bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Diversity of Liver Diseases among Outpatient Referrals for Elevated Serum Ferritin
Authors: Wong Karen , Adams Paul C 
Published: March 2016

BACKGROUND: The aim of the present study was to examine the diversity of liver diseases in outpatients referred because of elevated serum ferritin.METHODS: A retrospective review was performed of outpatient referrals for serum ferritin elevations made to a tertiary care centre liver clinic between 1999 and 2005. Information regarding serum ferritin, transferrin saturation, liver biopsy, liver iron concentration and final diagnosis was extracted. Patients were stratified into two groups based on ferritin concentration: ferritin concentration 300 μg/L to 1000 μg/L, and ferritin concentration greater than 1000 μg/L.RESULTS: A total of 482 charts were reviewed, of which 119 (25%) had ferritin concentrations greater than 1000 μg/L.HFE-linked hemochromatosis, nonalcoholic steatohepatitis and alcohol-related liver disease were the top three diagnoses.HFE-linked hemochromatosis accounted for 28% to 42% of the diagnoses in all subgroups. The percentage of patients diagnosed withHFE-linked hemochromatosis was similar in the ferritin 300 μg/L to 1000 μg/L and the ferritin greater than 1000 μg/L groups (P=0.067). Among patients with ferritin greater than 1000 μg/L, 63% underwent a liver biopsy. Of those with an elevated liver iron concentration (greater than 35 μmol/g dry weight), 71% had a transferrin saturation greater than 50% (88% of C282Y homozygotes and 43% of non-C282Y homozygotes). In non-C282Y homozygotes with an elevated serum ferritin concentration greater than 1000 μg/L, 64% did not have iron overload on liver biopsy.CONCLUSION:HFE-linked hemochromatosis accounted for less than one-half of the diagnoses in an outpatient population referred for elevated ferritin, suggesting a need to search further for an alternate cause.
Can Access to Spirometry in Asthma Education Centres Influence the Referral Rate by Primary Physicians for Education?
Authors: Labrecque M , Lavallée M , Beauchesne MF , Cartier A , Boulet LP 
Published: March 2016

BACKGROUND AND OBJECTIVES: Asthma remains uncontrolled in a large number of asthmatic patients. Recent surveys have shown that a minority of asthmatic patients are referred to asthma educators. The objective of the present study was to assess the influence of increased access to spirometry in asthma education centres (AECs) on the rate of patient referrals to these centres by general practitioners.METHODS: A one‐year, prospective, randomized, multicentric, parallel group study was conducted over two consecutive periods of six months each, with added spirometry being offered in the second six‐month period to the experimental group. Ten AECs were enrolled in the project. An advertisement describing the AECs’ services was sent by mail to a total of 303 general practitioners at the start of each period, inviting them to refer their patients. Measures of the frequency of medical referrals to the AECs were assessed for each period.RESULTS: The group of AECs randomly selected for spirometry in the second six‐month period received 48 medical referrals during the first period and 32 during the second one, following proposed spirometry. AECs that had not offered spirometry received five referrals during the first period and seven during the second period. One AEC withdrew a few weeks after the study began and others encountered administrative problems, reducing their ability to provide interventions.CONCLUSIONS: Referral to AECs is not yet integrated into the primary care of asthma and offering more rapid access to spirometry in the AECs does not seem to be a significant incentive for such referrals.
Discharge Delay in Patients with Community‐Acquired Pneumonia Managed on a Critical Pathway
Authors: Moeller Jeremy J , Ma Martin , Hernandez Paul , Marrie Thomas , Touchie Claire , Patrick Ward 
Published: March 2016

