bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences between Infected and Noninfected Patients with Acute Alcoholic Hepatitis
Authors: Minuk GY , Cohen A , Thompson V
Published: March 2016

The medical records of 97 patients with alcoholic hepatitis, including 20 with coexisting bacterial infections and 77 with no evidence of bacterial infection, were reviewed to determine whether commonly employed tests would be useful in distinguishing between the two groups. The results of the study revealed that patients with alcoholic hepatitis and bacterial infections had higher temperatures (38.4±0.9°C versus 37.9±0.7°C, P<0.05) and white blood cell counts (16.4±7.9 versus 11.2±6.4×109/L, P<0.005), but lower serum bilirubin levels (39±42 versus 115±152, P<0.05), than patients with alcoholic hepatitis alone. Patients with alcoholic hepatitis and bacterial infections also tended to reach maximum temperatures and white blood cell counts later in their hospital stay than patients with alcoholic hepatitis alone (5.1±5.3 versus 2.5±1.8 days, and 7.7±11.8 versus 4.4±5.7 days, respectively, P<0.05 and P<0.005). These results suggest that the extent and timing of peak abnormalities in body temperature, white blood cell count and serum bilirubin level may be of value in distinguishing patients with alcoholic hepatitis with bacterial infections from patients with alcoholic hepatitis alone.
The Importance of Surveillance in the Control of Influenza
Authors: Hannoun Claude
Published: March 2016

Surveillance of influenza has important practical uses for controlling the spread and the severity of epidemic episodes. The participation of sentinel practitioners directly involved in primary patient care is essential and can be promoted by active surveillance networks working in real time with a strong coordinating structure. The Groupes régionaux d’observation de la Grippe (grog) system, elaborated in France since 1984 on these principles, has allowed a short and middle term prevision of outbreaks and the isolation of a large number of influenza strains.
Home iv Antibiotic Therapy through a Medical Day Care Unit
Authors: Gourdeau Marie , Deschênes Louise , Caron Martine , Desmarais Marc
Published: March 2016

An out‐patient parenteral antibiotic therapy program provided through a medical day care unit was evaluated in a tertiary care hospital. From July 11, 1988 to December 31, 1990, 122 patients were treated either on site at the unit or at home with self‐administered intravenous antibiotics. In all, 142 courses of parenteral antibiotics (mostly cephalosporins and clindamycin) were given for a total of 124 infections, mostly bone and soft tissue infections (67 of 124, 54%). The duration of out‐patient therapy ranged from two to 62 days with a mean duration of 9.4 days if treated at the unit, or 13.2 days in the home care model (1476 patient‐days). Vein access was peripheral and catheters remained functional for an average of 4.9 days (range 0.5 to 22 days). Only two patients experienced adverse drug reactions that necessitated modification of treatment. One other case was readmitted to the hospital for surgical debridement. The average cost per patient‐day was $66 compared with $375 for in‐hospital therapy. This program proved to be safe, efficient, and cost‐effective.
An epidemic of Mycoplasma pneumoniae in Manitoba: A Serological Report
Authors: Sekla Laila , Stackiw Walter , Eibisch Gudrun , Kolton Donna
Published: March 2016

Objectives: To report an epidemic of Mycoplasma pneumoniae in Manitoba and to discuss the limitations of the serodiagnostic tests used.

Design: A retrospective analysis of the results of a province‐wide serological testing for respiratory infections caused by M pneumoniae, using a complement fixation test and an indirect immunofluorescent antibody test for the detection of immunoglobulin (Ig) M antibodies.

Material: From April 1, 1987, to March 31, 1991, 12,804 sera were tested and a serological diagnosis of recent M pneumoniae infections were established in 509 (3.97%). From April 1 to September 30, 1991, an additional 2088 persons were tested; the 158 (7.5%) recent cases of M pneumoniae were subjected to analysis.

Results: Compared with the previous three years, an increase in the number of recent cases of M pneumoniae was first noticed in July 1990 which persisted until September 1991. Of 856 single sera tested, 59 (6.8%) were recent M pneumoniae infections and 56 (96.1%) of these were positive for IgM antibodies. Of the 616 persons who submitted paired sera, 99 (16%) were recent infections, but only 46 (46.4%) had IgM antibodies. Primary infections (ie, positive for IgM antibodies) were detected in 102 (64.5%) and reinfections (ie, positive complement fixation test only) in the remaining 56 persons with recent M pneumoniae infections. Primary infections were detected more frequently in the ‘under 16’ than in the ‘over 16’ year age group (75% versus 55.8% of the recent cases of M pneumoniae in each age group). Reinfections were more common in the older age group. Of the 158 recent cases of M pneumoniae, 30.3% had a pneumonia; of these, 21 (55.2%) were under the age of 16 years.

Discussion: M pneumoniae is an important cause of morbidity. Serological tests are used for the diagnosis despite their limitations. The detection of IgM antibodies in acute serum establishes a diagnosis of primary M pneumoniae; however, their absence does not exclude M pneumoniae. A second (convalescent) blood test is required to diagnose all primary infections. To diagnose all reinfections, paired sera should be tested by complement fixation.

