bluuebunny/crossref_metadata_2025 huggingface dataset:
French Translation of the Multidimensional Pain Inventory: L’inventaire multidimensionnel de la douleur
Authors: Laliberté Simon , Lamoureux Julie , Sullivan Michael JL , Miller Jean-Marc , Charron Julie , Bouthillier Donald
Published: March 2016

BACKGROUND: The Multidimensional Pain Inventory (MPI) is a widely used tool in the evaluation of pain conditions. This questionnaire has been translated and validated in multiple languages. However, there is no validated French‐language version available for clinicians and researchers interested in evaluating people living with pain.

OBJECTIVES: The main objective of the present project was to make available a validated French‐language evaluation tool for the cognitive, behavioural and emotional aspects of pain.

METHODS: Following a reverse translation of the MPI, a French‐language version of the questionnaire, the Inventaire multidimensionnel de la douleur, that was presented to 227 participants living with chronic pain, was obtained. These participants were all involved in a rehabilitation program in four different settings. A series of exploratory and confirmatory factor analyses was executed.

RESULTS AND CONCLUSIONS: Although three items were removed from the original version of the MPI, the three sections of the Inventaire multidimensionnel de la douleur had good psychometric properties. The results concerning the questionnaire’s structure were very similar to those obtained with the original tool and during its translation into other languages. People wishing to evaluate pain in French‐speaking populations now have access to a French‐language version of the MPI.
Fecal DNA Screening in Colorectal Cancer
Authors: Richter Suzanne
Published: March 2016

Colorectal cancer (CRC) is the third most common type of cancer diagnosed in Canada, and is the leading cause of cancer-related deaths in nonsmokers. Although CRC is considered to be 90% curable if detected early, the majority of patients present with advanced stage III or IV disease. An effective screening test may significantly decrease disease burden. The present paper examines the rationale and potential of fecal DNA testing as an alternative and adjunct to other CRC screening tests. The most efficacious fecal DNA test developed to date has a sensitivity and specificity of 87.5% and 82%, respectively. The approach has a higher positive predictive value than the currently used fecal occult blood test and offers a noninvasive option to patients. It is not reliant on the presence of bleeding, which may be intermittent or altogether absent. The test is now commercially available and is supported by a number of American insurers. Current challenges include cost reduction and demonstration of mortality benefit in a rigorous clinical trial. Despite current challenges, fecal DNA testing is worth pursuing. Both the American Gastroenterological Society and the American Cancer Society maintain that molecular testing is in its infancy but is promising. Fecal DNA testing has the potential to be an exciting addition to the current armament of CRC screening options.
Colonic Interposition in a Woman with Attenuated Familial Adenomatous Polyposis: Does the Location of the Colon Affect Polyp Formation?
Authors: Beaton Melanie D , Taylor Brian , Driman David , Ainsworth Peter , Adams Paul C
Published: March 2016

Attenuated familial adenomatous polyposis (AFAP) is a rare but well-established cause of colorectal carcinoma and multiple polyps. The present paper describes a case of a woman diagnosed with colorectal cancer at 34 years of age and subsequently found to have AFAP by genetic testing. During infancy, the patient underwent surgical correction of esophageal atresia with colonic interposition. While she had developed adenomatous polyps in her native cecum, there was no evidence of polyps or cancer in the segment of large intestine interposed between her upper esophagus and stomach. Therefore, various environmental differences between the upper and lower gastrointestinal tract may play a role in the expression of AFAP phenotype.
Soft Drink Consumption Linked with Fatty Liver in the Absence of Traditional Risk Factors
Authors: Assy Nimer , Nasser Gattas , Kamayse Iad , Nseir William , Beniashvili Zaza , Djibre Agness , Grosovski Maria
Published: March 2016

BACKGROUND: Little is known about dietary habits and their relationships with liver disease in nonalcoholic fatty liver disease (NAFLD) patients, particularly in the absence of obesity, diabetes or hyperlipidemia.

OBJECTIVE: To assess the association between soft drink consumption and the presence of fatty liver in NAFLD patients who do not have classic risk factors.

METHODS: Three hundred ten patients with NAFLD diagnosed by ultrasound were assessed for 36 months in a cross-sectional manner. Thirty-one patients (10%) who had NAFLD without classic risk factors were compared with 30 healthy controls. Physical activity was assessed during the preceding week and year, and every six months for 36 months. Data on daily dietary intake of food and soft drink, and the source of added sugar were collected during two seven-day periods, at the beginning of the study, and within two weeks after the metabolic tests by using a validated food questionnaire given by a trained dietician. Insulin resistance and lipid peroxidation were assessed by homeostasis model assessment-insulin resistance index (HOMA-IRI) and malondialdehyde (MDA) levels, respectively.

RESULTS: Eighty per cent of patients (25 of 31) consumed an excessive amount of soft drink beverages (more than 50 g/day of added sugar) for 36 months, compared with 20% in healthy controls (P<0.001). Twenty per cent of patients consumed one drink per day, 40% consumed two to three drinks per day, and 40% consumed more than four drinks per day for most days during 36 months. The most common soft drinks consumed were regular Coca-Cola (40% of patients), Diet Coke (40%) and flavoured fruit juices (20%). Ultrasound findings revealed mild fatty liver in 44% of cases (n=14), moderate fatty liver in 38% (n=12), and severe fatty liver in 18% (n=5). HOMA-IRI and MDA levels were significantly higher in patients with NAFLD than in healthy controls (HOMA-IRI, 3.7 versus 1.7, P<0.001; and MDA, 420±300 μmol/mL versus 200±100 μmol/mL; P<0.001). When controlled for other factors, including dietary composition and physical activity, soft drink beverage consumption was the only independent variable that was able to predict the presence of fatty liver in 82.5% of cases with a sensitivity of 100%, a specificity of 76%, a positive predictive value of 57% and a negative predictive value of 100%.

