bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for and Outcomes Associated with Clinical Isolates of Escherichia coli and Klebsiella Species Resistant to Extended‐Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals
Authors: Ofner-Agostini Marianna , Simor Andrew , Mulvey Michael , McGeer Alison , Hirji Zahir , McCracken Melissa , Gravel Denise , Boyd David , Bryce Elizabeth 
Published: March 2016

BACKGROUND: Clinical features associated with Gram‐negative bacterial isolates with extended‐spectrum beta‐lactamase (ESBL)‐ and AmpC‐mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL‐ or AmpC‐mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures of Escherichia coli or Klebsiella species were matched with patients with a similar organism but susceptible to third‐generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P‐value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first‐generation cephalosporins (OR 2.38, P=0.02) or third‐generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for all E coli or Klebsiella species patients pending susceptibility testing results.
Pulmonary Vein Stenosis: Case Report and Literature Review
Authors: Amin R , Kwon S , Moayedi Y , Sweezey N 
Published: March 2016

BACKGROUND: Pulmonary vein stenosis is a rare cause of pulmonary hypertension, with variable onset and presentation. One or more of the four pulmonary veins can be primarily or secondarily affected. A five‐month‐old girl presented with respiratory distress, lethargy and cyanosis requiring intubation.METHODS: Echocardiography showed right ventricular dilation, a right ventricular systolic pressure of 97 mmHg, decreased ejection fraction and turbulent flow at the left atrium. Cardiac catheterization revealed stenosis of the left‐sided pulmonary veins, for which she underwent a Coles procedure.RESULTS: Postoperatively, there was a transient improvement in the patient’s pulmonary hypertension but she subsequently deteriorated. Her prognosis was considered bleak, and a decision was made with the family to withdraw care.CONCLUSION: Pulmonary vein stenosis is a rare cause of pulmonary hypertension, and is associated with significant morbidity and mortality. Surgical intervention may be of benefit in selected cases. It stands to reason that any treatment will have the best chance of success if completed before the pulmonary hypertension becomes fixed. Early diagnosis depends on a high index of clinical suspicion.
Short- and Long-Term Results of Transcatheter Embolization for Massive Arterial Hemorrhage from Gastroduodenal Ulcers Not Controlled by Endoscopic Hemostasis
Authors: Loffroy Romaric , Guiu Boris , Mezzetta Lise , Minello Anne , Michiels Christophe , Jouve Jean-Louis , Cheynel Nicolas , Rat Patrick , Cercueil Jean-Pierre , Krausé Denis 
Published: March 2016

BACKGROUND AND AIM: Severe bleeding from gastrointestinal ulcers is a life-threatening event that is difficult to manage when endoscopic treatment fails. Transcatheter embolization has been suggested as an alternative treatment in this situation. The present study reports on the efficacy and long-term outcomes of transcatheter embolization after failed endoscopic treatments were assessed in high-operative-risk patients.METHODS: A retrospective review of 60 consecutive emergency embolization procedures in hemodynamically unstable patients (41 men, 19 women; mean [±SD] age 69.4±15 years) was conducted. Patients were referred for selective angiography between 1999 and 2008 after failed endoscopic treatment of massive bleeding from gastrointestinal ulcers. Mean follow-up was 22 months.RESULTS: Embolization was feasible and successful in 57 patients. Sandwich coiling of the gastroduodenal artery was used in 34 patients, and superselective occlusion of the terminal feeding artery (with glue, coils or gelatin particles) was used in 23 patients. Early rebleeding occurred in 16 patients and was managed with endoscopy (n=8), reembolization (n=3) or surgery (n=5). No major embolization-related complications occurred. Sixteen patients died within 30 days after embolization (including three who died from rebleeding) and 11 died thereafter. No late bleeding recurrences were reported.CONCLUSIONS: Selective angiographic embolization is safe and effective for controlling life-threatening bleeding from gastroduodenal ulcers. The procedure usually obviates the need for emergency surgery in these high-risk patients. Survival depends chiefly on underlying conditions.
Vitamin D Deficiency and Chronic Lung Disease
Authors: Gilbert Christopher R , Arum Seth M , Smith Cecilia M 
Published: March 2016