Summary: Manitoba experienced an epidemic of M pneumoniae in 1990–91. Properly selected serological tests can provide a specific and rapid diagnosis.
A Prospective Randomized Trial of Imipenem‐Cilastatin Versus Clindamycin/Tobramycin in the Treatmentof Intra‐Abdominal and Pelvic Infections
Authors: Mandell Lionel A , Turgeon Pierre L , Ronalds Allan R , The Canadian Clinical Trials Group
Published: March 2016

Objective: A Canadian multicentre clinical trial in the treatment of intra‐abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem‐cilastatin (imipenem) (500 mg intravenously every 6 h) versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h).

Methods: Two hundred and fifty patients were entered (88 definite and 162 possible infections) and all were evaluable for analysis of adverse events and intention to treat analysis of efficacy. Dichotomous outcomes used were: cured versus noncured (improved, failed, relapsed).

Results: No statistically significant differences were found with the intention to treat analysis (P=0.88) or with definite infections (P=0.81). For overall bacteriological response, no significant differences were noted (P=0.1). Eleven and 15 patients on imipenem and clindamycin/tobramycin, respectively, were colonized with bacteria. Enterococci colonized four of 11 imipenem cases and five of 15 clindamycin/tobramycin cases while fungi colonized six patients on imipenem and four on clindamycin/tobramycin. Five patients on imipenem and seven on clindamycin/tobramycin developed superinfection. In the imipenem group, one case had a bacterial superinfection while four cases were due to Candida albicans. Seven of seven superinfections on clindamycin/tobramycin were bacterial. Three bacteria initially sensitive to the assigned study drug developed resistance. In two patients on imipenem, Enterococcus faecalis and Pseudomonas aeruginosa became resistant after 14 and 10 days of therapy, respectively. On clindamycin/tobramycin, one instance of Bacteroides fragilis resistance after eight days of therapy was seen. Eighty‐three adverse events occurred; 47 in the imipenem group and 36 in the clindamycin/tobramycin group. This resulted in discontinuation of antibacterial therapy in 13 patients, seven of whom were on imipenem and six on clindamycin/tobramycin. Comparison of adverse effects showed statistically significant differences for nausea (P=0.02) and hepatotoxicity (P=0.05) occurring with greater frequency in the imipenem and clindamycin/tobramycin groups, respectively.

Conclusions: These data support the conclusion that monotherapy with imipenem (500 mg intravenously every 6 h) is as efficacious as clindamycin/tobramycin for treatment of intra‐abdominal and pelvic infections. Both regimens are well tolerated.
Dengue Fever with Hemorrhagic Manifestations in Travellers Returning to Quebec from Asia
Authors: Duperval Raymond , Frost Eric H , Artsob Harvey
Published: March 2016

Two cases of dengue fever with hemorrhagic manifestations were observed in 1990 and 1992 among travellers returning from Asia, while a third presented with classical dengue fever after the patient’s first trip to an endemic region. All experienced rash, thrombocytopenia and coagulation disorders and had flavivirus serology consistent with exposure to dengue virus.
Extrapulmonary Abscess Formation due to Pseudomonas cepacia in a Cystic Fibrosis Patient
Authors: Langley Joanne M , Ford-Jones E Lee , Armstrong Derek C , Gold Ronald , Read Stanley , Levison Henry
Published: March 2016

A 19‐year‐old immunocompetent cystic fibrosis patient with recurrent neck abscesses due to a multiresistant Pseudomonas cepacia is described. After 13 drainage procedures over a two‐year period, a trial of interferon‐gamma therapy to enhance monocyte function was attempted. The patient had one minor recurrence but has otherwise been symptom free for almost two years. P cepacia is an unusual cause of extrapulmonary abscess formation. Such abscesses may not present with classical signs of inflammation, are likely to be multiresistant and to require surgical drainage. Immunotherapy may be justified in the immunocompetent host when infection is refractory to medical and surgical therapy.
In vitro Assays of Staphylococcus epidermidis Characteristics and Outcome in an Endocarditis Model
Authors: Herndon Betty , Dall Lawrence , Barnes William
Published: March 2016

Objective: Staphylococcus epidermidis adherence to indwelling polymers is important in prosthetic valve endocarditis. Earlier studies have related streptococcal endocarditis to isolates with high levels of cell‐associated hexoses. The objective of the present study was to determine if a relationship exists between an S epidermidis isolate assay score and production/severity of experimental endocarditis.

Design: Groups of patient S epidermidis isolates were screened for surface hexoses and an animal model of endocarditis with isolates testing highest and lowest on the screen was produced. Disease severity produced by ‘high hexose’ versus ‘low hexose’ organisms was evaluated. Endocarditis responding variables were bacterial vegetation weight and log10 colony forming units (cfu) and in survival tests, comparative time to death with different isolates. Bacterial characteristics were not measured. Baseline data showed a vegetation weight difference so that with a β error of 0.20 and a two‐tailed α error of 0.05, a significant difference would be noted using 30 animals. A total of 64 animals was used.

Population Studded: Bacterial isolates from two patient groups (n=42 and n=68) on which in vitro assays were run. An animal model of endocarditis (n=64) was used to evaluate four selected isolates for vegetation size, log10 cfu/g, and survival time.

Main Results: In a group of S epidermidis endocarditis animals evaluated for time of death, a significantly more rapid death time resulted in the group dosed with the high hexose‐scoring organism (P<0.025). Vegetations and log10 cfu produced by test high hexose isolates averaged larger but were not significantly different.

