bluuebunny/crossref_metadata_2025 huggingface dataset:
A Case‐Control Study of the Role of Cold Symptoms and other Historical Triggering Factors in Asthma Exacerbations
Authors: Tarlo Susan M , Broder Irvin , Corey Paul , Chan-Yeung Moira , Ferguson Alexander , Becker Allan , Warren Peter , Simons F Estelle R , Sherlock Christopher , Okada Marilyn , Manfreda Jure
Published: March 2016

BACKGROUND: Asthma exacerbations can be provoked by many triggers such as allergens, respiratory irritants and viral infections. The relative importance of these has not been prospectively documented in a case‐control study.

OBJECTIVE: To assess the relative importance of colds and other nonclimatic historical triggers of asthma exacerbations.

METHODS: One hundred and nineteen adults and children with asthma in two Canadian cities participated in a one‐year study of the role of exacerbating factors in asthma. Among these, 36 pairs (21 adult, 15 children) completed the case‐control study. Patients were considered cases if they developed an acute asthma exacerbation and notified the centre within 24 h to allow the completion of a questionnaire and viral studies (cultures of nasopharyngeal swabs and serology). Control people with asthma were matched for sex, age and area of residence, had no exacerbation during the preceding four weeks and participated within 48 h of the case patients.

RESULTS: Case patients versus control patients had a mean age of 22 years versus 20 years, 50% versus 55% were male, and 92% versus 86% had at least one positive aeroallergen skin test. Cases were more likely to have taken regular inhaled steroids (63% versus 33%, P<0.002). Cases were more likely to report the following within the previous week: fever (P<0.001), sore throat (P<0.001), increase in nasal symptoms (P<0.01), increased dust exposure (P<0.05), exposure to others with a cold (P<0.001) and, over the previous year, increased passive smoke exposure (P<0.05). Viral cultures and paired serology were negative.

CONCLUSIONS: Symptomatic colds were the most common trigger of asthma exacerbations in the winter and spring, while a transient increase in dust exposure was also identified as a significant trigger. The association with chronic, passive smoke exposure and the use of inhaled costicosteroid medications likely reflected less stable pre‐study asthma in those with exacerbations.
Allergen Induced Increase in Nonallergic Airway Responsiveness: A Citation Classic Revisited
Authors: Cockcroft Donald W
Published: March 2016

BACKGROUND:The present paper revisits the 1977 paper by DW Cockcroft, RE Ruffin, the late J Dolovich and FE Hargreave entitled "Allergen‐induced increase in nonallergic bronchial reactivity" (Clin Allergy 1977;7:503‐13) that became a citation classic. Although clinical types of asthma were recognized at the time, there was a poor understanding regarding the role of allergic reactions in causing increases in airway hyperresponsiveness. The objective was to study formally Dr Altounyan′s observation that patients with asthma showed increases in airway responsiveness at the times of natural allergen exposure during pollen season. Thirteen atopic patients with asthma were studied over two days, following inhalation of diluent (control) and following doubling amounts of an allergen solution at 10‐min intervals until forced expiration volume in 1 s fell by 20%. Methacholine and histamine challenges were performed before, at 8 h, at 32 h and seven days following the inhalations. A significant reduction (reduction of at least one doubling concentration) in the provocative concentration that causes a 20% fall in forced expiration volume in 1 s occurred in seven of 13 patients, and more often in subjects with a late bronchoconstrictor response to allergen challenge.

IMPORTANCE: The study showed that large changes in airway responsiveness could occur in patients with asthma and suggested that allergens could cause, rather than trigger, asthma. The study also led to the concept of asthma inducers and inciters ‐‐ inducers causing airway inflammation and inciters provoking bronchospasm. The results led to a series of observations that have now implicated immunoglobulin E‐mediated airway inflammation as perhaps the most important cause of airway hyperresponsiveness in asthma.
Serum and Red Blood Cell Antioxidant Status in Patients with Bronchial Asthma
Authors: Vural Hüseyin , Uzun Kürsat
Published: March 2016

Levels of vitamin C, ceruloplasmin, transferrin and albumin in serum, and glutathione in red blood cells were investigated in 40 patients with asthma to determine whether their antioxidant status was different from healthy subjects. Serum vitamin C and albumin levels were lower in the patient group (36.91±12.50 µM and 46.2±3.0 g/L, respectively) than in 43 healthy volunteers (53.38±13.06 µM and 48.8±2.1 g/L, P<0.001 and P<0.05, respectively). However, erythrocyte glutathione and serum ceruloplasmin levels were higher in the patient group (0.59±0.11 mol/mol hemoglobin and 442±73 µmol/L, respectively) than in controls (0.49±0.09 mol/mol hemoglobin and 308±47 µmol/L, P<0.001 and P<0.001, respectively). No difference was observed in transferrin levels between the groups. The results suggest that reactive oxygen species may be a contributing factor in patients with asthma, causing changes in serum vitamin C, ceruloplasmin and erythrocyte glutathione levels.
Pain with Life‐Threatening Illness: Its Perception and Control Are Inextricably Linked with Quality of Life
Authors: Cohen S Robin , Mount Balfour M
Published: March 2016

