bluuebunny/crossref_metadata_2025_split huggingface dataset:
Safety and Immunogenicity of a Fully Liquid Vaccine Containing Five‐Component Pertussis‐Diphtheria‐Tetanus‐Inactivated Poliomyelitis‐Haemophilus influenzae Type B Conjugate Vaccines Administered at Two, Four, Six and 18 Months of Age
Authors: Gold Ronald , Barreto Luis , Ferro Santiago , Thippawong John , Guasparini Roland , Meekison William , Russell Margaret , Mills Elaine , Harrison Dana , Lavigne Pierre 
Published: March 2016

OBJECTIVE: The safety, immunogenicity and lot consistency of a fully liquid, five‐component acellular pertussis combination vaccine, comprised of diphteria, tetanus and acellular pertussis, inactivated polio vaccine, Haemophilus influenzae type b (DTaP‐IPV‐Hib [Pediacel, sanofi pasteur, Canada]) were assessed and compared with that of Hib vaccine reconstituted with the five‐component acellular pertussis combination vaccine (DTaP‐IPV//Hib, Pentacel [sanofi pasteur, Canada]).METHODS: Infants were recruited at vaccine study centres in Montreal, Quebec; Simon Fraser Health Region, British Columbia, and southern Alberta after the protocol had been approved by the relevant institutional ethics committees. Written informed consent was obtained from the parents or guardians of all subjects. At two months of age, the infants were randomly assigned to receive one of three consecutive production lots of DTaP‐IPV‐Hib by intramuscular injection. Reactions to vaccinations were assessed by parental observation and through telephone interviews conducted by study nurses. Blood samples were obtained at two, six, seven, 18 and 19 months of age for measurement of antibodies to vaccine antigens.RESULTS: Most injection site and systemic reactions were mild or moderate, and of brief duration. All infants were protected against tetanus, diphtheria and all three polio serotypes after both primary and booster vaccinations. Antibody responses to pertussis antigens were similar to those observed in Swedish infants, in whom the five‐component vaccine was shown to be 85% effective. Proportions of infants with antipolyribosylribitol phosphate antibody of 0.15 μg/mL or greater and 1.0 μg/mL or greater, were 97.9% and 88.9%, respectively, following primary immunization, and 100% and 99% following booster vaccination. Safety and immunogenicity results with both reconstituted and fully liquid combination vaccines were comparable.CONCLUSIONS: The fully liquid combination vaccine was comparable in terms of safety and immunogenicity with the reconstituted combination vaccine.
Long-term Follow-Up of Individuals with Celiac Disease: An Evaluation of Current Practice Guidelines
Authors: Silvester Jocelyn A , Rashid Mohsin 
Published: March 2016

INTRODUCTION: Celiac disease can be treated by following a strict gluten-free diet for life. If properly followed, the diet resolves symptoms and nutritional deficiencies. It is generally recommended that individuals with celiac disease have careful long-term follow-up. However, it is not clear which elements of disease status evaluation, laboratory investigations and self-management support should be included in follow-up.OBJECTIVES: To examine the current practice guidelines and recommendations regarding follow-up of individuals with celiac disease.METHODS: Guidelines issued by gastroenterological societies and associations, and recommendations by experts were retrieved using MEDLINE and other Internet search engines.RESULTS: Practice guidelines were available from the American Gastroenterological Association; the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition; the National Institutes of Health Consensus Development Conference 2004; the World Gastroenterology Organization; the British Society for Gastroenterology and the United Kingdom-based Primary Care Society for Gastroenterology. Most guidelines recommended a scheduled annual review and regular measurements of body mass index. The British Society for Gastroenterology recommended dietary review only at times of stress, while others recommended dietary review with a nutritionist. All associations recommended serial tissue transglutaminase antibody testing. The American Gastroenterological Association and the Primary Care Society for Gastroenterology recommended annual hemoglobin, ferritin and folate checks. One guideline recommended annual hemoglobin, electrolyte, calcium, albumin, ferritin, folate, fat-soluble vitamin, liver function test, parathyroid hormone and bone density measurements (approximately $400 per patient).CONCLUSIONS: The current practice guidelines regarding the follow-up of patients with celiac disease varied greatly in their recommendations and many were not evidence-based. Prospective studies are required to develop rational, cost-effective and risk-stratified guidelines for long-term follow-up of these patients.
Postoperative Outcome after Coronary Artery Bypass Grafting in Chronic Obstructive Pulmonary Disease
Authors: Manganas Hélène , Lacasse Yves , Bourgeois Stéphanie , Perron Jean , Dagenais François , Maltais François 
Published: March 2016