Conclusions: A significantly more rapid death rate occurs in untreated endocarditis using a high hexose isolate than with S epidermidis with low surface hexoses. Using bacterial vegetation and cfu as endpoints, however, experimental endocarditis using patient isolates of S epidermidis does not show the same strong correlation to bacterial surface hexoses as does streptococcal endocarditis.
A Randomized Double‐Blind Placebo Controlled Trial of Oral Acyclovir in Renal Allograft Recipients
Authors: Schlech Walter F , Meagher Nancy , Cohen Allan D , Belitsky Philip , MacDonald AS , LeBlanc John C
Published: March 2016

Fifty renal transplant patients were randomized to receive either 800 mg acyclovir by mouth four times daily or identical placebo tablets for prophylaxis of herpes simplex infection. Patients were followed weekly to assess reactivation of herpes simplex, varicella zoster virus, Epstein‐Barr virus or cytomegalovirus (CMV) infections. The patients received standard immunosuppressive regimens including cyclosporine A. Acyclovir suppressed secretion of herpes simplex virus in treated patients (P=0.001). Three episodes of mucocutaneous herpes simplex virus occurred in placebo recipients and one in a noncompliant acyclovir recipient. A clinically important difference in graft survival was demonstrated, but because of sample size failed to reach statistical significance (P=0.11). No reactivation of varicella zoster virus, Epstein‐Barr virus or CMV infection was detected in either group. Toxicity was limited to central nervous irritability. The authors conclude that high dose oral acyclovir provides effective prophylaxis for prevention of herpes simplex virus infections in renal transplantation and may be associated with increased graft survival, perhaps from suppression of CMV infection.
Diagnosis of Cellulitis in Patients Infected with the Human Immunodeficiency Virus
Authors: Diaz Ireneo , Neelagaru Suresh , Dall Lawrence
Published: March 2016

A prospective microbiological evaluation of cellulitis in 22 patients infected with the human immunodeficiency virus was performed. Patients with helper lymphocyte counts of less than 200 cells/mm3 had a greater frequency of positive cultures. The most frequently isolated pathogens were Staphylococcus aureus and Streptococcus pyogenes, and initial antibiotic therapy should cover these Gram‐positive cocci.
Cefcanel Daloxate versus Penicillin in Acute Streptococcal Pharyngotonsillitis
Authors: Grunfeld A , Sinclair P , Nicolle LE , the Canadian Tonsillitis Study Group
Published: March 2016

Objective: To determine the efficacy, safety and tolerance of cefcanel daloxate and phenoxymethylpenicillin (PcV) in the treatment of acute pharyngotonsillitis caused by beta‐hemolytic streptococci group A (bhsga).

Patients and Methods: Randomized, double‐blind, multicentre study with subjects randomized 1:1:1:1 to four parallel treatment groups: cefcanel daloxate 150 mg bid, 300 mg bid, 600 mg daily and PcV 300 mg tid. Patients were treated for 10 days with clinical, bacteriological and safety evaluation at inclusion, during therapy (day 5), early after completion of therapy (day 14) and two weeks later (day 28).

Results: Of 340 subjects enrolled, 324 were valid for safety analysis and 249 for efficacy analysis. At the short term visit, clinical cure rates for cefcanel daloxate 300 mg bid and PcV groups were similar at approximately 70%. The cure rates for cefcanel daloxate 150 mg bid and 600 mg daily were significantly worse at 57.4 and 54.4%. Approximately 80% of all pretherapy throat swabs grew bhsga. All bhsga were susceptible or intermediately susceptible to PcV and cefcanel. The bacterial elimination rate for cefcanel daloxate was 82.8% and for PcV it was 89.8%. The elimination rate was significantly lower in the cefcanel daloxate 150 mg bid and 600 mg daily groups. The clinical cure rates and the bacteriological elimination rates increased by about 10% for cefcanel daloxate 300 mg bid and the PcV groups at the last valid visit and remained significantly better than the other two cefcanel daloxate doses. Adverse events were not significantly different among the four treatment groups.

Conclusions: Cefcanel daloxate 300 mg bid was as effective and as well tolerated as PcV 300 mg tid in the treatment of acute pharyngotonsillitis. A lower dose or once‐daily dose regimen of cefcanel daloxate was not as effective clinically or bacteriologically.
The Seroepidemiology of Toxoplasmosis in the Lower Fraser Valley of British Columbia
Authors: Proctor Eileen M , Banerjee Satyendra N
Published: March 2016

Objective: To determine the seroprevalence of toxoplasmosis in vegetarian and nonvegetarian members of different ethnic communities in the lower Fraser Valley of British Columbia.

Design: Serum samples were collected from 2027 participants drawn from various ethnic groups and tested by elisa for the presence of immunoglobulin (Ig) G and IgM antibodies to Toxoplasma gondii. Coded questionnaires requesting information relevant to the study were completed by each participant. The study population comprised 1334 females and 693 males; ages ranged from 17 to 102 years.

Main Results: Four hundred and nineteen (20.7%) individuals were IgG positive with titres ranging from 1:100 to 1:3200. IgM antibodies were detected in only four individuals. The seroprevalence rose with increase in age but there was no significant difference between males and females. A positive correlation was shown between ingestion of meat and between consumption of unpasteurized milk and antibodies to T gondii. Eighty per cent of females between the ages of 17 and 40, of all ethnic origins, were seronegative. Seropositivity did not differ between cat owners and non‐cat owners.

