bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molecular Epidemiology of Legionella pneumophila Infection at a Canadian Tertiary Care Institution
Authors: Nicolle LE , Bialkowska-Hobrzanska H , Dyck B , Sekla L , Parker S 
Published: March 2016

Objective: To characterize the molecular epidemiology of Legionella species infection at one Canadian tertiary care centre.Design: Twenty‐eight clinical isolates and 12 environmental isolates obtained over a six‐year period were analyzed by restriction fragment length polymorphism (rflp) of chromosomal dna. Isolates included 15 from 12 patients with hospital acquired illness and 13 from nine patients with community acquired infection.Results: One nosocomial strain was Legionella micdadei and one community strain was Legionella pneumophila serotype 6; all others were L pneumophila serotype 1. rflp typing revealed one clone for all cases of a 1985 single‐ward outbreak and five of six nonoutbreak L pneumophila nosocomial cases. An rflp pattern identical or highly related to that of the nosocomial clonal type was noted among nine of 12 L pneumophila serotype 1 community isolates. The remaining three isolates had two related rflp patterns distinct from the institutional strain. The nosocomial and community strains were isolated from multiple institutional water samples in the institution. For the environmental isolates, monoclonal antibody typing was more discriminating than rflp typing: seven monoclonal antibody subtypes were distinguished among 12 environmental isolates comprising three distinct rflp patterns.Conclusions: Despite multiple L pneumophila serotype 1 strains isolated in the authors’ institutional water, a single clone of L pneumophila produced most disease. Community acquired disease was caused by a wider variety of strains.
Screening and Treatment of Immigrants and Refugees to Canada for Tuberculosis: Implications of the Experience of Canada and other Industrialized Countries
Authors: Thomas Roger E , Gushulak Brian 
Published: March 2016

Objective: To assess the incidence of tuberculosis in immigrants and refugees in Canada and other industrialized countries; the effectiveness of the screening process; the incidence of drug resistance; recommendations for prophylaxis and therapy; and indications for and effectiveness of directly observed therapy.Data Sources: medline search of literature published from 1985 to 1995 with the key words ‘tuberculosis’, ‘Canada’, ‘screening’, ‘drug resistance’, ‘drug resistance, multiple’, ‘immigration and emigration’, and the title words ‘directly observed therapy’.Study Selection: All studies reporting data on incidence, the outcomes of screening, drug resistance, therapy and directly observed therapy were selected.Data Synthesis and Conclusions: Data synthesis led to the conclusions that immigrants and refugees to Canada have five times the nonimmigrant and non‐Aboriginal rate of tuberculosis; that screening programs discover new cases of tuberculosis on and after arrival and that up to 20% of those scheduled to attend a tuberculosis clinic after arrival may never attend; that drug resistance is widespread in countries from which Canada receives immigrants; and that directly observed therapy for active cases can result in 100% conversion rates.
Community Acquired, Nursing Home Acquired and Hospital Acquired Pneumonia: A Five‐Year Review of the Clinical, Bacteriological and Radiological Characteristics
Authors: Chow CW , Lee-Pack LR , Senathiragah N , Rawji M , Chan M , Chan CK 
Published: March 2016

Purpose: To assess the contemporary clinical, bacteriological and radiographic features of hospitalized patients with community acquired (ca), nursing home acquired (na) and hospital acquired pneumonia (ha) and to examine patient outcome.Patients and Methods: All hospital records of patients with pneumonia over a five‐year period from April 1987 to March 1992 were reviewed retrospectively. Patients included in the study were all those with a diagnosis of pneumonia as identified by computer records of diagnostic codes at discharge; patients with a specific diagnosis of Pneumocystis carinii pneumonia were excluded. Of 74,435 discharges over the five‐year period, 1782 patients met the inclusion criteria.Results: Charts of 1622 of the total 1782 cases were reviewed. Mean age was 64.4 years with 59.4% men and 40.6% women. Sixty‐three per cent were ca, 28.5% were ha and 8.5% were na. A total of 1542 patients (95%) had at least one concomitant medical condition. Chest roentgenogram was abnormal in 97%. Common organisms isolated overall were Haemophilus influenzae (from 204 patients), Staphylococcus aureas (from 152 patients), Streptococcus pneumoniae (from 143 patients ), Escherichia coli (from 113 patients) and Pseudomonas aeruginosa (from 111 patients). H influenzae and S pneumoniae were most common in ca pneumonia, whereas S aureus and Gram‐negative organisms were more common in the ha group and Gram‐negative agents in the na group. One hundred and four patients developed complications. Fifteen per cent required intensive care unit admission. The average length of hospitalization in the ca and na groups was 17 days and in the ha group, 43 days. At time of discharge 1261 patients (78%) were cured or improved, and 361 patients (22%) died during the admission.Conclusions: These results suggest that hospitalization for pneumonia in the 1990s is primarily for elderly patients with significant co‐morbidity. Although microbiology appears unchanged compared with earlier reports, the contemporary population is significantly sicker than previous cohorts. This may account for the persistently high morbidity and mortality despite better or newer antibiotics.
Risk Factors for Breakthrough Pneumocystis carinii Pneumonia on Aerosol Pentamidine Prophylaxis
Authors: McIvor RA , Rachlis AR , Berger P , Pack LR Lee , Chan Charles K 
Published: March 2016