This article describes how the quality of life of people with a life‐threatening illness is affected by pain, and how their pain is influenced by all aspects of their quality of life. These aspects include the physical, psychological, cognitive, social, and spiritual and existential domains. This concept of pain is placed in the context of Ron Melzack′s work highlighting the essential role of cognitive and emotional aspects of pain perception, and their influence on pain control. These issues continue to be a guiding force in the authors′ own work and that of many others working in the field.
Pain Management in Patients with Multiple Sclerosis
Authors: Murray T Jock
Published: March 2016

Although the idea that pain is not a symptom of multiple sclerosis (MS) continues, many studies have confirmed that over half of MS patients complain of pain. In some patients, it may be in part a result of the exacerbation of the disease. In other patients, it is an acute pain problem such as trigeminal neuralgia, bladder spasms, acute dysesthesia, Lhermitte′s phenomenon or painful tonic spasms. In even more cases, it is chronic pain that can take the form of dysesthesia, or repeated muscle spasms and aching. Although MS can cause pain, increasing disability can also produce other complications that are painful such as pressure palsies, decubiti, the effects of poorly fitting wheelchairs, or the musculoskeletal pain that results from the effort to maintain head position and posture with weakened muscles. All of the problem that MS patients experience do not necessarily result from their MS. MS patients can develop all of the medical conditions and pain situations that afflict the rest of the population, and these are usually manageable when the correct diagnosis is made and the approach is focused. Overall, most of the conditions causing pain in MS can be prevented, eliminated or improved, and the remaining patients with chronic pain are managed with strategies that are useful in approaching chronic pain in other situations.
Does Experience Influence Judgements of Pain Behaviour? Evidence from Relatives of Pain Patients and Therapists
Authors: Prkachin Kenneth M , Solomon Patty , Hwang Teresa , Mercer Susan R
Published: March 2016

OBJECTIVE: Judgments about an individual′s pain can be profoundly important to sufferers. Relatively few studies have examined variables that may affect observers′ judgments of the pain of others. The present article reports two studies investigating the relationship between different kinds of exposure to pain problems and observers′ ratings of the pain intensity of patients.

DESIGN: In the first study, 82 observers were classified into groups with positive and negative family histories of chronic pain. They viewed a videotape showing the facial expressions of shoulder pain patients undergoing physiotherapy assessments and rated the pain experienced by the subjects. In the second study, the data from observers having no experience with pain problems were compared with data collected from therapists having considerable experience with pain problems.

RESULTS: Observers with a positive family history of chronic pain attributed greater pain to the patients than those with a negative family history of chronic pain. Professionals′ pain judgments were lower than those of control subjects.

CONCLUSIONS: Together, the findings imply that one′s experiences with the different problems of pain patients may affect pain judgments. Alternative interpretations of the findings are considered.
Tuberculosis drug resistance in Canada, 1998 to 2000
Authors: Phypers Melissa D , Panaro Linda , Nault Penny
Published: March 2016

The emergence of drug‐resistant strains of tuberculosis (TB) is a global threat to TB prevention and control efforts. A recent study conducted by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease found strains of TB resistant to first‐line anti‐TB drugs in all countries surveyed (1). The WHO estimates that 50 million people are infected with strains of drug‐resistant TB (2).
The Case against Land Application of Sewage Sludge Pathogens
Authors: Reilly Maureen
Published: March 2016

There is currently a public debate about whether health, agricultural and environmental authorities should continue to allow sewage sludge to be spread on farmland. Some of the concern in the debate is about the pathogen content of sewage sludge. This concern was heightened by the tragedy at Walkerton where Eschericha coli 0157:H7 and other pathogens contaminated the drinking water supply of this Ontario town. The Canadian public were reminded how vulnerable they can be to disease when agricultural practices ajoin population centres without adequate health and environmental controls.
Reflections
Authors: Embree Joanne
Published: March 2016

Ideally, editorials are written one to two months before publication in the Journal. It was my turn to write this one. I had planned to write the first draft the evening after my clinic on Tuesday, September 11. It didn′t get done that night or during the next week. Somehow, the topic that I had originally chosen just didn′t seem that important anymore as I, along my friends and colleagues, reflected on the changes that the events of that day were likely to have on our lives.
A Critical Review of Oxazolidinones: An Alternative or Replacement for Glycopeptides and Streptogramins?
Authors: Zhanel George G , Schroeder Coleen , Vercaigne Lavern , Gin Alfred S , Embil John , Hoban Daryl J
Published: March 2016

OBJECTIVE: To review the available data on the oxazolidinones linezolid and eperezolid.

DATA SELECTION: Published reports were obtained by searching MEDLINE for articles published between 1992 and 2000, inclusive. References of published papers were also obtained and reviewed. Abstracts from scientific proceedings were reviewed.

DATA EXTRACTION: Due to the limited data available regarding these agents, the criteria for study inclusion were not restrictive.