Vitamin D deficiency is increasingly being recognized as a prevalent problem in the general population. Patients with chronic lung diseases such as asthma, cystic fibrosis, chronic obstructive lung disease and interstitial pneumonia appear to be at increased risk for vitamin D deficiency for reasons that are not clear.Several studies indicate that vitamin D possesses a range of anti‐inflammatory properties and may be involved in processes other than the previously believed functions of calcium and phosphate homeostasis. Various cytokines, cellular elements, oxidative stress and protease/antiprotease levels appear to affect lung fibroproliferation, remodelling and function, which may be influenced by vitamin D levels. Chronic lung diseases such as asthma and chronic obstructive lung disease have also been linked to vitamin D on a genetic basis. This immune and genetic influence of vitamin D may influence the pathogenesis of chronic lung diseases. A recent observational study notes a significant association between vitamin D deficiency and decreased pulmonary function tests in a large ambulatory population.The present review will examine the current literature regarding vitamin D deficiency, its prevalence in patients with chronic lung disease, vitamin D anti‐inflammatory properties and the role of vitamin D in pulmonary function.
The Quality of Screening Colonoscopies in an Office-Based Endoscopy Clinic
Authors: Bair Douglas , Pham Joe , Seaton M Bianca , Arya Naveen , Pryce Michelle , Seaton Trevor L 
Published: March 2016

BACKGROUND: Wait times for hospital screening colonoscopy have increased dramatically in recent years, resulting in an increase in patient referrals to office-based endoscopy clinics. There is no formal regulation of office endoscopy, and it has been suggested that the quality of service in some office locations may be inferior to hospital procedures.OBJECTIVE: To compare the quality of office-based screening colonos-copies at a clinic in Oakville, Ontario, with published benchmarks for cecal intubation, withdrawal times, polyp detection, adenoma detection, cancer detection and patient complications.METHODS: Demographic information on consecutive patients and colonoscopy reports by all nine gastroenterologists at the Oakville Endoscopy Centre between August 2006 and December 2007 were prospectively obtained.RESULTS: A total of 3741 colonoscopies were analyzed. The mean age of patients was 57.1 years and 51.9% were women. The cecal intubation rate was 98.98% with an average withdrawal time of 9.75 min. A total of 3857 polyps were retrieved from 1725 patients (46.11%), and 1721 adenomas were detected in 953 patients (25.47%). A total of 126 patients (3.37%) had advanced polyps and 18 (0.48%) were diagnosed with colon cancer. One patient (0.027%) had a colonic perforation and two patients had postpolypectomy bleeding (0.053%). These results meet or exceed published benchmarks for quality colonoscopy.CONCLUSIONS: The Oakville Endoscopy Centre data demonstrate that office-based colonoscopies, performed by well-trained physicians using adequate sedation and hospital-grade equipment, result in outcomes at least equal to or better than those of published academic/community hospital practices and are therefore a viable option for the future of screening colonoscopy in Canada.
Screening for Iron Overload: Lessons from the HEmochromatosis and IRon Overload Screening (HEIRS) Study
Authors: Adams Paul C , Barton James C , McLaren Gordon D , Acton Ronald T , Speechley Mark , McLaren Christine E , Reboussin David M , Leiendecker-Foster Catherine , Harris Emily L , Snively Beverly M , Vogt Thomas , Sholinsky Phyliss , Thomson Elizabeth , Dawkins Fitzroy W , Gordeuk Victor R , Eckfeldt John H 
Published: March 2016

