overall health care utilization. Morbidity and mortality disproportionately affect individuals born between 1945 and 1975. The recent development of well-tolerated and highly effective therapies for chronic HCV infection represents a unique opportunity to dramatically reduce rates of HCV-related complications and their costs. Critical to the introduction of such therapies will be well-designed provincial programming to ensure immediate treatment access to individuals at highest risk for complication, and well-defined strategies to address the global treatment needs of traditionally high-risk and marginalized populations. HCV practitioners in New Brunswick created a provincial strategy that stratifies treatment according to those at highest need, measures clinical impact, and creates evaluation strategies to demonstrate the significant direct and indirect cost savings anticipated with curative treatments.
Acceptability, Predictors and Attitudes of Canadian Women in Labour Toward Point‐of‐Care HIV Testing At A Single Labour and Delivery Unit
Authors: Iqbal Salikah , De Souza Leanne R , Yudin Mark H
Published: March 2016

OBJECTIVE: To assess attitudes and opinions surrounding point‐of‐care HIV testing among Canadian women, and to determine predictors for acceptance of testing.

METHODS: A survey assessing acceptability and attitudes toward rapid HIV testing was distributed on the labour and delivery unit in an academic hospital (St Michael’s Hospital) in Toronto, Ontario, in 2011. Information collected included demographic data, health and pregnancy history, willingness to undergo rapid HIV testing while in labour and barriers to testing.

RESULTS: Responses in 92 completed questionnaires were analyzed. The mean age of respondents was 32 years and all were HIV negative. Twelve percent of patients reported having at least one risk factor for HIV transmission. The study showed that only 59% of women were willing to be tested at the time of survey completion, and these women stated that they would accept saliva, urine or serum testing. If found to be positive, 96% would accept antiretroviral treatment and 94% would formula feed their infants. Of the 41% who were not willing to be tested, their reasons for refusal included “don’t want to know” (39%) and being in “too much labour pain” (29%). Regardless of willingness to be tested, the most frequently cited barriers to testing were social stigma (64%) and reaction from partners (69%).

CONCLUSIONS: Canadian women in labour were willing to undergo rapid HIV testing via urine, saliva or serum. If found to be positive, women were willing to undergo treatment and to formula feed to prevent mother‐to‐child transmission of HIV.
The Burden of Asthma among South Asian and Chinese Populations Residing in Ontario
Authors: Stanojevic Sanja , Shah Baiju R , Anand Sonia S , Sears Malcolm R , Su Jiandong , Subbarao Padmaja
Published: March 2016

BACKGROUND: The South Asian and Chinese populations represent a significant portion of the population of Ontario; however, little is known about the burden of respiratory diseases in these populations.

OBJECTIVE: To investigate the prevalence of asthma and the associated health care burden among South Asian and Chinese populations living in Ontario.

METHODS: Using administrative health data for Ontario, the authors identified individuals of South Asian and Chinese descent using a validated surname algorithm and compared the prevalence of asthma in these groups with the general population using an established asthma case definition for the period 2002 to 2010. Also compared were the rates of asthma‐specific emergency department visits and hospitalizations among the ethnic groups.

RESULTS: In 2010, the prevalence of asthma in South Asians residing in Ontario was similar to that of the general population (12.1% versus 12.4%), and was increasing at a faster rate than in the general population (0.51%/year versus 0.34%/year). Compared with the general population, the South Asian population had fewer emergency department visits for asthma, whereas the asthma‐related hospitalization rate was greatest among the South Asian population (0.45 per 100 person‐years). The Chinese population had the lowest asthma prevalence and associated health care use.

CONCLUSION: The burden of asthma among South Asians in Ontario is increasing and warrants further investigation to determine the reasons for this rise.
Inflammatory Bowel Disease Nurses in Canada: An Examination of Canadian Gastroenterology Nurses and Their Role in Inflammatory Bowel Disease Care
Authors: Stretton Jennifer G , Currie Barbara K , Chauhan Usha K
Published: March 2016

BACKGROUND/OBJECTIVE: Inflammatory bowel disease (IBD) is a chronic relapsing illness primarily including Crohn disease and ulcerative colitis. The disease course often fluctuates over time, and requires maintenance therapy and acute interventions to target disease flares. IBD management requires a multidisciplinary approach, with care from physicians, nurses, dieticians, social workers and psychologists. Because nurses play a pivotal role in managing chronic disease, the aim of the present study was to assess and determine how many nurses work primarily with IBD patients in Canada.