CONCLUSION: The present study may add important insight into the role of sugar-sweetened beverage consumption as a cause of fatty liver in patients without risk factors. Patients are encouraged to change their long-standing drinking behaviour.
The Costs of Colonoscopy in a Canadian Hospital using a Microcosting Approach
Authors: Sharara Nour , Adam Viviane , Crott Ralph , Barkun Alan N
Published: March 2016

BACKGROUND: Colonoscopy has become accepted as one of the most effective methods of screening patients for colorectal cancer, and is used to remove the majority of colonic adenomas.

OBJECTIVE: Because of the paucity of such estimates in the literature and the significant number of candidates for this procedure, the present study was performed to estimate the direct hospital costs of both diagnostic and therapeutic (polypectomy) colonoscopy.

METHODS: A microcosting methodology was used to itemize the costs of colonoscopy. Variable and fixed costs were divided into labour, supplies, equipment and overhead costs. A third-party payer perspective was adopted. All costs are expressed in 2007 Canadian dollars.

RESULTS: The cost of a diagnostic colonoscopy was $157 and the cost of a therapeutic colonoscopy was $199. Overhead costs represented approximately 30% of these amounts. When physician fees were added, these costs rose to $352 and $467, respectively.

CONCLUSION: Because the overhead costs represent a large proportion of the total costs, allocation methods for these costs should be improved to allow for a more precise determination of the total costs of a colonoscopy. These estimates are useful when analyzing the cost-effectiveness of a strategy that uses colonoscopy when screening for colorectal cancer.
The Impact of Preoperative Endoscopic Ultrasound on the Surgical Management of Pancreatic Neuroendocrine Tumours
Authors: Alsohaibani Fahad , Bigam David , Kneteman Norman , Shapiro AM James , Sandha Gurpal Singh
Published: March 2016

BACKGROUND: Endoscopic ultrasound (EUS) is accurate in diagnosing pancreatic neuroendocrine tumours (PNETs), but its impact on surgical management is unclear.

OBJECTIVE: To determine whether preoperative EUS findings altered the decision for, and extent of, surgery in patients with PNETs.

METHODS: A retrospective review of patients referred for EUS because of suspected PNETs was conducted. The diagnosis of PNETs was confirmed by EUS-guided fine needle aspiration cytology, where indicated, or by surgical histology. EUS findings were compared with computed tomography (CT) findings to determine whether there was an impact on the decision for surgical management.

RESULTS: Fourteen patients (10 women), with a mean age of 44 years, underwent EUS for suspected PNETs. PNETs were seen with CT in 10 of 13 patients (77%) and with EUS in 14 of 14 patients (100%). One obese patient could not fit into the CT scanner. This patient had five PNETs on EUS. Three patients with a normal CT scan were determined to have one or two PNETs on EUS. Three patients with one or two PNETs on CT were found to have five to eight PNETs on EUS. EUS altered the decision for possible surgical management in five of 14 patients (36%), either by identifying a PNET or by finding multiple and multifocal PNETs that were not visualized on CT scans.

CONCLUSION: EUS is useful in the preoperative assessment of PNETs by providing information that significantly influences the decision for surgical intervention or changes the extent of the planned surgery.
Addition of Sildenafil in Patients with Pulmonary Arterial Hypertension with Inadequate Response to Bosentan Monotherapy
Authors: Porhownik Nancy R , Al-Sharif Hassan , Bshouty Zoheir
Published: March 2016

BACKGROUND: Pulmonary arterial hypertension (PAH) remains a progressive disease despite improvement when using one of three medication classes: prostanoids, endothelin receptor antagonists or phosphodiesterase‐5 inhibitors. Combination therapy has been proposed for patients with unsatisfactory response to monotherapy.

OBJECTIVES: To examine the effect of adding sildenafil to bosentan on 6 min walk distance (6MWD) and New York Heart Association (NYHA) classification in patients with PAH who achieved inadequate improvement with bosentan monotherapy.

METHODS: Patients with idiopathic PAH or connective tissue disease‐associated PAH, and who had either self‐reported inadequate improvement in exercise tolerance or a decline in 6MWD after initial improvement, were included in the study (n=10). Data on 6MWD and NYHA class at baseline (before initiation of bosentan), three and six months after baseline, second baseline (before initiation of combination therapy with sildenafil), and three and six months after second baseline were analyzed for any changes.

RESULTS: Mean time from initiation of bosentan monotherapy to initiation of combination therapy was 558 days (range 150 to 900 days). Six months after initiation of bosentan, 6MWD increased by 57.2 m above the baseline of 314.4 m. Six months after combination therapy, 6MWD was 62.80 m higher than the baseline before initiation of combination therapy of 339 m (P<0.02). The overall increase in 6MWD six months after combination therapy was higher than the first baseline by 87.4 m (P not significant). NYHA functional class did not improve with combination therapy in all patients.