BACKGROUND: It is uncertain if the presence and severity of airflow obstruction in chronic obstructive pulmonary disease (COPD) is predictive of surgical morbidity and mortality after coronary artery bypass grafting (CABG).METHODS: Retrospective study of patients who underwent CABG between 1998 and 2003 in a university‐affiliated hospital for whom a preoperative spirometry was available. COPD was diagnosed in smokers or ex‐smokers 50 years of age or older in the presence of irreversible airflow obstruction. Patients were divided into three groups depending on the spirometry: controls (forced expiratory volume in 1 s [FEV1] 80% or more, FEV1/forced vital capacity [FVC] greater than 0.7), mild to moderate COPD (FEV1 50% or more and FEV1/FVC 0.7 or less) and severe COPD (FEV1 less than 50% and FEV1/FVC 0.7 or less).RESULTS: Among the 411 files studied, 322 (249 men, 68±8 years of age) were retained (controls, n=101; mild to moderate COPD, n=153; severe COPD, n=68). The mortality rate (3.0%, 2.6% and 0%, respectively) was comparable among the three groups. Patients with severe COPD had a slightly longer hospital stay than controls (mean difference 0.7±1.4 days, P<0.05). Pulmonary infections were more frequent in severe COPD (26.5%) compared with mild to moderate COPD (12.4%) and controls (12.9%), P<0.05. Atrial fibrillation tended to be more frequent in severe COPD than in the other two groups.CONCLUSION: Mortality rate associated with CABG surgery is not influenced by the presence and severity of airflow obstruction in patients with COPD. The incidence of pulmonary infections and length of hospital stay were increased in patients with severe COPD.
Endoscopic Management of a Relapsing Hepatic Hydatid Cyst with Intrabiliary Rupture: A Case Report and Review of the Literature
Authors: Manouras Andreas , Genetzakis Michael , Antonakis Pantelis T , Lagoudianakis Emmanuel , Pattas Michael , Papadima Artemisia , Giannopoulos Panagiotis , Menenakos Evangelos 
Published: March 2016

Hydatid disease, although endemic mostly in sheep-farming countries, remains a public health issue worldwide, involving mainly the liver. Intrabiliary rupture is the most frequent complication of the hepatic hydatid cyst. Endoscopy is advocated, preoperatively, to alleviate obstructive jaundice caused by intracystic materials after a frank rupture and is also a useful and well-established adjunct in locating postoperative biliary fistulas.Endoscopic retrograde cholangiography with sphincterotomy has been successful as the sole and definitive means of treatment of intra-biliary ruptured hydatid cysts. A case of an elderly woman with frank rupture is presented, where the rupture was definitively managed endoscopically in conjunction with sphincterotomy to remove the intrabiliary obstructive daughter cysts and to achieve decontamination of the biliary tree.Endoscopic retrograde cholangiography provided an excellent diagnostic and therapeutic modality in the present case and, thus, it should be considered as definitive treatment in similar cases especially if surgical risk is anticipated to be high.
Mortality of Elderly Patients in Ontario after Hospital Admission for Chronic Obstructive Pulmonary Disease
Authors: Nie Jason X , Wang Li , Upshur Ross EG 
Published: March 2016