METHODS: A 29-question survey was developed using an Internet-based survey tool (www.surveymonkey.com) to investigate nursing demographics, IBD nursing roles and nursing services provided across Canada. Distribution included the Canadian Society of Gastroenterology Nurses and Associates, the Canadian Association of Gastroenterology, Progress (AbbVie Corporation, USA) and BioAdvance (Janssen Inc, USA) coordinators (via e-mail), and online availability for 15 weeks.

RESULTS: Of 275 survey respondents, 98.2% were female nurses, with 68.7% employed in full-time positions. Among them, 42.5% were between 51 and 60 years of age, and 32.4% were between 41 and 50 years of age. In addition, 53.8% were diploma-prepared registered nurses, 35.3% were Baccalaureate-prepared nurses and 4.4% were Masters-prepared nurses. Almost one-half (44% [n=121]) were employed in Ontario, followed by 19.6% (n=54) in Alberta and 9.1% (n=25) in British Columbia. All provinces were represented with the exception of Nunavut and the Northwest Territories. Forty-three per cent (n=119) of nurses identified as working in endoscopy units. Of the 90% who responded as working with IBD patients, only 30% (n=79) had a primary role in IBD care. Among these 79 nurses with a primary role in IBD care, 79.7% worked with the adult population, 10.1% with the pediatric population, and 10.1% worked with both adult and pediatric patients. Their major service was an outpatient setting (67.1%).

CONCLUSIONS: Survey results showed that only a small percentage of Canadian gastroenterology nurses provide clinical IBD care. Many have multiple roles and responsibilities, and provide a variety of services. The exact depth of care and service is unclear and further study is needed.
The First case of Locally Acquired Tick‐Borne Babesia Microti Infection in Canada
Authors: Bullard Jared MP , Ahsanuddin Arshad N , Perry Anamarija M , Lindsay L Robbin , Iranpour Mahmood , Dibernardo Antonia , Van Caeseele Paul G
Published: March 2016

A child with a complicated medical history that included asplenia acquired an infection with Babesia microti in the summer of 2013 and had not travelled outside of Manitoba. Although the clinical findings were subtle, astute laboratory work helped to reach a preliminary identification of Babesia species, while reference laboratory testing confirmed the diagnosis. Blacklegged ticks (Ixodes scapularis) are known to transmit Borrelia burgdorferi and Anaplasma phagocytophilum in the province; however, the present case represents the first known instance of tick‐borne B microti, both in Manitoba and in Canada. The expanding territory of the blacklegged tick increases the relevance of this emerging infection. Clinicians, laboratory medical practitioners and public health officials should be aware of B microti as a potential locally acquired infection in Canada.
Canadian Recommendations for Critical Care Ultrasound Training and Competency
Authors: Arntfield Robert T , Millington Scott J , Ainsworth Craig D , Arora Rakesh C , Boyd John , Finlayson Gordon , Gallagher William , Gebhardt Colin , Goffi Alberto , Hockmann Edgar , Kirkpatrick Andrew W , McDermid Robert C , Waechter Jason , Wong Natalie , Zavalkoff Samara , Beaulieu Yanick
Published: March 2016

OBJECTIVE: To achieve national consensus on standards of training, quality assurance and maintenance of competence for critical care ultrasound for intensivists and critical care trainees in Canada using recently published international training statements.

DATA SOURCES: Existing internationally endorsed guidelines and expert opinion.

DATA SYNTHESIS: In November 2013, a day‐long consensus meeting was held with 15 Canadian experts in critical care ultrasound in which essential topics relevant to training ultrasound were discussed.