DISCUSSION: Initiating combination therapy in patients who achieve an inadequate improvement in exercise tolerance with mono‐therapy may result in further improvement in exercise tolerance.
Malignant Conversion of a Solitary Papilloma in the Distal Trachea: Report of a Case
Authors: Lioulias Achilleas , Misthos Panagiotis , Papagiannakis Georgios , Mermigkis Dimitrios , Karagianidis Napoleon , Neofotistos Kostas , Kokotsakis John
Published: March 2016

A solitary papilloma versus the usual multiple lesions of papillomatosis is extremely rare. Even more infrequent is a solitary papilloma of the trachea in an adult patient. In the present report, a case of a solitary papilloma in the distal trachea is presented. After two unsuccessful sessions of laser ablation, resection of the lower one‐third of the trachea was performed through a right posterolateral thoracotomy. Postoperative histology results disclosed a malignant degeneration into squamous cell carcinoma. The patient had an excellent outcome after resection of the affected portion of the trachea. There was no evidence of recurrence after 20 months of follow‐up.
Asthma Worsenings: Approaches to Prevention and Management from the Asthma Worsenings Working Group
Authors: Balter Meyer , Ernst Pierre , Watson Wade , Kim Harold , Cicutto Lisa , Beauchesne Marie-France , Cave Andrew J , Kaplan Alan , Hogg Donna , McIvor Andrew , Smiley Tom , Rouleau Michel , FitzGerald J Mark
Published: March 2016

Most asthma patients prescribed maintenance asthma therapies still experience periods of asthma worsenings characterized by daytime or nighttime symptoms, or an increased need for rescue medication. In fact, these episodes are highly prevalent even in patients with well‐controlled disease. Published literature suggests that asthma worsenings likely represent a window of opportunity during which patients could intervene early to prevent exacerbations or further deterioration of asthma symptoms. However, current evidence suggests that most patients fail to respond or to self‐manage appropriately during these periods.

To address the issue of asthma worsenings, an interdisciplinary committee of respirologists, allergists, family physicians, pharmacists and certified asthma educators from across Canada developed a practical definition of asthma worsenings and provided approaches to the prevention and management of these episodes based on current literature. To date, combination inhaled corticosteroid/long‐acting beta‐agonist therapy, particularly single inhaler maintenance and reliever therapy, appears to be an effective strategy for preventing asthma worsenings and exacerbations. Addressing the potential barriers to appropriate patient self‐management of asthma worsenings, such as failure to adequately identify and respond to worsenings, low expectations for controlling asthma, low health literacy and poor patient‐health care professional communication, are also critical to the successful prevention and management of these episodes. Finally, an interdisciplinary team approach involving patients and their families, certified asthma educators, primary care physicians, pharmacists and specialists is likely to have the greatest impact on the identification, prevention and management of asthma worsenings.
Perinuclear Antineutrophil Cytoplasmic Autoantibodies and Anti-Saccharomyces CerevisiaeAntibodies as Serological Markers Are Not Specific in the Identification of Crohn’s Disease and Ulcerative Colitis
Authors: Anand Vishal , Russell Anthony S , Tsuyuki Ross , Fedorak Richard
Published: March 2016

OBJECTIVE: To evaluate the diagnostic accuracy of perinuclear antineutrophil cytoplasmic autoantibodies (pANCAs) and anti-Saccharomyces cerevisiaeantibodies (ASCAs), as single agents and in combination, for the diagnosis of Crohn’s disease (CD) and ulcerative colitis (UC), including in cases of indeterminate colitis (IC).

METHODS: The sera from a total of 98 patients were studied: 77 with CD, 16 with UC and five with IC. The medical records of these patients were reviewed for disease diagnosis, demographic data, and patient symptoms and medications. ELISAs were utilized to detect the presence of ASCAs and deoxyribonuclease-sensitive pANCAs, and these results were then compared with the patients’ clinical data.

RESULTS: For UC, a positive pANCA test alone provided a sensitivity of 50% and a specificity of 82%. For CD, a positive ASCA test alone provided a sensitivity of 40% and a specificity of 100%. A combination of pANCA-positive and ASCA-negative results showed a sensitivity of 50% and specificity of 90% for the diagnosis of UC. Similarly, the combination of ASCA-positive and pANCA-negative results provided a sensitivity and specificity of 32% and 100% for the diagnosis of CD, respectively. Interestingly, 80% of IC patients showed serology results consistent with UC.

CONCLUSIONS:Although this combination of serological markers provides a diagnostic tool with generally high specificities, the low sensitivities of these serological markers, most notably in terms of CD, preclude the possibility that they can replace the tools currently used for inflammatory bowel disease diagnosis and management. It is possible, however, that these serological markers may prove beneficial in the management of IC.
Understanding the Psychosocial Profile of Women with Fibromyalgia Syndrome
Authors: Shuster Jill , McCormack Jana , Riddell Rebecca Pillai , Toplak Maggie E
Published: March 2016