DATA SYNTHESIS: The oxazolidinones (eg, linezolid) are a new antimicrobial class with a unique mechanism of action. They are active against resistant Gram‐positive cocci including methicillin‐susceptible and ‐resistant Staphylococcus aureus (MRSA), methicillin‐susceptible and ‐resistant Staphylococccus epidermidis, vancomycin‐resistant enterococci (VRE) and penicillin‐resistant Streptococcus pneumoniae (PRSP). Linezolid is active against anaerobes and displays modest activity against fastidious Gram‐negative pathogens such as Haemophilus influenzae, but is not active against Enterobacteriaceae. Linezolid is available both orally and parenterally, and has a bioavailability of 100%. Clinical trials comparing linezolid with standard therapy have demonstrated similar bacteriological and clinical cures rates to standard therapy in community‐ and hospital‐acquired pneumonia, uncomplicated and complicated skin and soft tissue infections, and infections caused by MRSA and VRE. Adverse effects have been minor and infrequent; however, platelets should be monitored in patients who have received more than two weeks of linezolid therapy. It is expected that these agents will have a bright future due to their excellent spectrum of activity against antibiotic‐resistant Gram‐positive organisms, such as MRSA, VRE and PRSP, and their excellent bioavailability.

CONCLUSION: The oxazolidinones represent a new class of antimicrobials with a unique mechanism of action. They have excellent activity against susceptible and resistant Gram‐positive organisms such as MRSA, methicillin‐susceptible S epidermidis, VRE and PRSP, and a good adverse effect profile; they can be administered both intravenously and orally. Their potential use in Canada may be as an intravenous and oral alternative to glycopeptides and streptogramins.
Canadian‐Acquired Hydatid Disease: A Case Report
Authors: Al Saghier Mohammed , Taylor Mark C , Greenberg Howard M
Published: March 2016

Echinococcal cysts are unusual in Canada, and most cases seen are in immigrants. In northern Canadian communities, Echinococcus granulosis infection occasionally is acquired from dogs that feed on the entrails of caribou or moose. Seventeen patients with Canadian‐acquired hydatid cysts were seen over an 11‐year period. One challenging case is described in detail. An 18‐year‐old aboriginal woman presented with jaundice, pain, lower extremity edema and coagulopathy from a 26 cm echinococcal hepatic cyst. She was successfully treated with a combination of oral albendazole, percutaneous drainage and surgery. One‐year follow‐up showed no recurrence of disease. The management options for echinococcal cysts are extensively reviewed.
Cannabinoids and the Immune System
Authors: Klein Thomas W , Newton Catherine A , Friedman Herman
Published: March 2016

The effect of cannabimimetic agents on the function of immune cells such as T and B lymphocytes, natural killer cells and macrophages has been extensively studied over the past several decades using human and animal paradigms involving whole animal models as well as tissue culture systems. From this work, it can be concluded that these drugs have subtle yet complex effects on immune cell function and that some of the drug activity is mediated by cannabinoid receptors expressed on the various immune cell subtypes. However, the overall role of the cannabinoid system of receptors and ligands in human health and disease is still unclear and requires extensive elucidation. Further studies will define the precise structure and function of the putative immunocannabinoid system, the potential therapeutic usefulness of these drugs in chronic diseases such as acquired immune deficiency syndrome and multiple sclerosis, the effects of these agents on tumour growth and induction of apoptosis, and the potential anti‐inflammatory and proinflammatory properties of cannabimimetic compounds. It is likely that the cannabinoid system, along with other neuroimmune systems, has a subtle but significant role in the regulation of immunity and that this role can eventually be exploited in the management of human disease.
How an Audit of Epidural Patients in a Community Hospital Setting Resulted in the Development of a Formal Acute Pain Management Service
Authors: Goldstein David H , VanDenKerkhof Elizabeth G , Sherlock Rebecca , Sherlock Judy , Harper Susan
Published: March 2016

PURPOSE: To describe the results of an audit of patients who received epidural analgesics postoperatively and the subsequent development of a formal acute pain management service in a community hospital.

METHODS: To understand how epidural analgesia was being used to treat postoperative pain at the Peterborough Regional Health Centre, Peterborough, Ontario, a retrospective chart review was performed. Audits were performed on 178 patients who had received epidural analgesia postoperatively from October 1994 to May 1995. Data pertaining to demographics, epidural analgesia, pain scores and side effects were collected.

RESULTS: Sixty‐one per cent of patients received bupivacaine/ fentanyl infusions, and 39% received epidural morphine boluses. More than 60% of patients reported no pain postoperatively. Patients who received bupivacaine/fentanyl were more likely than those who received epidural morphine to also receive coanalgesia and transitional analgesia. Patients who received epidural morphine were more likely than those who received bupivacaine fentanyl to experience respiratory depression, hypotension and pruritus. Patients were followed by the anesthesiologist who provided the anesthetic. Anesthesiologists practised independently, and formal policies and procedures did not exist.