Conclusions: Women of childbearing age are at risk of acquiring toxoplasmosis during pregnancy and of transmitting the infection transplacentally. Consumption of undercooked meat and unpasteurized milk may result in the acquisition of toxoplasmosis. Data suggest that acquisition of toxoplasmosis is more likely via environmental oocysts or cysts in food source animals than by direct contact with cats.
An Assessment of the Anaerobic Vial of Paired NR 6A and NR 7N Bactec Blood Cultures
Authors: Forward Kevin R , Kerr Elizabeth , Dalton Maurice
Published: March 2016

Objective: To determine the number of obligate anaerobes recovered in anaerobic blood culture vials and to determine if their recovery had a significant impact on patient care.

Design: Retrospective review.

Setting: Tertiary care teaching hospital.

Main Results: Six thousand nine hundred and five pairs of Bactec blood cultures were submitted (each set consisted of one 6A and one 7N vial). Of these, 690 sets were culture‐positive in at least one of the vials (10% of pairs). Both vials were positive in 406 (58.8%). The aerobic vial alone was positive in 176 (25.5%) and the anaerobic vial alone was positive in 107 (15.5%). Of these, most were facultative anaerobes; however, 20 blood culture sets from 18 patients were positive for obligate anaerobes. In five of the 18, the isolate was judged to be a contaminant. In 11 of 13 patients, the clinically significant obligate anaerobic bacteremia might have been predicted on clinical grounds, and in eight patients, empirical antianaerobic antibiotics had been started before the results of blood cultures were known.

Conclusions: Clinical laboratories should carefully examine the use of the routine anaerobic blood culture and consider its replacement with larger volume aerobic blood culture vials.
Treatment of Hypersensitivity Pneumonitis: Contact Avoidance versus Corticosteroid Treatment
Authors: Cormier Yvon , Desmeule Marc
Published: March 2016

OBJECTIVE: To compare the early response to oral corticosteroid treatment with contact avoidance in patients with acute hypersensitivity pneumonitis.

DESIGN: Prospective evaluation of patients with hypersensitivity pneumonitis. who chose either contact avoidance or low dose corticosteroid treatment.

STUDY POPULATION: Twenty‐eight patients with acute hypersensitivity pneumonitis.

INTERVENTIONS: Each subject had a clinical evaluation, chest radiographs. lung function measurements and a bronchoalveolar lavage at diagnosis and after one month of either form of treatment (contact avoidance or oral prednisone 20 mg daily).

RESULTS: Nineteen subjects (all with farmer′s lung) chose the
corticosteroid arm and nine chose the contact avoidance arm (three
farmer′s lung, four humidifier lung and two bird fancier′s lung).
Initially subjects in both groups had similar disease severity
(single breath carbon dioxide diffusion capacity [DLCO] 61.4±3.9
and 60.7±18.9% predicted. respeclively [mean ± SD]. total
bronchoalveolar lavage cells 101X106 versus 119x106.
All subjects improved with either treatment. and 10 subjects considered
themselves back to normal. DLCO increased from the above
values to 74.6±21.9 and 77.1±18.5. respectively. Bronchoalveolar
lavage lymphocytos is remained unchanged after one month of
either treatment.

CONCLUSIONS: Both low dose oral corticosteroids and contact avoidance provided adequate initial treatment of acute hypersensitivity
pneumonitis. Bronchoalveolar lavage cellular findings remained
abnormal despite clinical improvements; this technique did
not provide useful clinical information in the follow‐up of hypersensitivity pneumonitis.
Randomized Comparison of Two Spacer Devices in Subjects with Reversible Airflow Limitation
Authors: Clarke Fred W , Montgomery Leslie L , Stubbing David G
Published: March 2016

OBJECTIVE: To assess a new spacer device. the ACE. by comparing
it with the Aerochamber in subjects with reversible airflow
limilation and assessing the change in lung function after inhaled bronchodilator.

DESIGN: A randomized single‐blind cross‐over trial was performed.

SETTING: Hospital‐based pulmonary function laboratory.
POPULATION STUDIED: Thirty subjects with reversible airflow
limitation. Mean forced expired volume in Is (FEV1) was 1.37 L.
range O.8 to 3.3 L. All subjects had previously shown at least 15% reversibility after inhaled bronchodilator.
All inhaled bronchodilators were witheld for 6 h. Subjects were studied on two separate days.
Four subjects were excluded from the final analysis because
baseline FEV1 varied by greater than 10% between the two study
days. Maximum expiratory fow rates were used as the primary
outcome measure· Change in heart rate was assessed for adverse
effects.

INTERVENTIONS: The change in maximum expiratory flow rates
was assessed 15 mins after two, three and four pulls of inhaled
salbutamol delivered via one or the spacer devices. The use of
spacer was randomized.

RESULTS: Data from 26 subjects were analyzed. Baseline FEV1
was similar on the two study days: 1.37±0.13 L (ACE) and
1.38±0.14 L. (Aerochamber). The change in FEV1 was similar on
both study days. The change in all the maximum expiratory flow
rates was similar with both spacer devices. FEV1 after four pulls
of salbutamol was 1.7±0.16 L. (ACE) and I.71 ±0.16 L (Aerochamber).