CONCLUSIONS: Consensus was achieved to direct training curriculum, oversight, quality assurance and maintenance of competence for critical care ultrasound. In providing the first national guideline of its kind, these Canadian recommendations may also serve as a model of critical care ultrasound dissemination for other countries.
Longitudinal Surveillance of Outpatient Tetracycline, Sulfonamide‐Trimethoprim and ‘Other’ Antimicrobial Use in Canada, 1995 to 2010
Authors: Glass-Kaastra Shiona K , Finley Rita , Hutchinson Jim , Patrick David M , Weiss Karl , Conly John
Published: March 2016

INTRODUCTION: Monitoring the volume and patterns of use of antimicrobial agents is important in light of antimicrobial resistance.

OBJECTIVE: To assess the use of three antimicrobial groups – tetracycline, sulfonamide‐trimethoprim and ‘other’ antimicrobials – within Canadian provinces over time.

METHODS: Prescription counts from 1995 to 2010 were acquired for the tetracycline and sulfonamide‐trimethoprim groups of antimicrobials, and from 2001 to 2010 for the ‘other’ antimicrobial group. Linear mixed models were produced to assess differences among provinces and over time while accounting for repeated measurements. Prescription rate, defined daily dose per 1000 inhabitant‐days and defined daily doses per prescription measures for the year 2009 were also compared with those reported by participating European Union countries to determine where Canadian provinces rank in terms of antimicrobial use among these countries.

RESULTS: Prescribing of all three groups varied according to province and over time. Tetracycline and sulfonamide‐trimethoprim group prescribing were significantly reduced over the study period, by 36% and 61%, respectively. Prescribing of the ‘other’ antimicrobial group increased in all provinces from 2001 to 2010 with the exception of Prince Edward Island, although by varying amounts (10% to 61% increases).

DISCUSSION: The overall use of antimicrobials in Canada has dropped from 1995 to 2010, and the tetracycline and sulfonamide‐trimethoprim groups have contributed to this decline. The use of the ‘other’ antimicrobials has increased, however. These results may suggest that switches are being made among these groups, particularly among the antimicrobials used to treat urinary tract infections.
Effects of Breakpoint Changes on Carbapenem Susceptibility Rates ofEnterobacteriaceae: Results from the SENTRY Antimicrobial Surveillance Program, United States, 2008 to 2012
Authors: Rennie Robert P , Jones Ronald N
Published: March 2016

In the absence of clinical resistance, breakpoints for many antimicrobial agents are often set high. Clinical failures following use of the agents over time requires re‐evaluation of breakpoints. This is based on patient response, pharmacokinetic/pharmacodynamic information and in vitro minimal inhibitory concentration data. Data from the SENTRY Antimicrobial Surveillance Program has shown that Clinical and Laboratory Standards Institute breakpoint changes for carbapenems that occurred between 2008 and 2012 in North America have resulted in decreased levels of susceptibility for some species. In particular, reduced susceptibility to imipenem was observed for Proteus mirabilis (35%) and Morganella morganii (80%). Minor decreases in susceptibility were also noted for Enterobacter species with ertapenem (5%) and imipenem (4.3%), and Serratia species with imipenem (6.4%). No significant decreases in susceptibility were observed for meropenem following the breakpoint changes. There were no earlier breakpoints established for doripenem. Very few of these Enterobacteriaceae produce carbapenamase enzymes; therefore, the clinical significance of these changes has not yet been clearly determined. In conclusion, ongoing surveillance studies with in vitro minimum inhibitory concentration data are essential in predicting the need for breakpoint changes and in identifying the impact of such changes on the percent susceptibility of different species.
Exogenous and Endogenous Opioid‐Induced Pain Hypersensitivity in Different Rat Strains
Authors: Laboureyras Emilie , Aubrun Frédéric , Monsaingeon Maud , Corcuff Jean-Benoît , Laulin Jean-Paul , Simonnet Guy
Published: March 2016

BACKGROUND: Opioid‐induced hyperalgesia (OIH) is a recognized complication of opioid use that may facilitate the development of exaggerated postoperative pain.

OBJECTIVE: To examine the role of genetic factors on OIH by comparing four rat strains. Because the authors previously reported that the endogenous opioids released during non‐nociceptive environmental stress induce latent pain sensitization, genetic and environmental factor interactions were also evaluated.