INTRODUCTION: It has previously been reported that a critical pathway for community‐acquired pneumonia (CAP) significantly reduces bed days per patient managed but results in no difference in average length of stay, suggesting that discharge criteria were not successfully implemented. The present study sought to identify factors in the timing of discharge not taken into account by discharge criteria.METHODS: Patients admitted with CAP and placed on a pneumonia critical pathway were studied. Patients′ functional and cognitive status were evaluated using the Barthel Index, Hierarchical Assessment of Balance and Mobility (HABAM) and the Mini‐Mental Status Examination. Once discharge criteria were met, the patient, a family member and the treating physician were interviewed to identify other factors contributing to length of stay.RESULTS: Thirty‐one patients were enrolled in the study; 12 were discharged when they met discharge criteria and 19 stayed in hospital longer. There were no differences between patients discharged at stability versus those with an increased length of stay in terms of demographics, pneumonia severity score, functional or cognitive status at discharge using the Barthel Index (87.3±11.1 versus 83.8±8.6, respectively; P=0.46) and MMSE (27.1±1.1 versus 27.3±1.1, respectively; P=0.64); however, there was a significant difference in HABAM score at the time clinical stability was reached (22.6±1.3 versus 17.4±3.5, respectively; P=0.03), which correlated with physician and family assessments of patients′ readiness for discharge.CONCLUSIONS: HABAM may be a useful tool to identify patients at risk of remaining in hospital after objective discharge criteria are met. Additional resources may be targeted at these patients to reduce length of stay in CAP.
Eosinophilic Pancreatitis Mimicking Pancreatic Neoplasia
Authors: Cay Ali , Imamoglu Mustafa , Cobanoglu Umit 
Published: March 2016

Eosinophilic pancreatitis (EP) is a rare disease. It typically occurs in the setting of either eosinophilic gastroenteritis or the hypereosinophilic syndrome. Isolated eosinophilic infiltration of the pancreas is less common. EP usually presents as a pancreatic tumour with abdominal pain and/or obstructive jaundice. The diagnosis is often not made until after pancreatic resection under suspicion of a pancreatic tumour.The case of a 14-year-old boy whose initial presentation was suggestive of a pancreatic tumour is reported. Radiological evaluation revealed a pancreatic mass suggestive of a pancreatic tumour obstructing the duodenum and common bile duct. The patient underwent surgery and a gastrojejunal anostomosis, tube cholecystostomy and biopsy were performed with no postoperative complications. The diagnosis of EP was established after surgical biopsy. The biopsy specimen revealed prominent eosinophilic infiltration. Serum immunoglobulin E levels were elevated. The patient was treated with oral prednisolone (40 mg/day). After two months of oral steroid therapy, clinical manifestations rapidly improved and peripheral eosinophilia subsided. Computed tomography scan revealed remission of the pancreatic mass-like lesion.
Hypercalcemia in Patients with Newly Diagnosed Tuberculosis in Abuja, Nigeria
Authors: Dosumu EA , Momoh JA 
Published: March 2016

BACKGROUND: The prevalence of hypercalcemia has not previously been determined in newly diagnosed tuberculosis (TB) patients in Nigeria.OBJECTIVE: To determine the incidence of hypercalcemia in Nigerian patients with newly diagnosed TB before the commencement of anti‐TB treatment.METHODS: The present study is a prospective examination of consecutive patients with newly diagnosed TB confirmed by bacteriological and/or histological methods at the National Hospital (Abuja, Nigeria) from January 2004 to December 2004.RESULTS: Of 120 patients (70 males and 50 females), 70 had pulmonary TB, 10 had pulmonary and pleural TB, 20 had pleural TB without radiographic evidence of lung involvement, 18 had various other forms of extrapulmonary TB and two had disseminated TB. The mean age of the patients was 38.3±12.0 years. The mean albumin‐adjusted serum calcium concentration was 2.53±0.22 mmol/L. Hypercalcemia was present in 27.5% of the patients, but only 12% of these patients showed symptoms of hypercalcemia. The type of TB and, in the case of pulmonary TB, the extent of lung involvement, had no effect on the serum calcium concentration.CONCLUSION: Hypercalcemia is not uncommon among Nigerian patients with newly diagnosed TB, but it is rarely symptomatic.
Gluten Intolerance: Sex- and Age-Related Features
Authors: Llorente-Alonso MJ , Fernández-Aceñero MJ , Sebastián M 
Published: March 2016