BACKGROUND: The HEmochromatosis and IRon Overload Screening (HEIRS) Study provided data on a racially, ethnically and geographically diverse cohort of participants in North America screened from primary care populations.METHODS: A total of 101,168 participants were screened by testing forHFEC282Y and H63D mutations, and measuring serum ferritin concentration and transferrin saturation. In the present review, lessons from the HEIRS Study are highlighted in the context of the principles of screening for a medical disease as previously outlined by the World Health Organization.RESULTS: Genetic testing is well accepted, with minimal risk of discrimination. Transferrin saturation has high biological variability and relatively low sensitivity to detectHFEC282Y homozygotes, which limits its role as a screening test. Symptoms attributable toHFEC282Y homozygosity are no more common in individuals identified by population screening than in control subjects.CONCLUSIONS: Generalized population screening in a primary care population as performed in the HEIRS Study is not recommended. There may be a role for focused screening in Caucasian men, with some debate regarding genotyping followed by phenotyping, or phenotyping followed by genotyping.
Improvement in Health‐Related Quality of Life After Lung Transplantation
Authors: Santana Maria-Jose , Feeny David , Jackson Katherine , Weinkauf Justin , Lien Dale 
Published: March 2016

BACKGROUND/OBJECTIVE: Traditional survival outcomes do not reflect the effects on the health‐related quality of life (HRQL) of patients. HRQL following lung transplantation has not been studied systematically. The Health Utilities Index (HUI) is a family (HUI2 and HUI3) of measures of HRQL that has not been previously used to assess HRQL in lung transplantation. The objective of the present study was to assess the impact of lung transplantation on patient’s HRQL using the HUI.METHODS: A total of 43 patients completed a battery of questionnaires before lung transplantation, and at three months and six months after lung transplantation. The 15‐item questionnaire (HUI2 and HUI3) was used. Overall scores were based on a conventional scale (0.00 = dead, 1.00 = perfect health). Mental health was assessed by the Hospital Anxiety and Depression Scale. Adherence to medication and exercise were assessed by Morisky’s and Godin’s questionnaires, respectively.RESULTS: Sixty‐five per cent of the patients were men, with a mean age of 53 years (range 18 to 67 years). The mean overall HUI3 score for the lung transplant candidates (0.57) was much lower than for the lung transplant recipients (0.82) at six months post‐transplantation. This difference was clinically important and statistically significant (P<0.05 [paired ttest, degrees of freedom (df) = 35]). Differences in mean Hospital Anxiety and Depression Scale scores after transplantation were statistically significant (P<0.05 [paired t test, df=35]). After six months, transplant recipients were more adherent to medication (P<0.05 [χ2 test, df=1]). Recipients were able to increase the duration of exercise at all levels of intensity.CONCLUSION: Lung transplantation improved the patients’ HRQL and adherence to medication. Anxiety levels persisted six months after transplantation but depression levels had decreased significantly.
Putting Pain Assessment into Practice: Why Is It so Painful?
Authors: Franck Linda S , Bruce Elizabeth 
Published: March 2016

OBJECTIVE: To explore some of the reasons for poor compliance with the use of standardized pain assessment tools in clinical practice, despite numerous guidelines and standards mandating their use.METHODS: First, a review of research and clinical audit literature on the effects of standardized pain assessment tools on patient or process outcomes was conducted, and findings were critiqued. Second, a synthesis of recent literature on the biopsychosocial mechanisms of human detection and recognition of pain in others was presented. Third, the implications for pain assessment in pediatric clinical settings were discussed.RESULTS: There is a lack of good‐quality evidence for the efficacy, effectiveness or cost‐benefit of standardized pain assessment tools in relation to pediatric patient or process outcomes. Research suggests that there may be greater variability than previously appreciated in the ability and motivation of humans when assessing pain in others. It remains unknown whether pain detection skills or motivation to relieve pain in others can be improved or overcome by standardized methods of pain assessment.DISCUSSION: Further research is needed to understand the intra‐ and interpersonal dynamics in clinical assessment of pain in children and to test alternative means of achieving diagnosis and treatment of pain. Until this evidence is available, guidelines recommending standardized pain assessment must be clearly labelled as being based on principles or evidence from other fields of practice, and avoid implying that they are ‘evidence based’.
The Potential Impact of Contemporary Developments in the Management of Patients with Gastroesophageal Reflux Disease Undergoing an Initial Gastroscopy
Authors: Salem Suhail B , Kushner Yael , Marcus Victoria , Mayrand Serge , Fallone Carlo A , Barkun Alan N 
Published: March 2016