METHODS: First, the propensity of Sprague Dawley, Wistar, Lewis and Fischer rats to develop OIH following single or repeated fentanyl exposures was compared by measuring the nociceptive threshold using the paw pressure vocalization test. Second, Sprague Dawley and Fischer rats were exposed to a series of three non‐nociceptive environmental stress sessions to evaluate the ability of endogenous opioids to enhance hyperalgesia associated with a carrageenan‐induced hind‐paw inflammation test performed two weeks later.

RESULTS: Sprague Dawley, Wistar and Lewis rats exhibited OIH, although differences were observed. OIH was not observed in Fischer rats. Inflammatory hyperalgesia enhancement induced through previous stress in Sprague Dawley rats was not observed in Fischer rats.

CONCLUSIONS: The pain level not only reflects nociceptive inputs but also depends on both the history and genetic factors of the individual. Genetic and environmental models may provide new insights into the mechanisms that underlie individual differences observed in postoperative pain.
The Prospective Antifungal Therapy Alliance® Registry: A Two‐Centre Canadian Experience
Authors: Haider Shariq , Rotstein Coleman , Horn David , Laverdiere Michel , Azie Nkechi
Published: March 2016

BACKGROUND: The Prospective Antifungal Therapy Alliance® registry is a prospective surveillance study that collected data on the diagnosis, management and outcomes of invasive fungal infections (IFIs) from 25 centres in North America from 2004 to 2008.

OBJECTIVE: To evaluate surveillance data on IFIs obtained from study centres located in Canada.

METHODS: Patients with proven or probable IFIs at two Canadian medical centres were enrolled in the registry. Information regarding patient demographics, fungal species, infection sites, diagnosis techniques, therapy and survival were analyzed.

RESULTS: A total of 347 patients from Canada with documented IFIs were enrolled in the Prospective Antifungal Therapy Alliance registry. Infections occurred most commonly in general medicine (71.8%), nontransplant surgery (32.6%) and patients with hematological malignancies (21.0%). There were 287 proven IFIs, including 248 Candida infections. Forty‐six patients had invasive aspergillosis (IA); all of these were probable infections. Most cases of invasive candidiasis were confirmed using blood culture (90.5%), while IA was most frequently diagnosed using computed tomography scan (82.6%) and serological methods (82.6%). Fluconazole was the most common therapy used for Candida infections, followed by the echinocandins. Voriconazole therapy was most commonly prescribed for IA.

CONCLUSIONS: The present study demonstrated that general medicine, surgery and hematological malignancy patients in Canada are susceptible to developing IFIs. In contrast to the United States, Candida albicans remains responsible for most IFIs in these Canadian centres. Surrogate serum markers are commonly being used for the diagnosis of IA, while therapy for both IFIs has shifted to broader‐spectrum azoles and echinocandins.
Fibromyalgia and Disability Adjudication: No Simple Solutions to a Complex Problem
Authors: Harth Manfred , Nielson Warren R
Published: March 2016

BACKGROUND: Adjudication of disability claims related to fibromyalgia (FM) syndrome can be a challenging and complex process. A commentary published in the current issue of Pain Research & Management makes suggestions for improvement. The authors of the commentary contend that: previously and currently used criteria for the diagnosis of FM are irrelevant to clinical practice; the opinions of family physicians should supersede those of experts; there is little evidence that trauma can cause FM; no formal instruments are necessary to assess disability; and many FM patients on or applying for disability are exaggerating or malingering, and tests of symptoms validity should be used to identify malingerers.

OBJECTIVES: To assess the assertions made by Fitzcharles et al.

METHODS: A narrative review of the available research literature was performed.

RESULTS: Available diagnostic criteria should be used in a medicolegal context; family physicians are frequently uncertain about FM and/or biased; there is considerable evidence that trauma can be a cause of FM; it is essential to use validated instruments to assess functional impairment; and the available tests of physical effort and symptom validity are of uncertain value in identifying malingering in FM.

CONCLUSIONS: The available evidence does not support many of the suggestions presented in the commentary. Caution is advised in adopting simple solutions for disability adjudication in FM because they are generally incompatible with the inherently complex nature of the problem.