CONCLUSIONS: As a result of the audit, an acute pain management service was developed. This included a team that did daily rounds and consisted of a nurse clinician and an anesthesiologist who was assigned to the service on a weekly basis. A committee was created, and formalized policies and procedures were established. Standardized order sheets, data sheets and a computerized database were developed. Reports for administrative and quality improvement purposes were generated monthly. Education programs were developed. Coanalgesia and transitional analgesia are now part of routine care, and epidural catheter placement close to the site of incision is encouraged. A postoperative nausea and vomiting algorithm, and a treatment regimen for pruritus have also been implemented.
Rare but Not so Rare? The Evolving Spectrum of Whipple′s Disease
Authors: Conly John M , Johnston B Lynn
Published: March 2016

Knowledge about Whipple′s disease began to emerge in 1907, when George Hoyt Whipple recognized the first case of the disease that now bears his name. He reported the case of a 36‐year‐old physician with "a gradual loss of weight and strength, stools consisting chiefly of neutral fat and fatty acids, indefinite abdominal signs, and a peculiar multiple arthritis" (1). Findings at autopsy consisted of poly‐serositis, aortic valve vegetations and deposition of fat in the intestinal mucosa and regional lymph nodes with marked infiltration by foamy macrophages (1). It was originally thought to be a disorder of fat metabolism, and the term ′intestinal lipodystrophy′ was proposed. Whipple′s disease has since been recognized as a rare, multivisceral, chronic disease with a clinical presentation dominated by a symptom triad of diarrhea, weight loss and malabsorption. However, digestive symptoms are often preceded for months or years by other symptoms, the most common being arthralgia, although cardiovascular, neurological or pulmonary involvement may be more prominent at times. Once considered the ideal case report, recent characterization of Tropheryma whippelii by means of broad range bacterial ribosomal DNA polymerase chain reaction (PCR) analysis (2,3) and its subsequent cultivation (4) has led to a veritable explosion of individual case reports, case series and hitherto unrecognized manifestations of the disease, such that it is now considered an underdiagnosed infectious disease (5). It is timely to provide an update on new developments in Whipple′s disease.
Spirometry and Obstructive Lung Disease in Manitoba
Authors: Anthonisen NR , Dik N , Manfreda J , Roos LL
Published: March 2016

BACKGROUND: Spirometry, the measurement of forced expiratory volume in 1 s and forced vital capacity, is recommended in the diagnosis and management of the obstructive lung diseases asthma and chronic obstructive pulmonary disease (COPD). The present report describes spirometry use in Manitoba and tests the hypothesis that regional spirometry use correlates with the prevalence of physician‐diagnosed obstructive lung diseases.

METHODS: Spirometry is remunerated on a fee‐for‐service basis by Manitoba Health. Like other physician services, billing data include a diagnosis, patient identifiers, as well as the patient’s sex, date of birth and residential postal code. Physician billings for spirometry for 1991 to 1998 were analyzed, comparing data with billings for physician visits for obstructive diseases. Four age groups were examined, as were income quintiles in Winnipeg, Manitoba. In addition, the prevalence of physician‐diagnosed obstructive diseases were compared with spirometry rates in 49 service use areas of the province.

RESULTS: Annually, about 3% of the Manitoba population underwent spirometry, and in aggregate, about 14% underwent spirometry during the eight years of the study. Rates in Winnipeg were higher than in the remainder of the province. Spirometry rates did not increase with time, and people who underwent spirometry had 1.4 to 1.7 tests/year. In children, higher income quintiles were tested more than lower income quintiles, while in adults, income quintiles were tested with equal frequency. People with obstructive lung disease accounted for about 75% of those tested, and in people with these diagnoses, the likelihood of testing increased approximately linearly with the number of physician visits for asthma or COPD. Children with asthma were tested less often than adults, and adults with asthma or both asthma and COPD were tested more often than those with COPD alone. In adults with asthma or asthma and COPD who had more than 10 physician visits for these diagnoses, testing rates were more than 70%, and multiple tests were common. In patients labelled with COPD only and with more than 20 physician visits, about one‐third did not undergo spirometry. In children aged five to 14 years and in adults 15 to 44 years old, regional spirometry rates correlated well with regional asthma rates. Regional spirometry rates also correlated significantly with regional rates of asthma and/or COPD in people older than 34 years old.

INTERPRETATION: Spirometry use is considerably higher in patients with asthma than in patients with COPD, suggesting that guidelines are followed more closely in patients with asthma, and that many patients are labelled with COPD without appropriate documentation. Spirometry use is apparently indicative of physician interest in the problem of obstructive lung diseases.
Wasting Away: To Sludge or Not to Sludge?
Authors: Nicolle L , Miller M
Published: March 2016

Following a century of high standards of sanitation, food and water safety in North America are often taken for granted. Recent outbreaks of illness attributed to food and water contamination, however, have challenged this complacency. Now, sludge is added to the list of concerns. Sewage sludge is the muddy substance that remains after the treatment of municipal sewage. This material includes not only human waste, but also household and industrial toxic wastes disposed of in local sewers. Federal and provincial Canadian regulations support the use of this material as fertilizer, within acceptable guidelines, as does the Environmental Protection Agency in the United States. The safety of sludge, however, is questioned by some individuals and groups. Specifically, the risk of infectious agents and toxins to workers or other exposed individuals, and the potential for heavy metals and organic chemicals to be transferred from sludge‐treated fields into crops are concerns.
Pertussis Immunization for Adolescents: What Are We Waiting for?
Authors: Halperin SA
Published: March 2016