OBJECTIVE: To identify baseline characteristics of human immunodeficiency virus (HIV)‐infected individuals on aerosol pentamidine for Pneumocystis carinii prophylaxis that are predictive of subsequent breakthrough Pneumocystis carinii pneumonia (PCP).DESIGN: Nested case‐control study assembled from a cohort of patients enrolled in the Toronto aerosol pentamidine program.METHODS: Subjects were selected from a cohort of HIV‐infected individuals were enrolled in a community based aerosol pentamidine program between May 1989 and May 1992 in Toronto, Ontario. Cases ‐ individuals who had breakthrough PCP ‐ were matched with up to two controls enrolled in the same week. Risk factors examined for development of PCP for both primary and secondary prophylaxis
included age, sex, smoking history, evidence of bronchospasm during aerosol pentamidine administration (fall of forced expiratory volume [FEV] 15% or more), administration of salbutamol before aerosol pentamidine, pulmonary function tests including lung volumes, flow rates and diffusing capacity for carbon monoxide. In the primary prophylaxis group, CD4 count at enrolment and in the secondary prophylaxis group, time from the most recent episode of PCP to enrolment for aerosol pentamidine and total time from the most recent episode of PCP to breakthrough PCP were examined as additional risk factors.RESULTS: A total or 1344 patients we re enrolled in the aerosol pentamidine program, 78% for primary prophylaxis and 22% for secondary prophylaxis. At the time of census at the end or 1992 there had been 96 episodes or breakthrough PCP, 5% on primary prophylaxis and 14.5% on secondary prophylaxis. In the primary prophylaxis group, enrolment CD4 count was significantly lower in the cases developing breakthrough PCP: 116±74 compared with 175±85 cells/mm3 in the control group (P=0.001). There was no difference in any other variable. In the secondary
prophylaxis group, time from the most recent episode of PCP to initiation of aerosol pentamidine therapy was longer in the cases developing breakthrough PCP: mean delay 6.1±6.6 months compared with 3.1±2.1 in controls (P=0.02). There was no difference in the other variables examined.CONCLUSIONS: The results of this study support immune augmentation for patients receiving aerosol pentamidine for primary prophylaxis, and aerosol pentamidine should be recommenced as soon as possible following an episode of PCP, for secondary prophylaxis.
Discharge Considerations for Adult Asthmatic Patients Treated in Emergency Departments
Authors: Grunfeld Anton F , FitzGerald J Mark 
Published: March 2016

OBJECTIVE: To review the medical literature on outcome of treatment of acute asthma in the emergency department and issue recommendations regarding patient admission or discharge.DATA SOURCES: A MEDLINE search was done for articles in the English language on acute asthma and treatment in the emergency department for the years 1975 to 1993. In addition, references in pertinent review articles were reviewed.STUDY SELECTION: Studies addressing treatment of acute asthma in emergency departments were selected by consensus.DATA SYNTHESIS: Three major areas have been shown to affect outcome and the decision to admit or discharge a patient following treatment in the emergency department: first, the severity of the attack and the response to therapy; second, historical risk factors; and third, care following discharge from the emergency department. This paper reviews the literature on outcome of acute asthma attacks and issues recommendations regarding objective airflow measurements and co‐existing risk factors to be assessed before discharging patients. The role of anti‐inflammatory therapy in emergency department treatment and in postdischarge treatment of these patients is also reviewed.CONCLUSION: Evaluation for discharge following treatment of acute asthma should integrate objective measures of airflow obstruction with historical high risk factors. The use of systemic corticosteroids in the emergency department and following discharge, with careful follow‐up, may help control the attack and reduce relapse of asthma.
Diversity of Urine Bacteriology Practice in Ontario: An External Quality Assessment
Authors: Richardson Harold , Fleming Christine A , Mackenzie Andrew MR , The Microbiology Committee  
Published: March 2016