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with significant mortality. It is currently the fourth leading cause of death in Canada and the world.OBJECTIVES: To describe the mortality of elderly patients in Ontario after hospital admission for COPD.METHODS: A retrospective cohort study was conducted using the Discharge Abstract Database from the Canadian Institute for Health Information. Patients aged 65 years and older who were admitted to hospital between 2001 and 2004 with primary discharge diagnoses labelled with International Classification of Diseases, Ninth Revision codes 491, 492 and 496 were included in the study.RESULTS: Mortality rates were 8.81, 12.10, 14.53 and 27.72 per 100 COPD hospital admissions at 30, 60, 90 and 365 days after hospital discharge, respectively. Mortality also increased with age, and men had higher rates than women. No significant differences in mortality rates were found between different socioeconomic groups (P>0.05). Patients with shared care of a family physician or general practitioner and a specialist had significantly lower mortality rates than the overall rate (P<0.05), and their rates were approximately one‐half the rate of patients with only one physician.CONCLUSIONS: Hospitalization with COPD is associated with significant mortality. Patients who were cared for by both a family physician or general practitioner and a specialist had significantly lower mortality rates than those cared for by only one physician, suggesting that continuous and coordinated care results in better survival.
Chronic Obstructive Pulmonary Disease in Women
Authors: Laviolette Louis , Lacasse Yves , Doucet Mariève , Lacasse Miriam , Marquis Karine , Saey Didier , Leblanc Pierre , Maltais François 
Published: March 2016

BACKGROUND: Little is known about the comparative impact of chronic obstructive pulmonary disease (COPD) between women and men and about women’s response to pulmonary rehabilitation.OBJECTIVES: To compare lung function, disability, mortality and response to pulmonary rehabilitation between women and men with COPD.METHODS: In the present retrospective study, 68 women (mean age 62.5±8.9 years) and 168 men (mean age 66.3±8.4 years) were evaluated by means of pulmonary function testing and an incremental symptom‐limited cycle exercise test. Forty women and 84 men also participated in a 12‐week pulmonary rehabilitation program. A 6 min walking test and the chronic respiratory questionnaire were used to assess the effects of pulmonary rehabilitation. Survival status was also evaluated.RESULTS: Compared with men, women had a smaller tobacco exposure (31±24 versus 48±27 pack‐years, P<0.05), displayed better forced expiratory volume in 1 s (44±13 versus 39±14 % predicted, P<0.05), a higher functional residual capacity (161±37 versus 149±36 % predicted, P<0.05) and total lung capacity (125±20 versus 115±19 % predicted, P<0.001). Peak oxygen consumption was not different between women and men when expressed in predicted values but lower in women when expressed in absolute values. Pulmonary rehabilitation resulted in significant improvements in 6 min walking test and quality of life in both sexes, but women had a greater improvement in chronic respiratory questionnaire dyspnea. Survival status was similar between sexes, but predictors of mortality were different between sexes.CONCLUSIONS: Women may be more susceptible to COPD than men. The clinical expression of COPD may differ between sexes with greater degree of hyperinflation in women, who also benefit from pulmonary rehabilitation.
Canadian Economic Evaluation of Budesonide‐Formoterol as Maintenance and Reliever Treatment in Patients with Moderate to Severe Asthma
Authors: Miller Elizabeth , Sears Malcolm R , McIvor Andrew , Liovas Anna 
Published: March 2016

OBJECTIVES: To compare the cost‐effectiveness of budesonide‐formoterol in a single inhaler used as both maintenance and reliever medication versus clinician‐directed titration of salmeterol‐fluticasone as maintenance medication, plus salbutamol taken as needed, in controlling asthma in adults and adolescents.METHODS: A Canadian economic evaluation was conducted based on the results of a large (n=2143), open‐label, randomized, controlled effectiveness trial in which health resource use was prospectively collected. The primary outcome measurement was the time to the first severe exacerbation. Costs included direct medical costs (physician and emergency room visits, hospitalizations, asthma drug costs, etc) and productivity (absenteeism). The time horizon was one year, which corresponded to the duration of the clinical trial. Prices were obtained from 2005 Canadian sources. Both health care and societal perspectives were considered, and deterministic univariate sensitivity analyses were conducted.RESULTS: In the clinical trial, budesonide‐formoterol as maintenance and reliever treatment was superior to salmeterol‐fluticasone with respect to the time to the first severe exacerbation, overall rate of exacerbations and use of as‐needed reliever medication. The annualized rate of severe exacerbations was 0.24 events/patient in the budesonide‐formoterol arm and 0.31 events/patient in the salmeterol‐fluticasone arm (P=0.0025). From a health care perspective, the mean cost per patient‐year was $1,315 in the budesonide‐formoterol arm versus $1,541 in the salmeterol‐fluticasone arm. From a societal perspective, the mean cost per patient‐year was $1,538 in the budesonide‐formoterol arm and $1,854 in the salmeterol‐fluticasone arm. Budesonide‐formoterol was dominant (more effective and less expensive) in the base case analysis from both perspectives. The results were robust under sensitivity testing.CONCLUSIONS: The strategy that allows budesonide‐formoterol to be used in a single inhaler as both maintenance and reliever medication proved to be more effective and less expensive than a strategy of clinician‐directed titration of salmeterol‐fluticasone with salbutamol as reliever therapy.
Prevalence of USA300 Colonization or Infection and Associated Variables During an Outbreak of Community‐Associated Methicillin‐Resistant Staphylococcus aureus in a Marginalized Urban Population
Authors: Gilbert Mark , MacDonald Judy , Louie Marie , Gregson Dan , Zhang Kunyan , Elsayed Sameer , Laupland Kevin , Nielsen Diane , Wheeler Virginia , Lye Tara , Conly John 
Published: March 2016