Fibromyalgia syndrome (FMS) is a disease with a complex etiology characterized by symptoms of widespread pain and fatigue. FMS is more common in women. Both depression and anxiety have been found to be independently associated with the severity of pain in symptoms of FMS. The goal of the present study was to examine the psychosocial profile of women with FMS and to see how the attributions, perceived social support and cognitive biases of women with FMS are related to internalizing ratings of depression and anxiety. The current study included a sample of women with FMS from a local support group and a control group to examine how women with FMS differed from controls with respect to psychosocial variables, and to determine the relationship between these variables. Women with FMS reported a higher external locus of control, lower levels of adaptive cognitive bias, less perceived family support and lower mood than controls. Correlations between these variables were examined within the FMS group, and it was found that an external locus of control was significantly associated with higher ratings of anxiety and depressed mood. These results suggest that beliefs about locus of control and perceived family support of women with FMS may importantly impact their health outcomes, and that treatments related to locus of control and advocating for family support may considerably improve the quality of life of patients with FMS.
Long-Term Response Rates to Infliximab Therapy for Crohn’s Disease in an Outpatient Cohort
Authors: Teshima Christopher W , Thompson Adrienne , Dhanoa LeRose , Dieleman Levinus A , Fedorak Richard N
Published: March 2016

BACKGROUND: Infliximab’s efficacy in the induction and maintenance of remission in luminal Crohn’s disease has been confirmed by randomized, controlled trials. Less clearly described are long-term outcomes in the clinical practice setting since the establishment of regularly scheduled, every eight-week maintenance infliximab infusions. Existing reports describing clinical practice outcomes are limited by short durations of follow-up or by the use of episodic dosing, or focus on safety data rather than clinical outcomes.

OBJECTIVE: To examine induction and maintenance responses to infliximab in an outpatient inflammatory bowel disease clinic.

METHODS: A retrospective chart review was performed. Clinical outcomes were infliximab induction and maintenance responses, defined as the ability to stop and remain off corticosteroids while not requiring additional therapy for active disease.

RESULTS: One hundred thirty-three patients were identified with records sufficiently detailed to be analyzed. Of these, 117 patients (88%) demonstrated a clinical response to induction; 104 of 117 (89%) were on concomitant immunosuppressive therapy; 80 of 104 on azathioprine/6-mercaptopurine (77%); and 24 of 104 on methotrexate (23%). The mean duration of clinical response was 94 weeks (95% CI 78.8 to 109.2). The proportion of patients who maintained response at 30 weeks was 83.2%, at 54 weeks was 63.6% and at 108 weeks was 44.9%. Adverse events occurred for 15 of 117 patients (12.8%), consisting of nine infusion reactions, four serum sickness-like reactions, one rash and one infection.

CONCLUSION: Patients treated with infliximab therapy for luminal Crohn’s disease in our outpatient clinic achieved excellent induction and maintenance of response rates, confirming the real-life efficacy of maintenance infliximab established in clinical trials.
Acute Lung Injury during Antithymocyte Globulin Therapy for Aplastic Anemia
Authors: Goligher Ewan Christopher , Cserti-Gazdewich Christine , Balter Meyer , Gupta Vikas , Brandwein Joseph E
Published: March 2016

The case of a 33‐year‐old man with aplastic anemia who experienced recurrent episodes of hypoxemia and pulmonary infiltrates during infusions of antithymocyte globulin (ATG) is described. With the use of high‐dose corticosteroids, the patient’s original episodes resolved, and were subsequently prevented before additional administrations of ATG. Rare reports of an association between ATG and acute lung injury are found in the literature, but this is the first report of successful steroid‐supported re‐exposure. Although the mechanism of ATG‐related acute lung injury remains uncertain, it may be parallel to the mechanism of transfusion‐related acute lung injury because the pathogenesis of the latter relies, in part, on antileukocyte antibodies. ATG‐related toxicity should be included in the differential diagnosis of new, infusion‐associated pulmonary infiltrates, and corticosteroids may be a useful therapeutic consideration in the management.
Intravenous Pantoprazole as an Adjuvant Therapy following Successful Endoscopic Treatment for Peptic Ulcer Bleeding
Authors: Wang Jun , Yang Kehu , Ma Bin , Tian Jinhui , Liu Yali , Bai Zhenggang , Jiang Lei , Sun Shaoliang , Li Jun , Liu Ruifeng , Hao Xiangyong , He Xiaodong
Published: March 2016

BACKGROUND: Several studies have suggested that proton pump inhibitors are efficacious in preventing rebleeding when administered immediately after endoscopic treatments. However, there are limited clinical outcome data on the use of intravenous pantoprazole.

OBJECTIVE: To evaluate the efficacy of intravenous pantoprazole after successful endoscopic treatment for peptic ulcer bleeding using evidence from randomized controlled trials (RCTs).

METHODS: The Cochrane Library, MEDLINE, EMBASE and several Chinese databases up to July 2008 were searched. RCTs that compared the relative effectiveness of intravenous pantoprazole with placebo, H2receptor antagonist or other agents for patients with peptic ulcer bleeding who were pretreated with successful endoscopic therapies were retrieved.

RESULTS: Five RCTs comprising a total of 821 participants were included in the final meta-analysis. Overall, there were significant differences in ulcer rebleeding (RR 0.31; 95% CI 0.18 to 0.53; pooled rates were 4.7% for pantoprazole and 15.0% for control), surgical intervention (RR 0.28, 95% CI 0.09 to 0.83; pooled rates were 1.4% in pantoprazole group versus 6.5% in control) and total length of hospital stay (weighted mean difference −1.53; 95% CI −1.91 to −1.16), but not on mortality (RR 0.72, 95% CI 0.29 to 1.81; pooled mortality rates were 1.9% for pantoprazole versus 2.8% for control) and blood transfusion requirements (weighted mean difference −0.53; 95% CI for random effects −1.04 to −0.02) when compared with control treatments. A series of subgroup analyses supported the results from the main analysis.