OBJECTIVE: Assessment of urine bacteriology practice in Ontario regarding appropriateness of quantification and the accuracy and Système International d’Unités (SI) conformity in the reporting of results.DESIGN AND SETTING: A simulated urine specimen with Escherichia coli at a target of 100×10 colony forming units (CFU)/L was submitted to licensed Ontario bacteriology laboratories. Data on the isolation and quantification of the pathogen were required within a stipulated time. Reference values were determined by consensus agreement of the findings of seven designated laboratories.PARTICIPANTS: The challenge was administered to 182 Ontario laboratories licensed to perform urine bacteriological assessment. There was no stratification by type or complexity of facility.MAIN OUTCOMES: Samples were processed by routine procedures. Date and time of receipt of the sample, date tested, bacterial count, associated quantification units and the method used were the data required. A copy of the report using the laboratory’s normal reporting format to user‐physicians was requested.RESULTS: The organism was isolated and correctly identified by 179 laboratories. Only 58% of laboratories reported a count of 100×103 CFU/L or more, with 42% reporting a count of between 10 and 100×103 CFU/L. The majority used a standard 0.001 mL loop method. Only 87 participants reported using the correct notation of SI units, although a further 65 reported as CFU/L.CONCLUSION: The variety of reporting formats is of concern. Processing and reporting should be standardized. Laboratories should provide an explanatory note or interpretation when nomenclature or format of a report is changed.
HIV‐Related Non‐Hodgkin’s Lymphoma in Calgary
Authors: Beck Paul L , Gill M John , Blahey Walter B , Sutherland Lloyd R 
Published: March 2016

OBJECTIVE: To determine the incidence of human immunodeficiency virus (HIV) associated non‐Hodgkin’s lymphoma (NHL) in a cohort of patients from a distinct geographic region (southern Alberta). The type and location of NHL as well as how it affected the survival of these patients was examined.PATIENTS AND METHODS: The Southern Alberta HIV Clinic in Calgary serves all of southern Alberta, which has an estimated population of one million. The clinic has provided primary care for 1086 patients from January 1983 to August 1995. Data were obtained by reviewing the clinic’s database and patients’ charts.RESULTS: Over a 12‐year period, 39 cases of NHL were diagnosed in a group of 1086 HIV‐infected patients. Presentation of NHL was at an extranodal site in all but four cases, with the most common sites being the bowel and central nervous system. The mean CD4 count on presentation with NHL was 143.4±37.4×106/L (range 1 to 1219×106/L). Mean survival was 1.25±0.25 years with a range from 0 (diagnosed on autopsy) to 6.45 years. Patients with a CD4 count of less than 200×106/L and/or diagnosed with an AIDS‐defining illness before development of NHL had significantly reduced survival (0.85 years versus 2.48 years, P<0.02 and 0.57 years versus 2.09 years, P<0.001, respectively). Patients who presented with NHL involving either nodes alone or central nervous system had significantly decreased survival (0.28 years and 0.29 years, respectively, P<0.05). Patients with NHL involving the gastrointestinal tract had a longer mean survival than those with NHL elsewhere (P<0.05). All but seven cases received therapy for NHL including chemotherapy, radiotherapy, surgery or combined therapy. Fifteen patients (47% of treated) achieved a complete response that led to improved survival (P<0.01). Patients tolerated surgery, chemotherapy and radiotherapy well and no deaths were due to NHL therapy.CONCLUSIONS: These data suggest that development of NHL in HIV is associated with reduced survival, and that survival is predominantly determined by CD4 count and site of involvement at the time of diagnosis of NHL.
Short‐Course Itraconazole in the Treatment of Candida Vulvovaginitis: A Multicentre Canadian Study
Authors: Canadian Itraconazole Study Group  , Austin Thomas W , Steben Marc , Powell Marion , Romanowski Barbara , Megran David W , Garber Gary E , Margesson Lynette J 
Published: March 2016