OBJECTIVE: Gluten intolerance is an immune-mediated enteropathy associated with gluten-containing foods in genetically susceptible patients. The typical form mainly affecting children shows failure to thrive and/or gastrointestinal symptoms. The adult form is less typical, presenting vague gastrointestinal symptoms, iron deficiency (with or without anemia) or nonspecific serum chemistry abnormalities. The present study aims to analyze clinical and biochemical differences of celiac disease (CD) according to sex and age.PATIENTS AND METHODS: The present study reviewed clinical and biochemical features of patients with suspected CD admitted to the Hospital General of Móstoles (Madrid, Spain) between July 2001 and June 2005. Two hundred fifty-two patients were analyzed, in whom intestinal biopsy was performed due to clinical and/or biochemical abnormalities suggestive of CD. One hundred seventy-eight asymptomatic relatives of the affected patients were also included. Overall, 125 patients showed diagnostic features of CD in the intestinal biopsy.RESULTS: The results confirmed higher prevalence of typical forms of CD in children (67% in children compared with only 14.3% in adults). CD seemed to be more frequent in adult women than in men (ratio of women to men 4:1), but it is worth noting that men diagnosed were most often referred with a typical clinical picture, so atypical forms of the disease in men may have been underdiagnosed.CONCLUSIONS: CD shows atypical features in adults, and physicians must include this disorder in the differential diagnosis of adults with iron deficiency or slight hypertransaminasemia. Increased awareness of the disease and extensive availability of accurate serological tests will lead to improved diagnosis of this disorder, both in children and adults.
Liver Transplantation for Cirrhosis in Cystic Fibrosis
Authors: Lamireau T , Martin S , Lallier M , Marcotte JE , Alvarez F 
Published: March 2016

BACKGROUND: Liver disease is the third most common cause of death in children with cystic fibrosis (CF). Liver transplantation is an effective treatment in children with hepatic failure.AIMS: The objective of the present study was to review the indications and postoperative course of hepatic transplantation in a cystic fibrosis population.PATIENTS: Five children with CF, at a mean age of 16.5 years, underwent liver transplantation.RESULTS: All patients showed cirrhosis, portal hypertension and hepatic failure. The main postoperative complication was ascites refractory to treatment in two patients. No significant deterioration of the pulmonary function was noted. Two patients died, one of Hodgkin lymphoma and the other of progressive pulmonary failure.CONCLUSION: Liver transplantation was indicated in children with CF when hepatic failure and/or severe portal hypertension was present with well-preserved pulmonary function.
Combined Low-Volume Polyethylene Glycol Solution Plus Stimulant Laxatives versus Standard-Volume Polyethylene Glycol Solution: A Prospective, Randomized Study of Colon Cleansing before Colonoscopy
Authors: Hookey Lawrence C , Depew William T , Vanner Stephen J 
Published: March 2016

INTRODUCTION: The effectiveness of polyethylene glycol solutions (PEG) for colon cleansing is often limited by the inability of patients to drink adequate portions of the 4 L solution. The aim of the present study was to determine whether a reduced volume of PEG combined with stimulant laxatives would be better tolerated and as or more effective than the standard dose.METHODS: Patients undergoing outpatient colonoscopy were randomly assigned to receive either low-volume PEG plus sennosides (120 mg oral sennosides syrup followed by 2 L PEG) or the standard volume preparation (4 L PEG). The subjects rated the tolerability of the preparations and their symptoms. Colonoscopists were blind to the colonic cleansing preparation and graded the cleansing efficacy using a validated tool (the Ottawa scale).RESULTS: The low-volume PEG plus sennosides preparation was significantly better tolerated than the standard large volume PEG (P<0.001) but was less efficacious (P=0.03). Thirty-eight per cent of patients in the large volume PEG group were unable to finish the preparation, compared with only 6% in the reduced volume group. There were no adverse events reported.CONCLUSIONS: Although the low-volume PEG plus sennosides preparation was better tolerated, it was not as effective as standard large-volume PEG. However, in view of the significant difference in tolerance, further research investigating possible improvements in the reduced-volume regimen seems warranted.
Rare Lung Diseases I – Lymphangioleiomyomatosis
Authors: Juvet Stephen C , Hwang David , Downey Gregory P 
Published: March 2016

The present article is the first in a series that will review selected rare lung diseases. The objective of this series is to promote a greater understanding and awareness of these unusual conditions among respirologists. Each article will begin with a case that serves as a focal point for a discussion of the pathophysiology and management of the particular condition. The first article is on lymphangioleiomyomatosis (LAM); subsequent articles will focus on pulmonary alveolar proteinosis, alpha-1-antitrypsin deficiency and primary ciliary dyskinesia.LAM is a rare, progressive and (without intervention) often fatal interstitial lung disease that predominantly affects women of childbearing age. LAM is characterized by progressive interstitial infiltration of the lung by smooth muscle cells, resulting in diffuse cystic changes of the lung parenchyma. The molecular basis of this disorder has been delineated over the past five years and LAM is now known to be a consequence of mutations in the tuberous sclerosis genes. This knowledge, combined with advances in our understanding of the signalling pathways regulated by these genes, has given rise to potential molecular therapies that hold great promise for treating this devastating disease.
Le Rôle de l’Omalizumab dans le Traitement de l’Asthme Allergique Grave
Authors: Chapman Kenneth R , Cartier André , Hébert Jacques , McIvor R Andrew , Schellenberg R Robert 
Published: March 2016