Immunization against pertussis (whooping cough) has been part of the routine childhood immunization program for over 50 years. Until 1997, a whole cell pertussis vaccine was used, most often combined with diphtheria and tetanus toxoids; in some jurisdictions it was combined with inactivated poliovirus vaccine and later with Haemophilus influenzae type b (Hib)‐conjugate vaccine. Vaccine doses were given at two, four, six and 18 months of age, and again at four to six years of age. Use of the whole cell vaccine in children seven years of age and older was not recommended because "the incidence and severity of the disease greatly decrease with age, and because adverse reactions are (may be) more common in older children and adults…" (1‐3). Over a one‐year period in 1997/98, all provinces in Canada began using an acellular pertussis vaccine, again combined with diphtheria and tetanus toxoids, inactivated poliovirus vaccine and Hib‐conjugate vaccine. In 1999, an acellular pertussis vaccine that was combined with tetanus and diphtheria toxoids (TdaP) (Adacel, Aventis Pasteur, Canada) was licensed for use in individuals 12 to 54 years of age in Canada. In Germany, a similar adolescent and adult TdaP was licensed in 2000 (Boostrix, SmithKline Beecham, Belgium). With the availability of a TdaP product in Canada, should routine universal immunization against pertussis be provided for all adolescents and adults? Some of the key issues to be considered when answering this question are addressed in the questions and answers that follow. The focus of the present paper is on the adolescent population; however, similar issues about adult immunization need to be addressed by internal medicine and family practice practitioners.
Comparison of Intramuscular Betamethasone and Oral Pprednisone in the Prevention of Relapse of Acute Asthma
Authors: Chan John S , Cowie Robert L , Lazarenka Gerald C , Little Cinde , Scott Sandra , Ford Gordon T
Published: March 2016

OBJECTIVE: To compare the relapse rate after a single intramuscular injection of a long acting corticosteroid, betamethasone, with oral prednisone in patients discharged from the emergency department (ED) for acute exacerbations of asthma.

PATIENTS AND METHODS: Patients with acute exacerbations of asthma who were suitable for discharge from the ED were enrolled in a double-blind, randomized, placebo controlled pilot study. At discharge, patients were randomly assigned to receive either intramuscular betamethasone 12 mg and placebo capsules, or a placebo intramuscular injection and prednisone 50 mg daily for seven days. At days 7 and 21, patients were contacted by telephone to determine relapse. Relapse was defined as an unscheduled visit to a physician for treatment of continuing or worsening symptoms of asthma.

RESULTS: One hundred and seventy-one patients were enrolled, of whom 87 were randomly assigned to the betamethasone group and 84 to the prednisone group. Baseline char- acteristics were matched evenly between the groups, with the exception of asthma duration (15.5 versus 21.2 years, respectively) and use of inhaled corticosteroids (46% versus 64.3% respectively) (P<0.05). Using intention-to-treat analysis, the relapse rates for betamethasone and prednisone at day 7 were 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 of 87 patients) and 31% (26 of 84 patients), respectively (P=0.4). There were no differences in symptom score, peak flows and adverse effects between the two groups at days 7 and 21.

CONCLUSIONS: A single dose of intramuscular betamethasone 12 mg was safe and as efficacious as prednisone in preventing the relapse of acute asthma. There was a trend toward a reduced relapse rate at seven days. In select ED patients discharged for acute asthma, intramuscular betamethasone may be an effective alternative to prednisone.
Chronic Hepatitis B in Canada
Authors: Minuk GY , Uhanova J
Published: March 2016

Recent developments in the treatment and prevention of hepatitis B virus (HBV) infections warrant revisiting important epidemiological questions, such as how prevalent is chronic HBV infection in Canada, in which Canadian subpopulations are HBV prevalence rates the highest, in what percentage of infected individuals is the virus actively replicating, and how many infected Canadians are candidates for antiviral therapy? Currently available data suggest the overall prevalence of HBV‐infected individuals in the general population is approximately 2%, with 5% to 10% having serological evidence of previous HBV infection. In high risk groups, such as street‐connected individuals, Aboriginals and immigrants from endemic areas, these rates of viral prevalence and serological evidence of previous HBV infection are approximately two to 10 and five to 10 times higher, respectively, than in the general population. Candidates for antiviral therapy range from less than 1% of infected Aboriginals to 15% to 30% of Asians with chronic HBV. From these data, it is clear that chronic HBV remains an important public health problem in this country. Hence, resources must be identified to enhance Canadians′ awareness of HBV infection, maintain, if not expand, efforts to identify and implement safe and effective antiviral therapy for HBV‐infected individuals, and continue programs for universal vaccination to prevent new HBV infections.
The Effects of Cigarette Smoking on Cardiopulmonary Function and Exercise Tolerance in Teenagers
Authors: Louie Dianna
Published: March 2016

Teenagers who smoke are frequently warned that cigarette smoking will have detrimental effects on the function of their cardiopulmonary system and on their ability to perform exercise. However, there is little published evidence to support this statement. Therefore, in the present study, peak expiratory flow was measured as an indicator of lung function, expired carbon monoxide level was measured as an indicator of current smoking and the associated reduction in the oxygen carrying capacity of the blood, and blood pressure and heart rate were measured as indicators of cardiovascular hemodynamics before and after a one‐mile run in 27 teenagers. The results show that, even at a young age, cigarette smoking is associated with significant detrimental effects on cardiopulmonary function and exercise tolerance. Objective evidence of an effect of smoking on cardiopulmonary function and exercise tolerance in this age group may assist educators and health care professionals in convincing teenagers to quit smoking.
NSAID Antinociception Measured in a Chemical and a Thermal Assay in Mice
Authors: Miranda HF , Lopez J , Sierralta F , Correa A , Pinardi G
Published: March 2016