OBJECTIVE: To determine the clinical and mycological effectiveness of oral itraconazole in the treatment of acute candida vulvovaginitis.DESIGN: A prospective, randomized and single‐blinded, multicentre trial of 221 women, comparing a one‐day course of oral itraconazole 200 mg bid with vaginal clotrimazole 500 mg single‐dose therapy.MAIN OUTCOME MEASURES: Symptoms, signs and mycological results were assessed up to two months following treatment. Adverse events were recorded and evidence of hepatotoxicity sought.RESULTS: At 10 and 30 days post‐treatment, clinical and mycological cure rates were similar (61.3% clinical and 88.6% mycological 10 days after, and 67.7% clinical and 79.5 mycological 30 days after itraconazole; 64.0 clinical and 85.9% mycological 10 days after, and 62.1% clinical and 78.6 mycological 30 days after clotrimazole) with the majority of both treatment groups free from infection. A total of 69 patients reported adverse events, which were generally transient and mild. Itraconazole was more often associated with gastrointestinal or central nervous system complaints, while clotrimazole recipients more often had genitourinary symptoms. No evidence of hepatotoxicity was found. A higher incidence of relapse was noted among women on the birth control pill and among those who were symptomatic for longer than 10 days before treatment.CONCLUSIONS: A one‐day course of oral itraconazole is as effective as intravaginal clotrimazole in the treatment of acute yeast vulvovaginitis. The number of patients reporting adverse events was similar for the treatment groups, although the side effect profile differed. No hepatotoxicity was observed.
Comparison of Tuberculosis Infection Control Programs in Canadian Hospitals Categorized by Size and Risk of Exposure to Tuberculosis Patients, 1989 to 1993 – Part 2
Authors: Holton Donna , Paton Shirley , Gibson Helen , Taylor Geoffrey , Whyman Carol , Yang TC 
Published: March 2016

OBJECTIVE: To analyze tuberculosis (TB) programs in acute care hospitals (hospitals) categorized by size and risk of exposure to TB patients from 1989 to 1993.DESIGN: Retrospective survey.PARTICIPANTS: Members of the Community and Hospital Infection Control Association‐Canada and l’Association des professionnels pour la prévention des infections who worked in Canadian hospitals received questionnaires. One questionnaire per hospital was completed.OUTCOME: Hospitals reported the number of respiratory TB and human immunodeficiency virus (HIV) cases admitted, the engineering and environmental controls available, and the type of occupational TB screening programs available. Data were stratified by hospital size and risk of exposure to TB patients.RESULTS: Thirty‐four (10.9%) hospitals with at least 500 beds admitted more than 50% of the TB cases, more than 40% of the multidrug‐resistant TB (MDR‐TB) cases and more than 65% of the HIV cases. Thirty‐six (11.6%) facilities classified as high risk hospitals reported more than 70% of the TB cases, more than 58% of the MDR‐TB cases and more than 75% of the HIV cases. A significantly higher pooled average tuberculin test conversion rate was found in individuals working in high risk (4.4%) than in low risk hospitals (1.5%). Significantly more high risk than low risk hospitals had an isolation room with air exhausted outside, negative air pressure and at least six air changes per hour. Only 13 high risk hospitals had all three engineering characteristics. Surgical masks were used for respiratory protection in 18 (50%) high risk and 186 (77.8%) low risk hospitals.CONCLUSIONS: Nosocomial transmission of Mycobacterium tuberculosis may have occurred because TB programs available in many Canadian hospitals were inadequate.
Rubella Antibody Levels in School‐Aged Children in Newfoundland: Implications for a Two‐Dose Rubella Vaccination Strategy
Authors: Ratnam Samuel , West Roy , Gadag Veeresh , Williams Brett , Oates Elizabeth 
Published: March 2016