CONCLUSIONS: Intravenous administration of pantoprazole after endoscopic therapy for peptic ulcer bleeding reduces rates of ulcer rebleeding, surgical intervention and overall duration of hospital stay, but not mortality and blood transfusion requirements compared with placebo, H2receptor antagonist or somatostatin.
Improving Access to Care by Allowing Self-Referral to a Hepatitis C Clinic
Authors: Doucette Karen , Robson Vicki , Shafran Stephen , Kunimoto Dennis
Published: March 2016

BACKGROUND: Estimates suggest that more than 250,000 Canadians are infected with hepatitis C virus (HCV), but less than 10% have been treated. Access to specialists in Canada is usually via health care professional (HCP) referral and, therefore, may be a barrier to HCV care. However, clinics that operate in conjunction with the Hepatitis Support Program, Edmonton, Alberta, allow self-referral. It is hypothesized that this improves access to care without increasing inappropriate referrals.

OBJECTIVE: To compare the baseline characteristcs and outcomes of HCV patients who self-referred with those who were HCP-referred.

METHODS: Data were collected from the Hepatitis Support Program HCV database and chart reviews.

RESULTS: Between December 17, 2002, and December 31, 2007, 1563 patients were referred including 336 self- (21.5%) and 1227 HCP- referrals (78.5%). Self- and HCP-referred patients were similar in terms of age (mean [± SD] 43.0±10.3 years versus 43.9±10.0 years, respectively; P=0.18), sex (56.8% versus 62.0% [men], respectively; P=0.08) and risk factors for HCV (P=0.3), with 49.7% and 52.6%, respectively, identifying injection drug use as the primary risk factor. The two groups had similar HCV genotype distributions and liver biopsy fibrosis scores with similar treatment rates (31.3% versus 33.2%; P=0.6). Treatment outcomes were excellent (sustained virological response 40.2% for genotype 1, 67% for genotypes 2 and 3) in patients completing therapy and were similar between the two groups.

Conclusion: Self-referred patients comprised 21.5% of patients accessing care in the clinic. Self- and HCP-referred patients had similar characteristics, treatment rates and outcomes. Facilitating self- referral to an HCV clinic can improve access to care, including risk reduction education and HCV treatment.
Children’s Self‐Report of Pain Intensity: What We Know, Where We Are Headed
Authors: von Baeyer Carl L
Published: March 2016

The present paper provides a short, practical introduction to children’s self‐report measures of pain intensity, followed by an overview of principles and issues. Details on individual self‐report scales were previously reported in a landmark systematic review in 2006 and will not be repeated here. Broader measurement issues discussed here include interpretation of pain scores over time, across individuals and in relation to contextual factors; special considerations affecting children younger than six years of age; social communicative functions of pain reports; cognitive developmental factors in understanding pain scales and their anchors; screening for the ability to use self‐report scales and training for children who do not have this skill; level of measurement (interval versus ordinal); estimating clinically significant change for groups and individuals; and measurement of aspects of pain other than intensity. Also highlighted are areas in which there has been progress and a lack of progress since the last time this topic was featured at the International Forum on Pediatric Pain in 1996. The present article closes with an outline of key areas for further research on children’s self‐report of pain and a brief summary of recommendations for clinicians.
A Child with Raccoon Roundworm Meningoencephalitis: A Pathogen Emerging in your Own Backyard?
Authors: Hajek Jan , Yau Yvonne , Kertes Peter , Soman Teesta , Laughlin Suzanne , Kanani Ronik , Kazacos Kevin , Dangoudoubiyam Sriveny , Opavsky Mary Anne
Published: March 2016

Raccoon roundworm (Baylisascaris procyonis) is a cause of devastating neural and ocular disease. The first documented case of raccoon roundworm encephalitis in Canada, in a seven‐year‐old boy who presented with severe neurological impairment, is presented. His significant recovery illustrates the importance of clinical suspicion and the benefit of early treatment.
Prevalence and Antimicrobial Resistance of Diarrheagenic Escherichia coli and Shigella Species Associated with Acute Diarrhea in Tehran, Iran
Authors: Jafari Fereshteh , Hamidian Mohammad , Rezadehbashi Maryam , Doyle Michael , Salmanzadeh-ahrabi Siavosh , Derakhshan Faramarz , Reza Zali Mohammad
Published: March 2016

A study was performed to determine the prevalence and antimicrobial resistance of Shigella species and diarrheagenic Escherichia coli isolates cultured from patients with acute diarrhea in Tehran, Iran. Between May 2003 and May 2005, 1120 diarrheal specimens were collected and assayed for bacterial enteropathogens by conventional and molecular methods. Etiological agents were isolated from 564 (50.3%) specimens, and included 305 (54%) E coli, 157 (27.8%) Shigella species, and 102 (18%) from other genera of bacteria. The predominant E coli was Shiga toxin‐producing E coli (105 isolates [34.5%]) and the predominant Shigella serotype was Shigella sonnei (88 isolates [56.1%]). A high rate of antibiotic resistance was observed among E coli, with 40 of 53 (75.5%) Shiga toxin‐producing E coli isolates resistant to amoxicillin and tetra‐cycline, and eight (5.2%) E coli isolates resistant to more than six antibiotics. Most Shigella isolates were resistant to tetracycline (95%) and trimethoprim‐sulfamethoxazole (91.7%), with greatest antibiotic resistance observed among S sonnei (53 of 88 [60.2%] isolates). Antibiotic resistance is widespread in diarrheagenic E coli and Shigella in children with acute diarrhea in Tehran, Iran; hence, updated strategies for appropriate use of antimicrobial agents in Iran are needed.
Behavioural Assessment of Pediatric Pain
Authors: Blount Ronald L , Loiselle Kristin A
Published: March 2016