CONCLUSION: The bronchodilation achieved was similar with
both spacers. Because the ACE is cheaper. it may offer cost
savings to individuals or institutions.
Aeroallergens and Asthma
Authors: Chan-Yeung Moira , Quirce Santiago
Published: March 2016

The main aeroallergens in both the indoor and outdoor
environment that have been implicated in the pathogenesis
of allergic asthma are reviewed. Pollen and fungal spores
are important outdoor aeroallergens that cause sensitization
in atopic subjects, leading to rhinitis and asthma in a proportion
of the sensitized subjects. Each pollen type displays a
particular seasonal periodicity: tree pollen are prevalent in
the late winter and spring, grass in the spring and summer
and weed mainly in the fall. There are regional differences
in the type of pollen grains in Canada. Although the pollen
grains arc large fragments less than 10 µ can reach the
lower airways to cause asthma. Some fungal spores. such as
Alternaria and Cladosporium, have been implicated in
asthma. The full clinical impact of fungi in asthma has yet
lo be clarified. With the construction of homes that are
tightly scaled to conserve heat and the use or wall to wall
carpet. the type and concentration of indoor aeroallergens
have become increasingly different from outdoors. House
dust mite and pet allergens have now been shown to he
important acro:dlergcns that sensitize children in infancy
and are risk factors for asthma. Clinicians should recognize
the importance of aeroallergens in asthma because avoidance
and/or reduc1iun of exposure is an important part of the
management besides drug therapy.
Therapeutic Potential for Cytokine Antagonists: Thalidomide and Pentoxifylline in Hansen’s Disease
Authors: Peterson Theresa C
Published: March 2016

Cytokine antagonists are a group of drugs defined by their actions on specific cytokines. Cytokine antagonists can inhibit action of cytokines by acting directly on receptors, by affecting production of cytokines or by binding to cytokines and preventing their subsequent action. Recent evidence suggests that Hansen’s disease, which is characterized by reactional states, is associated with elevated serum levels of tumour necrosis factor‐α (tnf‐α) and interleukin‐1β during these reactional states. Thalidomide, a drug used to treat reactional states in Hansen’s disease, has been reported to enhance degradation of tnf‐α mrna. Pentoxifylline has also been reported to alter tnf‐α mrna levels by inhibiting tnf‐a transcription. Combination of these two drugs as cytokine antagonists may prove to be beneficial as therapeutic agents in the treatment of reactional states in Hansen’s disease. Pentoxifylline may prove to be beneficial in the treatment of reactional states in Hansen’s disease patients who are female and of childbearing age. Cytokine antagonists alone or in combination will likely fill a niche in future therapeutics.
Human to Human Transmission of Brucella Melitensis
Authors: Vigeant Patrice , Mendelson Jack , Miller Mark A
Published: March 2016

Human brucellosis is acquired mainly through contact with infected animal tissues, ingestion of unpasteurized dairy products or infected aerosols. Person to person transmission is still considered uncertain. The case of a woman diagnosed with proven brucellosis after her husband suffered a relapse of bacteremia with Brucella melitensis biotype 3, which was originally acquired abroad by eating goat cheese, is described. It was postulated that person to person spread of brucellosis is a likely mode of transmission in this case.
Validation of the Pain Beliefs and Perceptions Inventory
Authors: Mikail Samuel F , D′Eon Joyce L , Gagné Théo A De
Published: March 2016

OBJECTIVE: To examine the test‐retest reliability, construct validity and factor structure of the Pain Beliefs and Perceptions Inventory (PBPI).

DESIGN: A sample of 195 individuals attending a chronic pain clinic completed the PBPI along with a preclinic assessment battery. A subset of this sample completed the assessment package two to four weeks and four to six months later in order to examine the test‐retest reliability of the PBPI.

RESULTS: Confirmatory factor analysis revealed a four‐factor solution: pain constancy, self‐blame, mystery and understanding of chronicity. Internal consistency estimates ranged from 0.63 to 0.75. Pain constancy and understanding of chronicity had good test‐retest reliability, while test‐retest reliability of the remaining subscales was not adequate. These results differ from those reported in the initial development of the PBPI. Construct validity was determined through examination of correlations between the PBPI and the Beck Depression Inventory, the McGill Pain Questionnaire, the Multidimensional Pain Inventory and a self‐blame questionnaire.

CONCLUSIONS: The results of this investigation are consistent with the findings of recent investigations that revealed a four‐factor solution to the PBPI. However, the subscales of this instrument were not found to be uniformly stable over time. These results suggest that further examination and refinement of item content for two of the subscales are required before the instrument is suitable for clinical use.
Effect of Biological Sex Differences on the Perception of Acute Pain Stimulation in the Dental Setting
Authors: Eli Ilana , Bar-Tal Yoram , Fuss Zvi , Korff Ethan
Published: March 2016

BACKGROUND: Pain is a subjective sensory and emotional experience that is influenced by variables such as stress, anxiety and sex.
OBJECTIVE: To investigate the interrelationship among sex, state and dental anxiety, and the patient′s reaction to diagnostic tooth pulp stimulation.
SUBJECTS AND DESIGN: The study was conducted on 64 dental patients (age 18 to 78 years, 50% were female). All subjects were evaluated twice. At time 1, subjects were requested to fill out questionnaires concerning their state and dental anxiety, and participants underwent diagnostic tooth pulp stimulation by an electric pulp tester. Four variables of the experience were recorded: sensation threshold, pain threshold, pain tolerance and the subjective evaluation of the painful experience on a visual analogue scale (VAS). At time 2, subjects were requested to record their memory of the previous experience on a VAS, and the whole procedure was repeated including record of state and dental anxiety, sensation and pain thresholds, pain tolerance and its subjective evaluation on a VAS.
RESULTS: No direct correlations were found between sex and any other variable. However, there were significant differences in the relationship among the different pain and anxiety measures between both sexes.
CONCLUSIONS: A man′s reaction to acute pain stimulation may be more affected by psychological factors than a woman′s.
PEEP or No PEEP: That Is Not the Question
Authors: Villar Jesús , Slutsky Arthur S
Published: March 2016