Erratum to “Fibromyalgia and Disability Adjudication: No Simple Solutions to a Complex Problem”dx.doi.org/10.1155/2015/237405
Factors Associated with Noncompletion of Latent Tuberculosis Infection Treatment in an Inner‐City Population in Edmonton, Alberta
Authors: Malejczyk Kathy , Gratrix Jennifer , Beckon Avril , Moreau Danusia , Williams Gwenna , Kunimoto Dennis , Ahmed Rabia
Published: March 2016

A limited number of studies have been published that examine treatment completion rates and interventions used to increase treatment completion within an inner‐city population. The purpose of the present study was to determine the rate of latent tuberculosis infection (LTBI) treatment completion in an inner‐city population in Edmonton, Alberta, and to identify factors that correlated with treatment completion. A retrospective chart review was conducted involving patients who started LTBI treatment between January 1, 2005 and December 31, 2010 in Edmonton’s inner city. A total of 77 patients started treatment and 57 (74%) patients completed LTBI treatment. Homelessness was the only variable that was significantly associated with incomplete treatment (OR 8.0 [95% CI 1.4 to 45.6]) and it remained significant when controlling for drug use (adjusted OR 6.5 [95% CI 1.1 to 38.8]). While the present study demonstrated treatment completion rates comparable with or better than those described in the general population, it highlighted the need for continued emphasis on interventions aimed at improving outcomes within homeless populations.
Caesarean Section to Prevent Transmission of Hepatitis B: A Meta-Analysis
Authors: Chang Matthew S , Gavini Sravanya , Andrade Priscila C , McNabb-Baltar Julia
Published: March 2016

BACKGROUND: Vertical transmission of hepatitis B virus (HBV) occurs in up to 10% to 20% of births.

OBJECTIVE: To assess whether Caesarean section, compared with vaginal delivery, prevents HBV transmission.

METHODS: A systematic review and meta-analysis was conducted. Two investigators independently searched PubMed, EMBASE and other databases for relevant studies published between 1988 and 2013. A manual search of relevant topics and major conferences for abstracts was also conducted. Randomized trials, cohort and case-control studies assessing the effect of delivery mode on vertical transmission of HBV were included. Studies assessing antiviral therapy and patients with coinfection were excluded. The primary outcome was HBV transmission rates according to delivery method.

RESULTS: Of the 430 studies identified, 10 were included. Caesarean section decreased the odds of HBV transmission by 38% compared with vaginal delivery (OR 0.62 [95% CI 0.40 to 0.98]; P=0.04) based on a random-effects model. Significant heterogeneity among studies was found (I2=63%; P=0.003), which was largely explained by variation in hepatitis B immune globulin (HBIG) administration. Meta-regression showed a significant linear association between the percentage of infants receiving HBIG per study and the log OR (P=0.005), with the least benefit observed in studies with 100% HBIG administration. Subgroup analysis of hepatitis B e-antigen-positive women who underwent Caesarean section did not show a significant reduction in vertical transmission.

DISCUSSION: Caesarean section may protect against HBV transmission; however, convincing benefit could not be demonstrated due to significant study heterogeneity from variable HBIG administration, highlighting the importance of HBIG in HBV prevention.

CONCLUSION: More high-quality studies are needed before any recommendations can be made.
Antimicrobial Stewardship in Daily Practice: Managing an Important Resource
Authors: Le Saux Nicole , Canadian Paediatric Society, Infectious Diseases and Immuniz
Published: March 2016

Antimicrobial stewardship is a recent concept that embodies the practical, judicious use of antimicrobials to decrease adverse outcomes from antimicrobials while optimizing the treatment of bacterial infections to reduce the emergence of resistant pathogens. The objectives of the present statement are to illustrate the principles of antimicrobial stewardship and to offer practical examples of how to make antimicrobial stewardship part of everyday hospital and outpatient practice. Vital components of antimicrobial stewardship include appropriate testing to diagnose whether infections are viral or bacterial, and using clinical follow‐up rather than antibiotics in cases in which the child is not very ill and uncertainty exists. Other specific, important actions include questioning whether positive urine cultures are contaminated when there is no evidence of pyuria or inflammatory changes, and obtaining a chest radiograph to support a diagnosis of bacterial pneumonia. Optimizing the choice and dosage of antimicrobials also reduces the probability of clinical failures and subsequent courses of antimicrobials. A list of common clinical scenarios to promote stewardship is included.
Human Herpesvirus 6 is Associated with Status Epilepticus and Hyponatremia after Umbilical Cord Blood Transplantation
Authors: de Souza Franceschi Fernanda Leite , Green Jaime , Cayci Zuzan , Mariash Evan , Ezzeddine Mustapha , Bachanova Veronika , Ustun Celalettin
Published: March 2016