OBJECTIVE: To determine the prevailing levels of rubella immunity among school‐aged children who received a single dose of measles‐mumps‐rubella (MMR) vaccine at one year of age.DESIGN: Cross‐sectional study with a two stage cluster sampling of randomly picked schools across the province of Newfoundland.STUDY POPULATION AND METHODS: A total of 1053, five to 17‐year‐old children were enrolled; vaccination history was verified through official records; and a sample of blood was taken. Rubella immunity was determined by enzyme immunoassay based on a serum antibody protective cut‐off titre of more than 10 IU.RESULTS: A total of 145 (13.8%) were found to be nonimmune. The rate of susceptibility ranged from 3.2% to 25.9% for different age groups. The proportion susceptible was significantly higher at 16.5% in the age group eight to 17 years old versus 3.9% for the age group five to eight years old (χ2=24.08; df=1, P<0.001). There was a significant regression of logarithm titre values on the age of children with an average decline in titre values of 8.1% per annum.CONCLUSIONS: A substantial number of those who were given a single dose of MMR II vaccine may not have protective immunity against rubella as they reach prime reproductive age. There is a definite need to consider a two‐dose rubella vaccination strategy in Canada, and these data suggest the second dose given after eight years of age will be most beneficial. In the move towards a routine two‐dose measles vaccination strategy in Canada, the MMR II vaccine is being used for the second dose and given either at 18 months of age or at school entry. While this approach will have an overall beneficial effect, the impact of the above timing of the second dose on long term rubella immunity cannot be predicted at this time. These data also underscore the continuing need for prenatal rubella screening program.
Polymerase Chain Reaction‐And Rna Hybridization‐Based Method for the Investigation of Deep‐Seated Candidiasis
Authors: Couroux Peter R , Hussain Zafar , Rutledge Frank , Lannigan Robert , Ralph Edward D , Nancekivell Barbara , Austin Thomas W 
Published: March 2016

OBJECTIVE: To determine the usefulness of a polymerase chain reaction (PCR) and RNA hybridization method for the diagnosis of invasive candidiasis and to compare its sensitivity with blood cultures.DESIGN: Blood cultures and a blood sample for PCR were taken from patients with suspected invasive candidiasis. A 105 base pair conserved segment within the rDNA of Candida species was amplified. The amplicon was detected by hybridization and gel electrophoresis.SETTING: Intensive care units of two tertiary care hospitals.PATIENTS: One hundred and eighteen patients 16 years of age or older with four more risk factors for invasive candidiasis were enrolled. Present or recent past treatment with broad spectrum antibiotics, cancer chemotherapy, immunosuppressive drugs, granulocytopenia or granulocytosis, intravascular catheterization, tracheal intubation, recent abdominal surgery and parenteral nutrition were considered risk factors.RESULTS: Forty‐three patients had invasive candidiasis. PCR detected infections in 28 and 26 patients (sensitivity 65.1% and 60.4%) by hybridization and gel electrophoresis, respectively. The sensitivity of blood cultures was 58.1%. Of 25 patients with positive blood cultures, 17 were positive by PCR with the hybridization method. Eleven patients with invasive candidiasis had negative blood cultures but were positive by PCR.CONCLUSION: PCR, especially with a hybridization detection method, is more sensitive than blood culture for invasive candidiasis and may facilitate the diagnosis of nonfungemic disease.
Status of Tuberculosis Infection Control Programs in Canadian Acute Care Hospitals, 1989 to 1993 – Part 1
Authors: Holton Donna , Paton Shirley , Gibson Helen , Taylor Geoffrey , Whyman Carol , Yang TC 
Published: March 2016

OBJECTIVE: To document tuberculosis (TB) prevention and control activities in Canadian acute care hospitals from 1989 to 1993.DESIGN: Retrospective questionnaire.PARTICIPANTS: All members of the Community and Hospital Infection Control Association‐Canada and l’Association des professionnels pour la prévention des infections who lived in Canada and worked in an acute care hospital received a questionnaire. One questionnaire per hospital was completed.OUTCOME: The study documented the number of respiratory TB cases admitted to the hospital, the type of engineering and environmental controls available, and the type of occupational tuberculin skin test (TST) screening programs offered by the hospital.RESULTS: Questionnaires were received from 319 hospitals. Ninety‐nine (32%) hospitals did not admit a respiratory TB case during the study. Thirty‐one (10%) hospitals averaged six or more TB cases per year. TST results were reported for 47,181 health care workers, and 819 (1.7%) were reported as TST converters; physicians had a significantly higher TST conversion rate than other occupational groups. Most hospitals did not have isolation rooms with air exhausted outside the building, negative air pressure and six or more air changes per hour. Surgical masks were used as respiratory protection by 74% of staff.CONCLUSIONS: Canadian hospitals can expect to admit TB patients. Participating hospitals did not meet TB engineering or environmental recommendations published in 1990 and 1991. In addition, occupational TB screening programs in 1989 to 1993 did not meet Canadian recommendations published in 1988.