Generally, positive end‐expiratory pressure (PEEP) is applied to improve oxygenation, and has been shown to improve gas exchange and lung compliance in acute lung injury, but it is not without risk. To date, no controlled outcome studies have been published to demonstrate the best method of choosing the level of PEEP. Furthermore, it is not known whether the application of PEEP contributes to lung damage or helps to ameliorate it. The authors review the goals of PEEP and the current evidence on its effects on lung injury and its clinical utility. In the absence of controlled clinical trials, the use of PEEP in acute respiratory distress syndrome needs to be guided by physiological principles that balance the beneficial effects of an increase in functional residual capacity, prevention of alveolar closure, redistribution of lung water and improved ventilation of low ventilation‐perfusion areas against the potential harm of alveolar rupture (barotrauma and "volutrauma") and reduction in cardiac output.
Pseudomonas aeruginosa Blepharitis in a Patient with Vancomycin Induced Neutropenia
Authors: John Michael A , Austin Thomas W , Bombassaro Anne Marie
Published: March 2016

A patient who developed a necrotizing pseudomonas blepharitis as a complication of drug induced neutropenia is reported. Although the patient’s neutrophil count recovered and he survived his infection, radical reconstructive surgery of his eyelids was required. Clinicians should keep in mind that in patients with predisposing risk factors, even commonly encountered infections such as blepharoconjunctivitis may be caused by atypical pathogens.
High Frequency Oscillatory Ventilation
Authors: Bryan AC , Bohn D
Published: March 2016

High frequency oscillatory (HFO) ventilation using low tidal volume and peak airway pressures is extremely efficient at eliminating carbon dioxide and raising pH in the newborn infant with acute respiratory failure. Improvement in oxygenation requires a strategy of sustained or repetitive inflations to 25 to 30 cm H2O in order to place the lung on the deflation limb of the pressure‐volume curve. This strategy has also been shown to decrease the amount of secondary lung injury in animal models. Experience of the use of HFO ventilation as a rescue therapy as well as several published controlled trials have shown improved outcomes and a decrease in the use of extracorporeal membrane oxygenation when it has been used in newborns.
Analgesic and Nonanalgesic Effects of Intravenous Hydromorphone ‐ Relation to Plasma Concentrations in Healthy Volunteers
Authors: Westerling D , Bjork H , Svedman P , Hoglund P
Published: March 2016

OBJECTIVE: To investigate the analgesic and nonanalgesic effects and the pharmacokinetics of an intravenous infusion of 2 mg hydromorphone over 20 mins.
DESIGN: Open study.
SUBJECTS: Twelve healthy volunteers.
MEASUREMENTS: The analgesic effect of hydromorphone was evaluated serially using pressure pain thresholds (PPTs) measured on the third fingers and toes. The nonanalgesic effects of hydromorphone were measured as miosis, decrease of saliva production and central nervous effects such as euphoria/dysphoria, nausea, headache, fatigue and feeling of heaviness. Plasma concentration of hydromorphone was measured using high performance liquid chromatography.
RESULTS: PPTs were significantly increased compared with baseline levels for up to 2 h after the infusion of hydromorphone. Significant miosis and reduction of saliva production were registered up to 6 h after drug administration. Fatigue and heaviness were reported by all subjects. In the studied opioid‐naive subjects, the hydromorphone‐induced analgesic effect was of shorter duration than the studied nonanalgesic effects. The terminal elimination half‐life of hydromorphone was 1.87±0.4 h (± SD) (95% CI 1.61 to 2.13), systemic clearance was 1.81±0.25 L/min (95% CI 1.65 to 1.97) and volume of distribution was 4.15±0.86 L/kg (95% CI 3.6 to 4.71).
CONCLUSION: Analgesia and nonanalgesic effects appear to be well correlated with the plasma concentrations of the hydromorphone.
Clinical Experience in the Use of Inhaled Nitric Oxide in Infants with Pulmonary Hypertension
Authors: Lemke Robert P , Belik Jaques , Giddins Niels G , Fajardo Carlos A
Published: March 2016

Inhaled nitric oxide (iNO) is a potent local vasodilator. Numerous case reports describe its efficacy in treating persistent pulmonary hypertension of the newborn (PPHN). This report describes experience at the authors′ institution with iNO therapy in 10 consecutive infants with PPHN of a number of etiologies. Infants received iNO at doses of 0.2 to 80 ppm for 1 to 481 h. Five infants were classified as responders (20 torr or greater rise in PaO2) and one as a partial responder (PaO2 rise of 10 to 19 torr). The remaining four did not respond. Overall observed mortality was three of 10, with two of four of nonresponders and the only partial responder dying. Survivors required ventilation for 18±18 days and oxygen for 29±30 days, and they remained in hospital 40±30 days (mean ± SD). Although improvement in oxygenation with iNO was primarily due to reduction in pulmonary pressure, in selective patients, changes in ventilation‐perfusion relationships could account for some of the increase in oxygenation. The presence of significant methemoglobinemia in two patients (7% and 4.5%) when the infants′ iNO dose was increased to 80 ppm highlights the importance of careful monitoring for toxicity. Further studies are needed to define the best dosage and duration of iNO. While iNO shows great promise in the treatment of PPHN, randomized controlled trials are needed to delineate in which infants iNO use is indicated.
Monitoring during Mechnical Ventilation
Authors: Hess Dean
Published: March 2016