Behavioural assessment methods have been used to signal the need for intervention and to evaluate treatment effectiveness. Direct observation and rating scales have been used to assess pain and distress associated with acute medical procedures, postoperative pain, critical care, analogue pain induction procedures and other sources. Two recent scholarly reviews of behavioural assessment methods were conducted by the Society of Pediatric Psychology Evidence‐Based Assessment Task Force and the Pediatric Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials, which classified various instruments as well established, approaching well established or promising. The characteristics of the eight behavioural assessment scales that were recommended by one of these task forces are further reviewed in the present paper. The results indicate that behavioural assessment scales have been used flexibly to assess pain in a wide variety of situations, across different pediatric populations and for patients of different ages. In the present review, there appears to be no basis for designating the scales as measures of distress versus pain; both emotional and sensory components of pain seem to be assessed by each of the scales. There is considerable overlap among the behavioural indicators of pain used in the different scales. Furthermore, the behavioural codes indicative of pain may occur before, during and after painful events. Recommendations for future research are provided, including using behavioural assessment to focus on children’s coping and adults’ behaviours, as well as pain.
Acute Pancreatitis and Ileus Postcolonoscopy
Authors: Ko Hin Hin , Jamieson Trevor , Bressler Brian
Published: March 2016

Postpolypectomy bleeding and perforation are the most common complications of colonoscopy. A case of acute pancreatitis and ileus after colonoscopy is described. A 60-year-old woman underwent a gastroscopy and colonoscopy for investigation of iron deficiency anemia. Gastroscopy was normal; however, the colonoscope could not be advanced beyond the splenic flexure due to a tight angulation. Two polypectomies were performed in the descending colon. After the procedure, the patient developed a distended, tender abdomen. Bloodwork was remarkable for an elevated amylase level. An abdominal x-ray and computed tomography scan showed pancreatitis (particularly of the tail), a dilated cecum and a few air-fluid levels. The patient improved within 24 h of a repeat colonoscopy and decompression tube placement. The patient had no risk factors for pancreatitis. The causal mechanism of pancreatitis was uncertain but likely involved trauma to the tail of the pancreas during the procedure. Our patient developed ileus, likely secondary to pancreatitis. The present case is the first report of clinical pancreatitis and ileus associated with colonoscopy.
Hepatitis C Virus-Infected Patients Are ‘Spared’ from the Metabolic Syndrome but Not from Insulin Resistance. A Comparative Study of Nonalcoholic Fatty Liver Disease and Hepatitis C Virus-Related Steatosis
Authors: Lonardo Amedeo , Ballestri Stefano , Adinolfi Luigi E , Violi Enrico , Carulli Lucia , Lombardini Silvia , Scaglioni Federica , Ricchi Matteo , Ruggiero Giuseppe , Loria Paola
Published: March 2016

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) and chronic hepatitis C feature steatosis and insulin resistance (IR), conditions associated with the metabolic syndrome (MS).

OBJECTIVES: To assess the prevalence of MS and determinants of IR in patients with NAFLD and chronic hepatitis C.

METHODS: Ninety-three consecutive patients with NAFLD, 97 with chronic hepatitis C virus (HCV) genotypes 1 and 2, and 182 ‘healthy’ controls without steatosis were enrolled in the present study. The prevalence of MS was assessed by modified Adult Treatment Panel III criteria and IR by the homeostasis model assessment of insulin resistance (HOMA-IR). IR was defined as the 75th percentile of the HOMA-IR of control subjects.

RESULTS: While the prevalence of IR was similar in NAFLD and HCV-infected subjects (70.0% and 78.7%, respectively), the prevalence of MS was significantly higher in NAFLD patients than in HCV-infected patients (27.9% versus 4.1%) and in controls (5.6%). With multivariate analysis, IR was predicted by body mass index (OR 1.263; 95% CI 1.078 to 1.480) and triglyceridemia (OR 1.011; 95% CI 1.002 to 1.020) in NAFLD and by sex (OR for female sex 0.297; 95% CI 0.094 to 0.940) and fibrosis stage (OR 2.751; 95% CI 1.417 to 5.340) in chronic hepatitis C.

CONCLUSIONS: IR is independently associated with body mass index and triglyceridemia in NAFLD, sex and fibrosis in chronic HCV infection, and has a higher prevalence in NAFLD and chronic hepatitis C than in controls. However, the frequency of MS in HCV-infected patients, similar to that of controls, is significantly lower than that seen in NAFLD patients. The current diagnostic criteria of MS are more likely to ‘capture’ patients with NAFLD than with chronic hepatitis C, although both groups are insulin resistant.
Chyloptysis with Right Middle Lobe Syndrome Complicated Postoperatively by Chylothorax: An Unusual Cause of Right Middle Lobe Syndrome
Authors: Illamperuma Chamani , Reid John , Kanthan Rani
Published: March 2016