The antinociceptive activity of several nonsteroidal anti‐inflammatory drugs (NSAIDs) that were administered either intraperitoneally or intrathecally was assessed in mice by two algesiometric tests. The first was the writhing test, which assessed the abdominal constrictions that were induced by intraperitoneal acetic acid (a chemical test), and the second was the tail flick test, which measured pain responses to heat stimuli. The corresponding effective doses and their relative potencies were compared because these tests use different nociceptive stimuli with different transmission pathways. The intraperitoneal and intrathecal dose‐response curves for the antinociception induced by every NSAID that was tested were parallel in the writhing test. In the tail flick test, however, only the intraperitoneal and intrathecal dose‐response curves for ketoprofen, piroxicam, naproxen, nimesulide, paracetamol and diclofenac were parallel. The results obtained in this study confirm that NSAIDs possess different abilities to induce inhibition of cyclooxygenase, and they can be indirectly assessed by their different antinociceptive activities, depending on the algesiometric assays that are used. The antinociception of most NSAIDs might involve central mechanisms. The findings demonstrate the increasing importance of the spinal cord in processing and modulating nociceptive input, because intrathecal administration of NSAIDs is always more effective (in terms of potency) than systemic administration; thus, the antinociceptive efficacy of NSAIDs strongly depends on the algesiometric assay that is used and on the type of the nociceptive stimulus to which the test subject is exposed.
Effects of Flotation‐REST on Muscle Tension Pain
Authors: Kjellgren Anette , Sundequist Ulf , Norlander Torsten , Archer Trevor
Published: March 2016

The purpose of the present study was to investigate whether the floating form of the restricted environmental stimulation technique (REST) may be applied within the field of pain relief. Flotation‐REST consists of a procedure whereby an individual is immersed in a tank filled with water of an extremely high salt concentration. Thirty‐seven patients (14 men and 23 women) suffering from chronic pain consisting of aching muscles in the neck and back area participated in the study. They were randomly assigned to either a control group (17 participants) or an experimental group (20 participants). The experimental group received nine opportunities to use the flotation‐REST technique in the water tank over a three‐week period. The results indicated that the most severe perceived pain intensity was significantly reduced, whereas low perceived pain intensity was not influenced by the floating technique. Further, the results indicated that circulating levels of the noradrenaline metabolite 3‐methoxy‐4‐hydroxyphenylethyleneglycol were reduced significantly in the experimental group but not in the control group following treatment, whereas endorphin levels were not affected by flotation. Flotation‐REST treatment also elevated the participants′ optimism and reduced the degree of anxiety or depression; at nighttime, patients who underwent flotation fell asleep more easily. The present findings describe possible changes, for the better, in patients presenting with chronic pain complaints.
Creutzfeldt‐Jakob Disease and Infection Control
Authors: Johnston Lynn , Conly John
Published: March 2016

Over the past year, several situations have occurred in Canada in which patients who had recently undergone a surgical procedure were subsequently diagnosed with confirmed or suspected Creutzfeldt‐Jakob disease (CJD). This raised concerns over contamination of surgical instruments: which instruments might have been contaminated from direct exposure to tissues; can instruments become cross‐contaminated by exposure to other contaminated instruments; what assessment is necessary to determine cross‐contamination; and what should be done with instruments that have been contaminated. Additionally, should there be a patient traceback in the face of potential but unproven exposure? Unfortunately, there are no easy answers to most of the above questions. Australia, the United Kingdom and the World Health Organization have developed guidelines for the infection control management of patients with CJD, as well as instruments and devices that come into contact with them and their tissues (1‐3). Health Canada′s draft CJD infection control guidelines, withdrawn from the Health Canada Web site until safety concerns regarding sodium hydroxide can be addressed, closely mirrored recommendations made in those documents. The Centers for Disease Control and Prevention guidelines for CJD are under revision. However, a recent American publication made recommendations on what procedures should be used for reprocessing items that have been in contact with the prion protein (PrP) (4). These recommendations differ substantially from the draft Canadian guidelines. This article reviews current knowledge about CJD, and highlights some of the infection control concerns and controversies.
Epidemiology of Hepatitis B in Canada
Authors: Zhang Jun , Zou Shimian , Giulivi Antonio
Published: March 2016

OBJECTIVE: To provide a current and comprehensive review of the epidemiology of hepatitis B virus (HBV) in Canada.

DATA SOURCES: Published and unpublished epidemiological studies and surveillance reports of the past decade, primarily from Canada were studied. Fifty reports addressing HBV surveillance, incidence and prevalence, transmission‐associated risk factors, co‐infections, and prevention strategies were reviewed.