Monitoring is a continuous, or nearly continuous, evaluation of the physiological function of a patient in real time to guide management decisions, including when to make therapeutic interventions and assessment of those interventions. Pulse oximeters pass two wavelengths of light through a pulsating vascular bed and determine oxygen saturation. The accuracy of pulse oximetry is about ±4%. Capnography measures carbon dioxide at the airway and displays a waveform called the capnogram. End‐tidal PCO2 represents alveolar PCO2 and is determined by the ventilation‐perfusion quotient. Use of end‐tidal PCO2 as an indication of arterial PCO2 is often deceiving and incorrect in critically ill patients. Because there is normally very little carbon dioxide in the stomach, a useful application of capnography is the detection of esophageal intubation. Intra‐arterial blood gas systems are available, but the clinical impact and cost effectiveness of these is unclear. Mixed venous oxygenation (PvO2 or SvO2) is a global indicator of tissue oxygenation and is affected by arterial oxygen content, oxygen consumption and cardiac output. Indirect calorimetry is the calculation of energy expenditure and respiratory quotient by the measurement of oxygen consumption and carbon dioxide production. A variety of mechanics can be determined in mechanically ventilated patients including resistance, compliance, auto‐peak end‐expiratory pressure (PEEP) and work of breathing. The static pressure‐volume curve can be used to identify lower and upper infection points, which can be used to determine the appropriate PEEP setting and to avoid alveolar overdistension. Although some forms of monitoring have become a standard of care during mechanical ventilation (eg, pulse oximetry), there is little evidence that use of any monitor affects patient outcome.
Isolated Facet Joint Fracture as a Cause of Chronic Low Back Pain and Sciatica
Authors: Teasell Robert W
Published: March 2016

A case of facet joint fracture following a rear‐end motor vehicle accident who presented with chronic low back pain and sciatica is outlined. Diagnosis was made with 99Tc nuclear bone scan and was confirmed on computed tomographic scan after diagnosis with regular radiographs had failed. Facetectomy relieved pain but led to symptoms related to asymmetric load on the opposite facet joint. Symptoms were substantially relieved with a facet joint deinnervation procedure. Facet joint fracture was felt to occur as a consequence of compression forces on the facet joint at the time of impact.
Management of Fibromyalgia
Authors: Carette Simon
Published: March 2016

This article reviews an approach to the management of patients with fibromyalgia, with particular emphasis on the principles of education and the active involvement of the patient in treatment.
Impaired Discriminative Function in Patients with Chronic Pain Measured by Variance in Straight Leg Raising
Authors: Hoirch Ann Marie , Smith Vicky , Beugnot Sophie , Turner Joanne , Catchlove Richard FH
Published: March 2016

Many chronic pain patients seem to have difficulty regulating exercise programs and require detailed, precise instructions of what exercises to do as well as their frequency and timing. This may be due to a lack of information concerning the state of the damaged tissues, which may result from inadequate feedback mechanisms for pain, stretch and position. The straight leg raising test was used as a model of this mechanism, and variance in targeting the end‐point of this test was measured in patients with chronic pain and in controls. Variance about the end‐point in chronic pain patients was more than three times larger than that in controls. Although chronic pain patients were older, there was no correlation between straight leg raising and age. The implications of these findings to the maintenance of the original injury and the importance of this in the maintenance and continuation of chronic pain states are discussed.
Pulmonary Kaposi′s Sarcoma: Diagnostic Features and Natural History in Patients with Acquired Immuneodeficiency Syndrome
Authors: Tsai Willis , Chan Charles K , Shepherd Frances , Sawka Carol
Published: March 2016

OBJECTIVE: This retrospective descriptive study was undertaken to highlight the diagnostic features and natural history of pulmonary Kaposi′s sarcoma (KS).

METHODS: Thirty‐three patients with symptomatic pulmonary KS were assembled from a cohort of 239 patient with KS. Pulmonary KS was diagnosed by visualization of endobronchial lesions at bronchoscopy or based on clinical‐radiological correlation and exclusion of opportunistic infections.

RESULTS: The median time from initial presentation with KS to the development of pulmonary involvement was nine months. Dyspnea (79%) and dry cough (79%) were the most common presenting symptoms. Oral palatal involvement was present in 58% of patients with pulmonary KS. Pulmonary nodules (58%) were the most common radiological finding, but an interstitial pattern was noted in 42% of patients. Pleural effusion was present in 39%. Radiological patterns were not static, as 50% of patients with an initial interstitial pattern progressed to develop poorly formed nodules in the peripheral lung fields. Endobronchial lesions were noted on bronchoscopy in 23 patients. A presumptive diagnosis of pulmonary KS was made in 10 patients, with autopsy confirmation in four. Chemotherapy completely resolved symptoms in nine of 25 treated (36%) patients, and a further nine (36%) experienced a significant reduction in symptoms. Radiological improvement was noted in two of the clinical responders. Median survival from the time of diagnosis of pulmonary KS was only eight months, and symptoms relapsed within six weeks of achieving the best clinical response with chemotherapy.