Chyloptysis, in the context of middle lobe syndrome, and chylothorax are rare clinical entities. They are reported in the medical literature mostly as case reports, but never together in the same patient. The present report describes the case of a 34‐year‐old woman who presented with chyloptysis associated with recurrent right middle lobe syndrome since she was 20 years of age, and eventually underwent right middle lobectomy. A few weeks postoperatively, she developed a right‐sided chylothorax, which was refractory to medical therapy, and was successfully treated with thoracic duct ligation. She has been symptom‐free for two years postsurgery.
Canadian Thoracic Society: Presenting a New Process for Clinical Practice Guideline Production
Authors: Gupta Samir , Bhattacharyya Onil K , Brouwers Melissa C , Estey Elizabeth A , Harrison Margaret B , Hernandez Paul , Palda Valerie A , Boulet Louis-Philippe
Published: March 2016

A key mandate of the Canadian Thoracic Society (CTS) is to promote evidence‐based respiratory care through clinical practice guidelines (CPGs). To improve the quality and validity of the production, dissemination and implementation of its CPGs, the CTS has revised its guideline process and has created the Canadian Respiratory Guidelines Committee to oversee this process. The present document outlines the basic methodological tools and principles of the new CTS guideline production process. Important features include standard methods for choosing and formulating optimal questions and for finding, appraising, and summarizing the evidence; use of the Grading of Recommendations Assessment, Development and Evaluation system for rating the quality of evidence and strength of recommendations; use of the Appraisal of Guidelines for Research and Evaluation instrument for quality control during and after guideline development and for appraisal of other guidelines; use of the ADAPTE process for adaptation of existing guidelines to the local context; and use of the GuideLine Implementability Appraisal tool to augment implementability of guidelines. The CTS has also committed to develop guidelines in new areas, an annual guideline review cycle, and a new formal process for dissemination and implementation. Ultimately, it is anticipated that these changes will have a significant impact on the quality of care and clinical outcomes of individuals suffering from respiratory diseases across Canada.
Assessing Pain in Infancy: The Caregiver Context
Authors: Riddell R Pillai , Racine Nicole
Published: March 2016

BACKGROUND: Pain is largely accepted as being influenced by social context. Unlike most other developmental stages throughout the lifespan, infancy is marked by complete dependence on the caregiver. The present paper discusses the primary importance of understanding the caregiver context when assessing infant pain expression.

OBJECTIVES: Based on a review of research from both the infant pain and infant mental health fields, three lines of evidence are presented. First, pain assessment is as subjective as the pain experience itself. Second, assessors must be cognizant of the relationship between infant pain expression, and caregiver sensitivity and emotional displays. Finally, larger systemic factors of the infant (such as caregiver relationship styles, caregiver psychological distress or caregiver acculturative stress) directly impact on infant expression.

CONCLUSIONS: As a result of infants’ inability to give a self‐report of their pain experience, caregivers play a crucial role in assessing the pain and taking appropriate action to manage it. Caregiver behaviours and predispositions have been shown to have a significant impact on infant pain reactivity and, accordingly, should not be ignored when assessing the infant in pain.
Development and Psychometric Evaluation of a New Measure of Pain‐Related Support Preferences: The Pain Response Preference Questionnaire
Authors: McWilliams Lachlan A , Saldanha Kate M , Dick Bruce D , Watt Margo C
Published: March 2016

BACKGROUND: Behavioural conceptualizations of chronic pain posit that solicitous responses to pain behaviours are positively reinforcing and play a role in the development of chronic pain and disability. Recent research suggests that studies investigating this model were likely limited by the use of only a few narrowly defined categories of responses to pain behaviour. A measure of preferences regarding pain‐related social support has the potential to improve behavioural models of chronic pain by identifying other potentially reinforcing responses to pain behaviour.

OBJECTIVE: The Pain Response Preference Questionnaire (PRPQ) was created to assess preferences regarding pain‐related social support. The purpose of the present study was to empirically develop PRPQ scales and examine their psychometric properties.

METHODS: A large university student sample (n=487) free of chronic pain completed the 39‐item PRPQ. Factor analysis was applied to the data from the present sample to empirically develop PRPQ scales. Using a second student sample (n=87), relationships between the PRPQ scales and theoretically related measures were examined to evaluate the construct validity of the scales. Factor analysis supported four factors that reflected preferences for emotional and instrumental support, assistance in managing pain and emotions, having one’s pain ignored, and being encouraged to persist with one’s activities. Based on this analysis, scales labelled solicitude, management, suppression and encouragement were created. Correlation analyses supported the construct validity of these scales.

CONCLUSIONS: The PRPQ is a psychometrically sound measure of preferences of pain‐related social support. Research with clinical samples is needed to further evaluate its psychometric properties and clinical utility.
Anxiety Influences Children’s Memory for Procedural Pain
Authors: Rocha Elizabete M , Marche Tammy A , von Baeyer Carl L
Published: March 2016

OBJECTIVE: To examine the effects of temperament and trait anxiety on memory for pain.

METHODS: Three dimensions of temperament, as well as trait anxiety, were assessed in 36 children (five to 12 years of age) undergoing dental procedures; after the procedure, the children provided pain ratings. Following a six‐ to eight‐week delay, the children reported how much pain they remembered.

RESULTS: Most children (85%) accurately recalled their pain. Temperament had no significant effect, but trait‐anxious children showed a greater likelihood of recalling more pain than they initially reported, suggesting that they may negatively distort recollections of painful experiences.