BACKGROUND: Recent developments may alter the approach to patients presenting with gastroesophageal reflux disease (GERD)-like symptoms. A newly proposed Montreal consensus definition of Barrett’s esophagus includes all types of esophageal columnar metaplasia, with or without intestinal-type metaplasia. There is also increasing recognition of eosinophilic esophagitis (EE) in patients with GERD-like symptoms.OBJECTIVE: To quantify the impact of these developments on a multiphysician general gastroenterology practice in a tertiary care medical centre.METHODS: Medical charts of all patients having an initial gastroscopy for GERD-like symptoms over a one-year period were reviewed retrospectively, and audits of their endoscopic images and esophageal biopsies were performed.RESULTS: Of the 353 study participants, typical symptoms of heartburn and acid reflux were present in 87.7% and 23.2%, respectively. Less commonly, patients presented with atypical symptoms (eg, dysphagia in 9.4%). At endoscopy, 26% were found to have erosive esophagitis and 12% had endoscopically suspected esophageal metaplasia. Histological evaluation was available for 65 patients. Ten of the 65 biopsied patients (15%) met traditional criteria for Barrett’s esophagus (ie, exhibiting intestinal-type metaplasia), whereas 49 (75%) fulfilled the newly proposed consensus definition of Barrett’s esophagus. Five patients (7.7%) met the study criteria for EE (more than 20 eosinophils per high-power field), four of whom had not been previously recognized.CONCLUSIONS: Among patients presenting with GERD-like symptoms, the prevalence of Barrett’s esophagus may increase markedly if the Montreal definition is adopted. In addition, growing awareness of EE may lead to an increase in the prevalence of this diagnosis. Prospective studies of the management implications of these findings are warranted.
A Study of the Prevalence of Cytotoxic and Non‐Cytotoxic Klebsiella oxytoca Fecal Colonization in Two Patient Populations
Authors: Smith Stephen A , Campbell Sarah J , Webster Duncan , Curley Michael , Leddin Desmond , Forward Kevin R 
Published: March 2016

BACKGROUND: Klebsiella oxytoca is a cause of antibiotic‐associated hemorrhagic colitis. Few reports of the occurrence of K oxytoca within stool exist and there is no gold standard method for its isolation.METHODS: MacConkey agar was modified to culture K oxytoca. Ampicillin was added and adonitol was substituted for lactose. Rectal swabs from 200 patients being screened for vancomycin‐resistant enterococci (VRE) and stool specimens from 429 patients who tested negative for Clostridium difficile cytotoxin were cultured. K oxytoca isolates were evaluated for cytotoxicity to HEp‐2 cells. Available charts of K oxytoca‐positive patients and a convenience sample of 93 K oxytoca‐negative patients who underwent testing for C difficile cytotoxicity were reviewed retrospectively for documentation of bloody stool.RESULTS: K oxytoca was isolated from 14 of 200 patients (7.0%) being screened for VRE; only one of the 14 isolates (7.1%) was cytotoxic. The organism was isolated from 42 of 429 patients (9.8%) tested for C difficile cytotoxicity; 10 isolates (23.8%) were cytotoxic. Differences in isolation and cytotoxicity rates between groups were not statistically significant. Two of 13 (15.4%) K oxytoca‐positive patients screened for VRE, three of 27 (11.1%) K oxytoca‐positive patients tested for C difficile cytotoxicity, and 11 of 93 (11.8%) patients from the convenience sample had documented bloody stool.CONCLUSIONS: A medium that greatly facilitates isolation of K oxytoca was developed. Occurrence of K oxytoca colonization was similar in the two patient populations studied and isolation of cytotoxic K oxytoca was not usually associated with hematochezia. Current understanding of the occurrence and causality of antibiotic‐associated hemorrhagic colitis is insufficient for clinical laboratories to begin culturing K oxytoca and testing for cytotoxicity.
Prevention ofClostridium difficileInfection withSaccharomyces boulardii: A Systematic Review
Authors: Tung Jennifer M , Dolovich Lisa R , Lee Christine H 
Published: March 2016