DATA SYNTHESIS: HBV infection is an important vaccine‐preventable infectious disease in Canada. The incidence rate of clinically recognized, acute HBV infection in 1998/1999 was estimated to be 2.3/100,000 people or approximately 700 cases a year. The prevalence of HBV carriers is estimated to be 0.5% to 1.0% of the population, but varies substantially according to population‐specific risk factors. Most acute HBV infections are associated with injection drug use or high risk heterosexual activities, but 20% to 30% of acute cases did not report any identified risk factors. Surveillance activities such as the National Notifiable Disease Reporting system provide information regarding trends and risk factors. The primary preventive strategy for HBV consists of universal immunization for preadolescents and/or infants. Other strategies, such as the universal prenatal screening and postnatal immunization, and the prevention of nosocomial acquistion, are also important. The recently described hepatitis B surface antigen (HBsAg) escape mutants may not be detected by current HBsAg test assays, and the existing HBV vaccines may not protect vaccinees from infections by such mutants.

CONCLUSION: Ongoing surveillance and research are required to assess risk factors for HBV transmission, evaluate the effectiveness of immunization programs and monitor the impact of HBsAg escape mutants.
An Examination of Pain Perception and Cerebral Event‐Related Potentials following Carbon Dioxide Laser Stimulation in Patients with Alzheimer’s Disease and Age‐Matched Control Volunteers
Authors: Gibson Stephen J , Voukelatos Xenophon , Ames David , Flicker Leon , Helme Robert D
Published: March 2016

BACKGROUND: Pain perception is known to depend on integrated cognitive processing. Alzheimer′s disease affects 5% to 10% of older adults, but the impact of this disease on pain sensitivity and report has yet to be fully investigated.

AIM OF INVESTIGATION: The present study examined pain threshold, the reliability of pain report and the central nervous system processing of noxious input, as indexed by cerebral event‐related potentials (CERP).

METHODS: Carbon dioxide laser detection and heat pain thresholds were determined on the hand dorsum of 15 healthy older adults (Mini‐Mental State Examination [MMSE] score 29.9±0.3) and 15 persons with cognitive impairment (MMSE score 12.7±6.1). Using an array of 15 silver/silver chloride scalp electrodes, the CERP and subjective rating of stimulus intensity were recorded after fixed intensity, 25 W laser stimuli.

RESULTS: Compared with age‐matched controls, the detection threshold for just noticeable sensation was significantly increased in elderly adults suffering from Alzheimer′s disease. There was no difference in pain threshold intensity between persons with cognitive impairment and controls, although the former group was less reliable in reporting detection and pain threshold sensations. The subjective rating of a 25 W stimulus was virtually identical in both groups, and the amplitude of the major CERP component (P400) was similar; however, cognitively impaired adults exhibited a significant increase in the latency of the P400 response.

CONCLUSION: The present findings indicate that pain perception in response to an acute heat pain stimulus is not diminished in older persons with cognitive impairment. Patients with Alzheimer′s disease may be slightly less reliable in threshold pain report, although the subjective rating of evoked pain and the level of poststimulus cortical activation following noxious stimulation were found to be similar to those of controls. A longer latency of the CERP may suggest slower cortical processing of nociceptive input by persons with Alzheimer′s disease.
Treatment of CMV Retinitis with Intravitreal Ganciclovir in the HAART Era
Authors: Campbell Robert J , Chow Benjamin , Victor Gary , Kravcik Steven , Hodge William G
Published: March 2016

OBJECTIVE: To describe the course and outcome of cytomegalovirus (CMV) retinitis among AIDS patients treated with intravitreal ganciclovir and systemic highly active antiretroviral therapy (HAART). The secondary objective was to compare the course of CMV retinitis between patients receiving HAART and those not receiving this treatment.

DESIGN: A retrospective cohort design consisting of 21 eyes from 16 patients with AIDS and CMV retinitis consecutively enrolled between January 1996 and August 1999. All patients received intravitreal ganciclovir therapy, and half of the patients began HAART as well. Duration of intravitreal therapy and ensuing disease quiescence, as well as CD4+ T cell counts at diagnosis and at cessation of ganciclovir, were calculated. Secondly, instantaneous hazards for outcomes such as CMV retinitis progression, ocular complications and mortality were compared.

SETTING: Tertiary care centre in Ottawa, Ontario.

RESULTS: Five of eight patients receiving HAART discontinued intravitreal ganciclovir after a mean treatment period of 428 days. During this period, their mean CD4+ count rose from 7.5 to 190/mL. Subsequently, none of these patients experienced retinitis progression during follow‐up periods lasting up to 820 days (mean of 617 days). Progression of CMV retinitis was 11.4 times more likely among those not receiving HAART (P=0.049).

CONCLUSIONS: On initiating HAART, patients with CMV retinitis may enjoy significant recovery in CD4+ counts and sustained retinitis quiescence without specific anti‐CMV therapy. Intravitreal ganciclovir injections seem well suited to offer effective CMV control during temporary periods of decreased CD4+ counts while awaiting HAART‐mediated immune system reconstitution.
Clinical Practice Guideline for Suctioning the Airway of the Intubated and Non-Intubated Patient
Authors: Brooks Dina , Anderson Cathy M , Carter Margaret A , Downes Laurie A , Keenan Sean P , Kelsey Carol J , Lacy Janet B
Published: March 2016

OBJECTIVE: To provide physicians, physiotherapists, nurses and respiratory therapists with guidelines for the application of airway suctioning.