CONTEXTE : Un nouveau traitement anti‐immunoglobuline E (anti‐IgE) contre l’asthme, l’omalizumab, a été approuvé au Canada.OBJECTIF : Passer en revue les données fondamentales et cliniques sur l’omalizumab et examiner le rôle possible de ce médicament dans la prise en charge de l’asthme au Canada.MÉTHODOLOGIE : Une recherche documentaire a été effectuée dans MEDLINE afin de repérer les études menées de 1960 à 2006 sur l’omalizumab. La recherche a également porté sur les résumés de réunions scientifiques récentes dans le domaine des maladies respiratoires et des allergies; par ailleurs, toute donnée non publiée a été demandée au fabricant. Après avoir revu et résumé les données, un comité mixte constitué de spécialistes des maladies respiratoires et des allergies a rédigé un ensemble de recommandations relatives à l’utilisation de l’omalizumab.RÉSULTATS : L’omalizumab est un anticorps monoclonal humanisé qui se lie au domaine C epsilon 3 de la molécule d’IgE pour former des complexes immuns solubles qui sont éliminés par le système réticulo‐endothélial. L’administration d’injections sous‐cutanées espacées de deux ou de quatre semaines à la dose recommandée entraîne une diminution rapide des taux d’IgE circulantes libres. Lors de deux essais cliniques de phase III menés auprès de 1 405 adultes et adolescents atteints d’asthme modéré à grave qui recevaient des doses moyennes stables de corticostéroïdes en inhalation (CSI), l’omalizumab a diminué les taux d’exacerbation par rapport au placebo et a été associé à une amélioration des symptômes ainsi qu’à une épargne plus importante des corticostéroïdes. Dans un essai mené auprès de 419 patients atteints d’asthme grave non maîtrisé malgré l’utilisation de doses élevées de CSI et de la prise concomitante d’agonistes bêta‐2 à action prolongée, les exacerbations graves étaient de 50 % moins fréquentes chez les patients traités par l’omalizumab que chez les sujets témoins. Des analyses rétrospectives ont permis d’identifier les caractéristiques des patients les plus susceptibles de répondre au traitement par l’omalizumab.RECOMMANDATIONS : L’omalizumab pourrait être envisagé comme traitement d’appoint dans les cas atopiques d’asthme grave non maîtrisé avec des traitements classiques par des doses optimales de CSI et un traitement d’appoint approprié (p. ex. : agonistes bêta‐2 à action prolongée). En général, les patients sont classés en fonction de leur recours – traitement court et fréquent ou continu et oral – aux corticostéroïdes. Il ne faut amorcer le traitement qu’après avoir consulté un spécialiste pour confirmer le diagnostic et s’assurer que le traitement classique est optimal.
A Randomized Trial of Yoga for Adolescents with Irritable Bowel Syndrome
Authors: Kuttner Leora , Chambers Christine T , Hardial Janine , Israel David M , Jacobson Kevan , Evans Kathy 
Published: March 2016

BACKGROUND: Adolescents with irritable bowel syndrome (IBS) frequently experience interference with everyday activities. Mind‐body approaches such as yoga have been recommended as interventions for patients with IBS. Despite promising results among adult samples, there have been limited studies exploring the efficacy of yoga with pediatric patients.OBJECTIVE: To conduct a preliminary randomized study of yoga as treatment for adolescents with IBS.METHODS: Twenty‐five adolescents aged 11 to 18 years with IBS were randomly assigned to either a yoga or wait list control group. Before the intervention, both groups completed questionnaires assessing gastrointestinal symptoms, pain, functional disability, coping, anxiety and depression. The yoga intervention consisted of a 1 h instructional session, demonstration and practice, followed by four weeks of daily home practice guided by a video. After four weeks, adolescents repeated the baseline questionnaires. The wait list control group then received the yoga intervention and four weeks later completed an additional set of questionnaires.RESULTS: Adolescents in the yoga group reported lower levels of functional disability, less use of emotion‐focused avoidance and lower anxiety following the intervention than adolescents in the control group. When the pre‐ and postintervention data for the two groups were combined, adolescents had significantly lower scores for gastrointestinal symptoms and emotion‐focused avoidance following the yoga intervention. Adolescents found the yoga to be helpful and indicated they would continue to use it to manage their IBS.CONCLUSIONS: Yoga holds promise as an intervention for adolescents with IBS.
An Open‐Label, Multicentre Pilot Study of Bosentan in Pulmonary Arterial Hypertension Related to Congenital Heart Disease
Authors: Ibrahim Reda , Granton John T , Mehta Sanjay 
Published: March 2016