Status epilepticus after allogeneic hematopoietic cell transplantation (alloHCT) is rare. The authors report a case involving a 65‐year‐old man with nonconvulsive status epilepticus 34 days after umbilical cord blood transplantion for chronic lymphocytic leukemia. Cerebrospinal fluid and serum were positive for human herpesvirus 6 (HHV6). Magnetic resonance imaging of the brain showed symmetric T2 hyper‐intensity bilaterally in the mesial temporal lobes, and T2 hyperintensi‐ties and restricted diffusion of bilateral putamina. Despite aggressive anticonvulsive therapy, his seizures only abated with initiation of ganciclovir therapy. The patient completed six weeks of combination antiviral therapy (ganciclovir and foscarnet). His cognitive function gradually improved and, after prolonged rehabilitation, the patient was discharged home with residual intermittent memory loss but otherwise functional. HHV6 should be considered in the differential diagnosis of nonconvulsive status epilepticus after alloHCT, especially in patients with hyponatremia. Empirical antiviral therapy targeting HHV6 should be administered to these patients.
Higher Effective Oronasal versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: Effect of Mandibular Stabilization
Authors: Kaminska M , Montpetit A , Mathieu A , Jobin V , Morisson F , Mayer P
Published: March 2016

BACKGROUND: In some individuals with obstructive sleep apnea (OSA), oronasal continuous positive airway pressure (CPAP) leads to poorer OSA correction than nasal CPAP. The authors hypothesized that this results from posterior mandibular displacement caused by the oronasal mask.

OBJECTIVE: To test this hypothesis using a mandibular advancement device (MAD) for mandibular stabilization.

METHODS: Subjects whose OSA was not adequately corrected by oronasal CPAP at pressures for which nasal CPAP was effective were identified. These subjects underwent polysomnography (PSG) CPAP titration with each nasal and oronasal mask consecutively, with esophageal pressure and leak monitoring, to obtain the effective pressure (Peff) of CPAP for correcting obstructive events with each mask (maximum 20 cmH2O). PSG titration was repeated using a MAD in the neutral position. Cephalometry was performed.

RESULTS: Six subjects with mean (± SD) nasal Peff 10.4±3.0 cmH2O were studied. Oronasal Peff was greater than nasal Peff in all subjects, with obstructive events persisting at 20 cmH2O by oronasal mask in four cases. This was not due to excessive leak. With the MAD, oronasal Peff was reduced in three subjects, and Peff <20 cmH2O could be obtained in two of the four subjects with Peff >20 cmH2O by oronasal mask alone. Subjects’ cephalometric variables were similar to published norms.

CONCLUSION: In subjects with OSA with higher oronasal than nasal Peff, this is partially explained by posterior mandibular displacement caused by the oronasal mask. Combination treatment with oronasal mask and MAD may be useful in some individuals if a nasal mask is not tolerated.
Comparing Outcomes of Donation After Cardiac Death Versus Donation After Brain Death in Liver Transplant Recipients with Hepatitis C: A Systematic Review and Meta-Analysis
Authors: Wells Malcolm , Croome Kris , Janik Toni , Hernandez-Alejandro Roberto , Chandok Natasha
Published: March 2016

BACKGROUND: Liver transplantation (LT) using organs donated after cardiac death (DCD) is increasing due, in large part, to a shortage of organs. The outcome of using DCD organs in recipients with hepatits C virus (HCV) infection remains unclear due to the limited experience and number of publications addressing this issue.

OBJECTIVE: To evaluate the clinical outcomes of DCD versus donation after brain death (DBD) in HCV-positive patients undergoing LT.

METHODS: Studies comparing DCD versus DBD LT in HCV-positive patients were identified based on systematic searches of seven electronic databases and multiple sources of gray literature.