BACKGROUND: In 2004, an outbreak of the USA300 strain of methicillin‐resistant Staphylococcus aureus (MRSA) was identified in persons with histories of homelessness, illicit drug use or incarceration in the Calgary Health Region (Calgary, Alberta). A prevalence study was conducted to test the hypotheses for factors associated with USA300 colonization or infection.METHODS: Participants were recruited at sites accessed by this marginalized population. Health care staff administered a questionnaire and collected crack pipes and nasal, axillary and skin infection swabs. Pipes and swabs were cultured according to standard techniques. MRSA isolates were further characterized by polymerase chain reaction (mecA, Panton‐Valentine leukocidin and Staphylococcal cassette chromosome mec) and typing methods (pulsed‐field gel electrophoresis, staphylococcal protein A typing and multilocus sequence typing). Colonization or infection was determined by having any one of nasal, axillary, skin infection or pipe swabs positive for USA300. Colonized participants had one or more nasal, axillary or pipe swab positive for USA300; infected participants had one or more skin infection swab positive for USA300.RESULTS: The prevalence of USA300 colonization or infection among 271 participants was 5.5% (range 3.1% to 9.0%). USA300 cases were more likely to report manipulation of skin infections (OR 9.55; 95% CI 2.74 to 33.26); use of crack pipes was not significant despite identification of the USA300 strain on two of four crack pipes tested. USA300 cases were more likely to report drug use between sex trade workers and clients (OR 5.86; 95% CI 1.63 to 21.00), and with casual sex partners (OR 5.40; 95% CI 1.64 to 17.78).CONCLUSION: Ongoing efforts to promote the appropriate treatment of skin infections in this population are warranted. The association of USA300 colonization or infection and drug use with sexual partners suggest a role for sexual transmission of the USA300 strain of MRSA.
IsHelicobacter pyloriBeing Treated Appropriately? A Study of Inpatients and Outpatients in a Tertiary Care Centre
Authors: Nazareno Jose , Driman David K , Adams Paul 
Published: March 2016

BACKGROUND:Helicobacter pyloriis causally associated with peptic ulcer disease and gastric cancer. Although effective treatment is available, studies have shown that patients withH pyloriare often not well managed. Recently, there has also been increasing awareness of patient safety concerns arising from missed follow-up of abnormal test results.OBJECTIVE: To examine whether inpatients and outpatients diagnosed withH pylorireceive appropriate treatment.PATIENTS AND METHODS: All patients who were diagnosed withH pyloriby gastric biopsy in London, Ontario between January 1, 2004, and December 31, 2004, were identified. The hospital charts of these patients were reviewed. Outpatient office charts, clinic notes, pathology reports and endoscopy reports were also reviewed.RESULTS: One hundred ninety-three patients were diagnosed withH pyloriby gastric biopsy in 2004. Of the 193 patients, 143 (74%) were outpatients and 50 (26%) were inpatients. Overall, 89% of patients received treatment forH pylori. Ninety-two per cent of outpatients were treated, while only 60% of inpatients received treatment (P<0.001). Among the inpatients, the pathology report was available in 40% of the cases before the patient was discharged from the hospital. After discharge from the hospital, 30% of inpatients received appropriate treatment and follow-up. There was no significant difference in treatment whether the patient was admitted to a medical or a nonmedical service.CONCLUSION:H pyloriis treated relatively poorly in inpatients compared with outpatients. Results of the present study reveal opportunities to improve delivery of care for inpatients on a number of different levels. More research is needed to ensure safety, effectiveness and timeliness in the test result management process.
The Impact of Ulcerative Colitis is Greater in Unmarried and Young Patients
Authors: Maunder Robert G , Greenberg Gordon R , Lancee William J , Steinhart A Hillary , Silverberg Mark S 
Published: March 2016