DESIGN: This clinical practice guideline was developed using the model by Browman and colleagues. A working group of representatives from four professional colleges (nurses, physicians and surgeons, physiotherapists and respiratory therapists) and research experts was formed to conduct a systematic review, develop evidence-based recommendations and generate clinical practice guidelines. MEDLINE (1966 to 1998), CINAHL (1982 to 1997) and EMBASE (1974 to 1996) as well as the reference lists of identified articles were searched. Inclusion of articles was determined by at least two group members, and studies were classified according to type. Randomized, controlled; randomized; and nonrandomized crossover and comparative cohort trials were grouped by type of intervention and population for use in the development of recommendations. Other observational and animal studies dealing with adverse effects of suctioning were included in the review but were not used in the development of recommendations. Input on the evidence-based recommendations was sought and incorporated from members of all four professions and from experts on content and methodology.

SETTING: Any setting (hospital or home) where suctioning is performed.

POPULATION: Intubated and nonintubated adults, infants and children.

RESULTS AND CONCLUSIONS: An attempt was made to develop recommendations in each of the subcategories of suctioning techniques addressed by at least one study. In some subcategories, definite recommendations were made (13 in adults, and three in children and infants); in other subcategories, insufficient evidence precluded recommendations. The recommendations addressed the following aspects of suctioning: preoxygenation, hyperinflation, insufflation, hyperoxygenation, hyperventilation, saline instillation, adaptor use, medication use, open and closed systems, and various types of catheters.
Giant Pulmonary Bulla
Authors: Ng CSH , Sihoe ADL , Wan S , Lee TW , Arifi AA , Yim APC
Published: March 2016

The present report describes a case of a giant pulmonary bulla in a 32‐year‐old man that progressed to occupy almost the entire left hemithorax. This report is unique in documenting the natural history of progression of this condition. Bullectomy was performed using the video‐assisted thoracoscopic surgery approach.
The Impact of Health Care Restructuring on Nosocomial Infections and Transmission of Antimicrobial Resistant Organisms
Authors: Conly J , Johnston Lynn
Published: March 2016

The past decade has seen a dramatic change in Canadian health care as the treatment of many patients shifts from the hospital setting to the home or other alternative health care settings (1). Complex advances in technology and significant changes in the funding environment have also precipitated many changes in the functional capacity of our health care system. The portion of the total Canadian health care expenditures that has been allocated to hospitals and other institutions has declined steadily over the past two decades (2,3). This reduction in institutional‐based funding reflects the need to develop a system that improves the use of out‐of‐hospital sites for delivery of health care services and decreases reliance on the specific institutional component of the health care sector. Recent data reveal that Canadian hospital discharge rates have decreased by 14% between 1994 and 1998, and there has been a reduction in the length of stay from 7.4 to 7 days (4). In conjunction with a reduction in the number of hospital beds, there has been a massive shift in the proportion of surgeries that are performed on an outpatient basis. Further developments in the delivery of care include the increased use of telehealth, which allows health care professionals to provide increasingly complex services centralized hospital sites to outlying areas.
Underdiagnosis of Chronic Obstructive Pulmonary Disease: A Rationale for Spirometry as a Screening Tool
Authors: McIvor R Andrew , Tashkin Donald P
Published: March 2016

Chronic obstructive pulmonary disease (COPD) is associated with significant morbidity and mortality. It is the fourth leading cause of death in the United States, and its impact on quality of life can be severe. The debate on spirometry as a screening tool has been raised and dropped on various occasions over the past 30 years. This paper readdresses the debate in the light of recent evidence from population studies. Spirometry is an underused, easy to perform office-based procedure that has been further facilitated by the advent of modern technology. Despite the fact that spirometry is the gold standard for the diagnosis and assessment of COPD, mass screening using this tool remains controversial. This article provides a discussion based on a recent review of the literature regarding the current and future status of spirometry as a screening tool. A thoughtful approach to spirometry screening should include assessments of the magnitude of underdiagnosis, potential effectiveness of intervention, predictive value of spirometry and clinical profile of patients with COPD.
Gemella Species Endocarditis in a Child
Authors: Purcell Laura K , Finley John P , Chen Robert , Lovgren Marguerite , Halperin Scott A
Published: March 2016

Organisms of the genus Gemella can, on occasion, cause serious systemic illness. The present paper reports a successfully treated case of endocarditis in a 12‐year‐old girl with congenital heart disease caused by species of Gemella. The child presented with cough, fatigue and decreased appetite without fever. Echocardiogram demonstrated marked mitral insufficiency with flail posterior mitral valve leaflet, mitral valve vegetations, and an enlarged left atrium and ventricle. While being treated with vancomycin, the child initially had persistent bacteremia, which resolved after the addition of gentamycin; the course of therapy was completed with penicillin G and gentamycin once antimicrobial susceptibilities were available. Attempts to identify the species of Gemella were unsuccessful in the local laboratory, and at reference laboratories in Canada and the United States. The isolate is undergoing further evaluation to determine its taxonomic status.