RESULTS: The search identified 58 citations, including three studies, with 324 patients meeting eligibility criteria. The use of DCD livers was associated with a significantly higher risk of primary nonfunction (RR 5.49 [95% CI 1.53 to 19.64]; P=0.009; I2=0%), while not associated with a significantly different patient survival (RR 0.89 [95% CI 0.37 to 2.11]; P=0.79; I2=51%), graft survival (RR 0.40 [95% CI 0.14 to 1.11]; P=0.08; I2=34%), rate of recurrence of severe HCV infection (RR 2.74 [95% CI 0.36 to 20.92]; P=0.33; I2=84%), retransplantation or liver disease-related death (RR 1.79 [95% CI 0.66 to 4.84]; P=0.25; I2=44%), and biliary complications.

CONCLUSIONS: While the literature and quality of studies assessing DCD versus DBD grafts are limited, there was significantly more primary nonfunction and a trend toward decreased graft survival, but no significant difference in biliary complications or recipient mortality rates between DCD and DBD LT in patients with HCV infection. There is insufficient literature on the topic to draw any definitive conclusions.
Third-Generation Cephalosporin-Resistant Spontaneous Bacterial Peritonitis: A single-Centre Experience and Summary of Existing Studies
Authors: Chaulk Jennifer , Carbonneau Michelle , Qamar Hina , Keough Adam , Chang Hsiu-Ju , Ma Mang , Kumar Deepali , Tandon Puneeta
Published: March 2016

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is the most prevalent bacterial infection in patients with cirrhosis. Although studies from Europe have reported significant rates of resistance to third-generation cephalosporins, there are limited SBP-specific data from centres in North America.

OBJECTIVE: To evaluate the prevalence of, predictors for and clinical impact of third-generation cephalosporin-resistant SBP at a Canadian tertiary care centre, and to summarize the data in the context of the existing literature.

METHODS: SBP patients treated with both antibiotics and albumin therapy at a Canadian tertiary care hospital between 2003 and 2011 were retrospectively identified. Multivariate logistic regression was used to determine independent predictors of third-generation cephalosporin resistance and mortality.

RESULTS: In 192 patients, 25% of infections were nosocomial. Forty per cent (77 of 192) of infections were culture positive; of these, 19% (15 of 77) were resistant to third-generation cephalosporins. The prevalence of cephalosporin resistance was 8% with community-acquired infections, 17% with health care-associated infections and 41% with nosocomial acquisition. Nosocomial acquisition of infection was the only predictor of resistance to third-generation cephalosporins (OR 4.0 [95% CI 1.04 to 15.2]). Thirty-day mortality censored for liver transplantation was 27% (50 of 184). In the 77 culture-positive patients, resistance to third-generation cephalosporins (OR 5.3 [1.3 to 22]) and the Model for End-stage Live Disease score (OR 1.14 [1.04 to 1.24]) were independent predictors of 30-day mortality.

CONCLUSIONS: Third-generation cephalosporin-resistant SBP is a common diagnosis and has an effect on clinical outcomes. In an attempt to reduce the mortality associated with resistance to empirical therapy, high-risk subgroups should receive broader empirical antibiotic coverage.
Iron Overload Is Rare in Patients Homozygous for the H63D Mutation
Authors: Kelley Melissa , Joshi Nikhil , Xie Yagang , Borgaonkar Mark
Published: March 2016

BACKGROUND: Previous research has suggested that the H63DHFEmutation is associated with elevated iron indexes. However, the true penetrance of this mutation remains unclear.

OBJECTIVE: To assess the proportion of H63D homozygotes with laboratory abnormalities consistent with iron overload.

METHODS: The present study was a retrospective analysis of all individuals referred forHFEgenotyping in Newfoundland and Labrador between 1999 and 2009, who were found to be homozygous for the H63D mutation. Using electronic health records, results of ferritin, transferrin saturation, aspartate aminotransferase and alanine aminotransferase testing performed closest to the time of genetic testing were recorded for each patient. Iron overload was classified using previously published definitions from the HealthIron study. SPSS version 17.0 (IBM Corporation, USA) was used for descriptive statistics and to compare means using one-way ANOVA.