GOALS: To determine whether the perceived impact of ulcerative colitis (UC) on activities of living (illness intrusiveness) is greater for people who are not living in a married or common-law relationship.BACKGROUND: In general, social and occupational achievement is not greatly impaired by UC, yet patients, especially young adults, often have interpersonal concerns.METHODS: One hundred fifty-five outpatients with UC were assessed for disease activity, and completed self-reports of marital status, income, social support and illness intrusiveness.RESULTS: Fifty-one patients (32.9%) were single, separated or divorced, and 104 patients (67.1%) were married or in common-law relationships. Compared with those who were married or in common-law relationships, single or separated patients were younger, had a lower household income, had lived with UC for fewer years and were less satisfied with social support. Among 135 patients in remission, marital status was significantly associated with illness intrusiveness, controlling for age, income and perceived social support (F=5.73; P=0.02). Low social support (F=4.94; P=0.03) and younger age (F=7.24; P=0.008) were independently associated with illness intrusiveness. Single patients in remission reported illness intrusiveness of similar severity to that reported by patients with active disease.CONCLUSIONS: The perceived impact of UC on the lives of patients is greater in those who are not married or living in common-law relationships. Youth, single status and lower social support commonly coexist, and exert additive effects on the functional impact of UC. Resources to improve social support should be directed toward this group of patients.
Induction Versus Noninduction Antiviral Therapy for Chronic Hepatitis C Virus in Patients with Congenital Coagulation Disorders: A Canadian Multicentre Trial
Authors: Chatterjee A , Swain MG , Lee SS , Bain VG , Peltekian K , Croitoru K , Adams PC , Kaita K , Teitel J , Heathcote EJ 
Published: March 2016

BACKGROUND: Patients with congenital coagulation disorders and chronic hepatitis C virus (HCV) infection have multiple risk factors (ie, infection predominantly with genotype-1 HCV, long duration of the disease, HIV coinfection and male sex) for poor response to antiviral therapy. The present study compared induction therapy with interferon-alpha (IFN-α)-2b with standard IFN-α2b therapy. Pegylated IFN was not available at the time that the study was initiated.PATIENTS AND METHODS: A randomized study was performed comparing the efficacy of traditional IFN-α2b therapy (group A –three million units, three times weekly for 24 to 48 weeks) and daily ribavirin (1.0 g to 1.2 g according to weight for 24 to 48 weeks), with induction IFN-α2b therapy (group B – three million units, daily for eight weeks followed by the same dose administered three times a week for a further 16 to 40 weeks) and daily ribavirin (same dose as above) in IFN-naive patients with congenital coagulation disorders and chronic HCV infection.RESULTS: Between 2000 and 2003, 54 HIV-negative patients were recruited and randomly assigned to group A or B (n=27 each). Both groups were comparable in terms of age, sex, ethnicity, body mass index, baseline HCV RNA titre, viral genotype, liver fibrosis stage and type of coagulation disorder. Induction therapy did not significantly alter sustained virological response rates (group A 50%, group B 50%; P=1.0). Multiple logistic regression analysis indicated that induction therapy did not benefit individuals with difficult-to-treat infection (ie, those infected with genotypes 1 and 4, or those with high baseline viral loads).CONCLUSIONS: There was no benefit with induction antiviral therapy for HCV infection in individuals with congenital coagulation disorders.