BACKGROUND: Bosentan has been shown to be a safe and efficacious treatment for idiopathic pulmonary arterial hypertension (PAH) and PAH associated with connective tissue disease. However, there are limited studies examining the benefits of bosentan in PAH associated with congenital heart disease (CHD).OBJECTIVE: The aim of the present pilot study was to explore the safety and efficacy of bosentan in patients with PAH associated with CHD.PATIENTS AND METHODS: In the present study, 11 patients with PAH associated with CHD were enrolled to receive bosentan for a minimum of 16 weeks (62.5 mg twice a day for four weeks; thereafter 125 mg twice a day). Safety was assessed by monitoring adverse events, oxygen saturation, systemic blood pressure, pulse, complete blood count and liver function tests. Efficacy was assessed by the World Health Organization functional class, 6 min walk test (6‐MWT), modified Borg dyspnea index, echocardiography and the 36‐item short form health survey.RESULTS: Ten patients completed the 16‐week treatment period (one patient withdrew). Bosentan was not associated with a deterioration in resting oxygen saturation (83.0±4.6% at week 16 versus 81.9±6.1% at baseline; P=0.402), or a deterioration in post‐6‐MWT oxygen saturation (70.1±10.9% at week 16 versus 68.7±15.1% at baseline; P=0.747). Two patients experienced three serious adverse events. The distance walked in 6 min improved significantly by 28 m (P=0.005) at week 16 compared with baseline, and the modified Borg dyspnea index also improved at week 16 compared with baseline (P=0.050). The World Health Organization functional class improved from class III to class II for five of 10 patients (50%). Patients’ self‐rated quality of life (36‐item short form health survey) demonstrated a non‐significant improvement in each of the eight domains. Obtaining reliable echocardiographic measurements was difficult. Most echocardiographic parameters were only measurable on few patients, and none were measured on all patients, questioning the usefulness of echocardiography as a measuring tool for patients with complex CHD.CONCLUSION: Bosentan was not associated with worsening of resting oxygen saturation or exercise systemic oxygen saturation, suggesting its potential as a safe treatment option for patients with PAH associated with CHD. Improved 6‐MWT and the modified Borg dyspnea index also suggested the possibility of bosentan as an efficacious treatment option for these patients. The results of the present study provide evidence for the need and feasibility of a large randomized, placebo‐controlled clinical trial.
Asthma Control in Canada Remains Suboptimal: The Reality of Asthma Control (TRAC) Study
Authors: FitzGerald J Mark , Boulet Louis-Philippe , McIvor R Andrew , Zimmerman Sabrina , Chapman Kenneth R 
Published: March 2016

BACKGROUND: Two Canadian studies showed that 55% of patients with asthma had daily symptoms (in 1996) and that 57% of patients suffered from poorly controlled asthma (in 1999).OBJECTIVES: To assess the state of asthma control of adult Canadians, and asthma knowledge and practices of Canadian physicians actively involved in the care of patients with asthma.METHODS: Telephone interviews were conducted with adults 18 to 54 years of age who had been diagnosed with asthma at least six months before the survey, who did not have chronic obstructive pulmonary disease and who had a smoking history of fewer than 20 pack‐years. Physicians were surveyed by telephone and mail. The surveys took place between April and August 2004.RESULTS: Almost all (97%) of the 893 patients believed that they had controlled asthma; however, only 47% had controlled disease according to symptom‐based guideline criteria. Just 39% of 463 physicians based their treatment recommendations on the Canadian asthma guidelines most or all of the time, despite having a high awareness of them. Only 11% of patients had written action plans, and one‐half of patients with action plans did not use them regularly. Almost three‐quarters of patients expressed concerns about taking inhaled corticosteroids.CONCLUSIONS: Since the last major national survey, guideline implementation has not resulted in significant changes in asthma‐related morbidity. Effective means of knowledge transfer should be developed and implemented to improve the translation of guideline recommendations into care.