CONCLUSIONS: When treating children, in particular trait‐anxious children, clinicians should consider what children remember as part of pain management intervention.
Relevance of Segmental Colitis with Diverticulosis (SCAD) to Other Forms of Inflammatory Bowel Disease
Authors: Freeman Hugh J
Published: March 2016

A well localized inflammatory process involving only the sigmoid colonic segment associated with diverticulosis (SCAD), has become increasingly recognized as a distinct clinical and pathological disorder, usually described in older adults, often with rectal bleeding. Although some resolve spontaneously, most patients appear to respond to treatment only with 5-aminosalicylate. Endoscopic evaluation reveals a nonspecific inflammatory process localized in the sigmoid colon that usually completely resolves with histologically normal colonic mucosa. Recurrent symptoms with evidence of recurrent segmental colitis may occur, but most have an entirely benign clinical course. Further definition of the underlying molecular signalling that occurs in this apparently distinctive disorder may be critically important to understand the elements of a colonic inflammatory process that can completely and spontaneously resolve.
Pyogenic Granuloma: An Unusual Cause of Massive Gastrointestinal Bleeding from the Small Bowel
Authors: Moffatt Dana C , Warwryko Paul , Singh Harminder
Published: March 2016

Small bowel hemorrhage is responsible for approximately 4% of all cases of gastrointestinal bleeding. The etiology of bleeding from the small bowel is a tumour in approximately 10% of cases. Pyogenic granuloma is a common inflammatory vascular tumour of the dermis, which rarely occurs in the gastrointestinal tract. Pyogenic granuloma is a rare cause of overt or obscure small bowel bleeding. The present paper reports the first case of pyogenic granuloma presenting as a massive gastrointestinal bleed, and reviews the relevant literature to date regarding the clinical presentation, diagnosis and management of this rare gastrointestinal lesion.
Recurrent Hemoptysis with Penicillium Marneffei and Stenotrophomonas Maltophilia in Job’s Syndrome
Authors: Ma Bosco HM , Ng Calvin SH , Lam Rebecca KY , Wan Song , Wan Innes YP , Lee Tak Wai , Yim Anthony PC
Published: March 2016

Pulmonary infection caused by the opportunistic organisms Penicillium marneffei and Stenotrophomonas maltophilia in patients with Job’s syndrome is rare and not well documented. The case of a 30‐year‐old man with Job’s syndrome who developed recurrent pneumonia and lung abscesses caused by P marneffei and S maltophilia, complicated by massive hemoptysis, is described. Bronchial artery embolization was successful in controlling the hemoptysis; however, the infection proved fatal despite appropriate antimicrobial therapy. A brief review of the literature on Job’s syndrome and its associated infective pulmonary manifestations is also presented.
Abnormal Hematological Indices in Cirrhosis
Authors: Qamar Amir A , Grace Norman D
Published: March 2016

Abnormalities in hematological indices are frequently encountered in cirrhosis. Multiple causes contribute to the occurrence of hematological abnormalities. Recent studies suggest that the presence of hematological cytopenias is associated with a poor prognosis in cirrhosis. The present article reviews the pathogenesis, incidence, prevalence, clinical significance and treatment of abnormal hematological indices in cirrhosis.
An Appendiceal Neoplastic Lesion: Case Report and Implications for Colonoscopic Screening and Surveillance
Authors: Freeman Hugh J , Webber Douglas L , Meneghetti Adam T
Published: March 2016

A 65-year-old man with a history of previously resected colonic adenomas had an apparent cecal lesion detected during colonoscopy. The polyp proved to be a tubulovillous adenoma with high-grade dysplasia involving most of the body of the appendix along with the base of the cecum. The appendiceal mucosa is biologically similar to the colonic mucosa, yet remains relatively ‘hidden’ in screening and surveillance studies, which suggests important implications for evolving detection strategies in the follow-up of patients with a previous colon polyp or cancer resections. Although endoscopic removal of the appendix has been reported, treatment of these localized appendiceal lesions requires a wide surgical excision.
Mortality in a Heterogeneous Population of Low‐Risk Febrile Neutropenic Patients Treated Initially with Cefazolin and Tobramycin
Authors: Le Piane Francesca , Walker Sandra AN , Walker Scott E , Lathia Nina , De Angelis Carlo , Simor Andrew
Published: March 2016

BACKGROUND: At Sunnybrook Health Sciences Centre in Toronto, Ontario, the recommended empiric regimen for febrile neutropenia has been cefazolin and tobramycin for at least 25 years. However, we had no objective data to reassure us that patient mortality had not increased over the past five years.

METHODS: A retrospective chart review of 48 episodes occurring in 44 patients admitted for the treatment of febrile neutropenia secondary to chemotherapy in 2002, and initially managed with cefazolin and tobramycin was conducted. Prospective data from 48 episodes in 2007 had previously been collected. Patients who developed febrile neutropenia while in hospital were excluded. The primary objective of the present study was to compare the all‐cause mortality in 2007 with that from 2002.

RESULTS: There were no statistically significant differences between the groups (P>0.05). All‐cause mortality in 2007 was 8.3% (four of 48) compared with 10.4% (five of 48) in 2002 (P=1). All deaths occurred in patients considered to be at high risk according to the Talcott score.

CONCLUSION: Mortality has not increased in the past five years with the use of empiric cefazolin and tobramycin for the treatment of patients admitted with febrile neutropenia at Sunnybrook Health Sciences Centre. Rates are comparable with those reported in the literature for similar patients. The results of the present study provide reassurance that the regimen continues to be effective for lower‐risk febrile neutropenic patients.