CONCLUSIONS: Pulmonary KS presents a difficult diagnostic challenge due to a nonspecific constellation of symptoms and radiological findings. Bronchoscopy is diagnostic when endobronchial lesions are visualized but, more important, it can exclude opportunistic infections. In some patients, even with a negative bronchoscopy, the diagnosis may still be established using clinical‐radiographic correlation, particularly if there is radiological evolution to a nodular pattern over time. Multidrug chemotherapeutic regimens appear to have some symptomatic benefit, but radiological improvement is extremely limited. Progression of disease occurs in virtually all patients, and the median survival is only eight months from the point of recognition of pulmonary KS.
Evaluation of Non‐HIV‐Related, Drug‐Sensitive Cluster Outbreaks of Tuberculosis with PCR‐based DNA Fingerprinting
Authors: FitzGerald JM , Black WA , Kunimoto D
Published: March 2016

OBJECTIVES: To characterize two cluster outbreaks of tuberculosis by DNA fingerprinting and to evaluate the possibility of their association with human immunodeficiency virus (HIV) infection and multiple drug‐resistant Mycobacterium tuberculosis.

SETTING: Two clusters of tuberculosis cases in adjoining aboriginal Canadian reserves and a control population.

METHODS: All cases of tuberculosis diagnosed in the two communities and a number of control isolates were fingerprinted using a novel simplified DNA‐based technique. Demographic data, purified protein derivative (PPD) skin test response to 5TU PPD, type of disease and HIV serology were also evaluated. Positive cultures were assessed for susceptibility to antituberculous drugs.

RESULTS: Two distinct clusters with five cases in one community and 21 cases in the second were identified. Isolates from both communities differed in their DNA pattern but were identical within communities. Thirteen cases had bacteriologically proven disease and grew susceptible organisms. Serological analysis for HIV infection was carried out in 15 of 18 adults, and all were negative.

CONCLUSIONS: The study shows the potential for the rapid transmission of tuberculosis infection in HIV‐negative subjects with susceptible organisms. It further highlights the usefulness of DNA fingerprinting for molecular epidemiology in evaluating particular outbreaks.
Evaluation of Routine Enteric Pathogens in Hospitalized Patients: A Canadian Perspective
Authors: Gough Kevin , Alfa Michelle , Harding Godfrey
Published: March 2016

Diarrhea is a frequently encountered problem in hospitalized patients. Since nosocomial spread of routine enteric pathogens such as Salmonella species, Shigella species, Campylobacter species and Escherichia coli O:157 H:7 seldom occurs, testing for these organisms in patients hospitalized for longer than three days has been questioned. The goal of this study was to determine the length of hospitalization preceding detection of routine enteric pathogens and Clostridium difficile cytotoxin, and to develop guidelines for enteric cultures from hospitalized patients. The enteric pathogens detected in 1991 were C difficile toxin B(+), 77%; Campylobacter species, 10%; Salmonella species, 9%; E coli O:157 H:7, 3%; and Shigella species, 1%. For 1992, these numbers were 86%, 9%, 3%, 2% and 0%, respectively. None of the routine enteric pathogens isolated in 1991 or 1992 was detected in patients after their second day of hospitalization. Routine cultures for enteric pathogens on hospitalized patients were eliminated in February 1993, and physician ordering practices were monitored. With the exception of one campylobacter isolate per year, all routine enteric pathogens isolated in 1993 and 1994 were detected by the second day of hospitalization. Compliance with the changed protocol was 76% measured over a four‐month period in 1993 and 74% over the year 1994. Savings of $3,648.10 were associated with rejecting 191 ‘inappropriate’ specimens in 1994. It was concluded that routine enteric cultures are unnecessary for patients hospitalized more than two days, and that appreciable financial savings can be achieved if revised protocols for processing stool cultures are instituted. However, when enteric protocol changes are in place compliance must be evaluated to ensure appropriate utilization.
The Unsettled Question of Brochodilator Aerosol Administration in Mechanically Ventilated Patients
Authors: Lacasse Yves , Boulet Louis-Philippe , Lampron Noël
Published: March 2016

Aerosols have gained wide acceptance over the past 10 years for the treatment of obstructive diseases. However, much controversy still exists about their use and mode of administration in the setting of intensive care units for intubated patients. The current literature was reviewed addressing the following question: In intubated and mechanically ventilated patients with airway obstruction, should bronchodilator aerosols be delivered through a metered‐dose inhaler (MDI) or a nebulizer in order to reduce complications associated with high airway resistance? Most often investigators have examined, in uncontrolled trials, the effect of bronchodilator aerosols administered either through MDIs or nebulizers in lung models, or in populations of patients with heterogeneous conditions. An extremely wide range of bronchodilator dosages has been studied. Clinical outcomes have consisted of either drug deposition or lung mechanical characteristics. Only three randomized controlled trials comparing the effects of bronchodilator aerosols delivered through a nebulizer to those delivered through an MDI have been published, without clearly demonstrating the superiority of one mode of administration over the other. There is a need for randomized controlled trials comparing the effect of bronchodilator aerosols delivered through nebulizer versus MDI on the incidence of ventilator‐associated complications in mechanically ventilated patients with obstructive lung diseases.