BACKGROUND:Clostridium difficileis a major cause of antibioticassociated diarrhea within the hospital setting. The yeastSaccharomyces boulardiihas been found to have some effect in reducing the risk ofC difficileinfection (CDI); however, its role in preventive therapy has yet to be firmly established.OBJECTIVE: To review the effectiveness ofS boulardiiin the prevention of primary and recurrent CDI. Benefit was defined as a reduction of diarrhea associated withC difficile. Risk was defined as any adverse effects ofS boulardii.METHODS: A literature search in MEDLINE, EMBASE, CINAHL and the Cochrane Library was performed. Included studies were English language, randomized, double-blind placebo controlled trials evaluatingS boulardiiin CDI prevention.RESULTS: Four studies were reviewed. Two studies investigated the prevention of recurrence in populations that were experiencing CDI at baseline. One trial showed a reduction of relapses in patients experiencing recurrent CDI (RR=0.53; P<0.05). The other demonstrated a trend toward reduction of CDI relapse in the recurrent treatment group of patients receiving high-dose vancomycin (RR=0.33; P=0.05). Two other studies examined primary prevention of CDI in populations that had been recently prescribed antibiotics. These studies lacked the power to detect statistically significant differences. Patients on treatment experienced increased risk for thirst and constipation.CONCLUSION:S boulardiiseems to be well tolerated and may be effective for secondary prevention in some specific patient populations with particular concurrent antibiotic treatment. Its role in primary prevention is poorly defined and more research is required before changes in practice are recommended.
Is the presence ofHelicobacter pyloriin the Dental Plaque of Patients with Chronic Periodontitis a Risk Factor for Gastric Infection?
Authors: Al Asqah Mohammed , Al Hamoudi Nawaf , Anil Sukumaran , Al jebreen Abdulrahman , Al-hamoudi Waleed Khalid 
Published: March 2016

BACKGROUND:Helicobacter pyloriis considered to be a pathogen responsible for gastritis and peptic ulcers, and a risk factor for gastric cancer. A periodontal pocket in the teeth of individuals with chronic periodontitis may function as a reservoir forH pylori.OBJECTIVE: The present study was undertaken to evaluate whether the presence ofH pyloriin the dental plaque of patients with and without periodontitis correlates with gastric involvement.METHODS: A total of 101 patients with dyspepsia were included in the present study. Subjects were divided into periodontitis and non-periodontitis groups. For the detection ofH pyloriin dental plaque, samples were collected from two teeth using a periodontal curette. Subgingival plaque was obtained by inserting two sterile paper points into periodontal pockets for 20 s. This was followed by an upper gastrointestinal endoscopy and antral biopsies.RESULTS: Sixty-five per cent of patients had dental plaque positive forH pyloriand more than 50% harboured the bacteria in their stomach. Periodontitis patients had a significantly higher percentage ofH pyloriin their dental plaque (79% versus 43%; P<0.05) and the stomach (60% versus 33%; P<0.05) than patients with no periodontitis. Additionally, 78% of patients from the periodontitis group versus only 30% from the nonperiodontitis group had a positive test result for the coexistence ofH pyloriin both dental plaque and the stomach.CONCLUSION: Patients with poor oral hygiene have a higher prevalence ofH pyloriin dental plaque and in the stomach. This finding suggests that the oral cavity may be a reservoir forH pylori,and potentially a source of transmission or reinfection.