RESULTS: Between 1999 and 2009, 170 individuals tested positive for H63D/H63D. At the time of genotyping, 28.8% had an elevated mean (± SD) ferritin level of 501±829 μg/L and 15.9% had an elevated transferrin saturation of 0.45±0.18. At genotyping, 94 individuals had sufficient data available to classify iron overload status. Only three (3.2%) had documented iron overload while the majority (85.1%) had no evidence of iron overload. Sixty individuals had follow-up data available and, of these, only four (6.7%) had documented iron overload, while 45 (75.0%) had no evidence of iron overload. Only one individual had evidence of iron overload-related disease at genotyping and at follow-up.

CONCLUSIONS: H63D homozygosity was associated with an elevated mean ferritin level, but only 6.7% had documented iron overload at follow-up. The penetrance of the H63D mutation appeared to be low.
Action Plans in Patients Presenting to Emergency Departments with Asthma Exacerbations: Frequency of Use and Description of Contents
Authors: Cross Elfriede , Villa-Roel Cristina , Majumdar Sumit R , Bhutani Mohit , Rosychuk Rhonda J , Couperthwaite Stephanie , Rowe Brian H
Published: March 2016

BACKGROUND: Although underused, written asthma action plans (AAPs) are associated with reduced numbers of emergency department (ED) visits and hospitalizations.

OBJECTIVE: To describe the frequency of use and contents of any AAPs reported by patients presenting with exacerbations to three urban Canadian EDs.

METHODS: Prospective data were collected through ED interview and chart review. Descriptive analyses used proportions and medians with interquartile range; multivariable logistic regression was used for the adjusted analyses.

RESULTS: Among 176 enrolled patients, the median age was 27 years (interquartile range 23 to 39 years) and 97 (55%) were female. Few (n=42 [24%]) reported having AAPs at ED presentation and only six were written. Most (n=35 [75%]) patients with any AAP took action before the ED visit; none used a valid anti‐inflammatory strategy. The first step of 27 plans was to increase asthma medication; no patients appropriately increased inhaled corticosteroids (ICS). In multivariable analyses, only the use of either ICS or ICS/long‐acting β‐agonist combination agents (31% had AAPs versus 12% did not have AAPs (adjusted OR 3.0 [95% CI 1.14 to 8.07]) and asthma education (47% had AAPs versus 21% did not have AAPs, adjusted OR 3.2 [95% CI 1.13 to 9.19]) were independently associated with AAP possession.

CONCLUSION: Possession of AAPs among patients presenting to the ED with acute asthma was low, and only one in 10 AAPs were written. Patients who reported having any AAP used ineffective strategies to abort or mitigate the severity of an ED visit. Increasing frequency of written AAPs and improving their contents holds immediate promise in improving outcomes related to asthma.
Small Bowel Obstruction Following Computed Tomography and Magnetic Resonance Enterography Using Psyllium Seed Husk As an Oral Contrast Agent
Authors: Chen Yingming Amy , Cervini Patrick , Kirpalani Anish , Vlachou Paraskevi A , Grover Samir C , Colak Errol
Published: March 2016

The authors report a case series describing four patients who developed small bowel obstruction following the use of psyllium seed husk as an oral contrast agent for computed tomography or magnetic resonance enterography. Radiologists who oversee computed tomography and magnetic resonance enterography should be aware of this potential complication when using psyllium seed husk and other bulking agents, particularly when imaging patients with known or suspected small bowel strictures or active inflammation.
An Atypical Cause of Atypical Chest Pain
Authors: Zaheen Ahmad , Siemieniuk Reed A , Gudgeon Patrick
Published: March 2016

The present report describes a case involving a 57‐year‐old HIV‐positive man who presented with acute retrosternal chest pain accompanied by 24 h of fever. Septic arthritis of the manubriosternal joint was diagnosed based on magnetic resonance imaging findings in addition to Staphylococcus aureus bacteremia. To the authors’ knowledge, the present case is only the 12th reported case of manubriosternal septic arthritis, and the first in an HIV‐positive patient. Early diagnosis and treatment can circumvent the need for surgical intervention. Based on the present case report and review of the literature, the authors summarize the epidemiology, appropriate imaging and suggestions for antibiotic therapy for this rare presentation.