bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Role of The Cytomegalovirus Antigenemia Assay in the Detection and Prevention of Cytomegalovirus Syndrome and Disease in Solid Organ Transplant Recipients: A Review of the British Columbia Experience
Authors: Greanya Erica D , Partovi Nilufar , Yoshida Eric M , Shapiro R Jean , Levy Robert D , Sherlock Chris H , Stephens Gwen M 
Published: March 2016

BACKGROUND: The pp65 cytomegalovirus (CMV) antigenemia assay has been used as a means of guiding the pre‐emptive therapy of CMV disease in solid organ transplant (SOT) recipients. Recently, concerns have been raised regarding the utility of the test to accurately and precisely detect viral activity early enough to reduce the morbidity and mortality associated with CMV.OBJECTIVE: To determine the performance characteristics of the method of antigenemia testing of SOT recipients used at Vancouver General Hospital, Vancouver, British Columbia.METHODS: All SOT recipients between January 1, 1999, and June 30, 2000, were retrospectively reviewed for six months following transplantation. Physical examination results, laboratory parameters, antigenemia results and treatment information were reviewed.RESULTS: A total of 134 kidney, liver, lung and kidney‐pancreas transplant recipients were included in the analysis. The overall performance characteristics of the antigenemia assay in predicting CMV disease included a sensitivity of 64%, a specificity of 81%, a positive predictive value of 76% and a negative predictive value of 71%. A mean of 18 days passed between the onset of signs and symptoms of CMV disease/syndrome and the first recorded positive antigenemia result, and only 26% of patients had a positive test result before the onset of symptoms. It was found that an antigenemia test breakpoint of at least one positive cell for defining a positive test provided the most sensitive and specific prediction, with increased odds of developing CMV disease.CONCLUSIONS: Based on performance characteristics, the Vancouver General Hospital′s current method of antigenemia testing to guide pre‐emptive ganciclovir therapy in SOT patients is not optimal for the early detection of disease. Further study is needed on new molecular testing methods to determine if our ability to predict CMV disease can be improved.
Pain in the Emergency Department with One‐Week Follow‐Up of Pain Resolution
Authors: Johnston C Celeste , Gagnon Anita J , Pepler Carolyn J , Bourgault Patricia 
Published: March 2016

OBJECTIVES: To determine the intensity of pain in the emergency department (ED), the use of analgesics in relation to pain intensity, which patients are at risk for unresolved pain at one week post‐discharge, and the postdischarge treatment of pain.METHODS: Patients (n=871) admitted to two urban, university‐affiliated EDs who were experiencing any pain were recruited on different shifts over the summer months of 1997. Pain intensity was self‐reported, and chart reviews of the assessment, immediate treatment and follow‐up prescriptions were conducted. Patients (n=699) were contacted one week later, and reports of pain intensity, activity, resuming normal functions and patient attitudes toward pain were documented. Descriptive and regression analyses were performed on the results of patients with complete data (n=585).RESULTS: Mean pain intensity on admission was 6.0 (SD=2.5) on a zero to 10 visual analogue scale, and 5.0 (SD=2.9) at discharge (n=871). One‐quarter (23%) of patients were given analgesics while in the ED; their mean pain intensity was 7.0 (95% CI 6.7 to 7.3) versus 5.7 (95% CI 5.5 to 5.9) for those who were not given analgesics (P<0.001). At one week, the mean intensity for worst pain in the past 24 h was 5.2 (SD=2.9) and the usual pain intensity was 3.7 (SD=2.6). Using a cutoff point of pain greater than three on the zero to 10 visual analogue scale as residual pain at one week, 35% (n=207) remained in pain, with musculoskeletal pain accounting for half (n=102) of those cases. Logistic regression showed that the following patients were most likely to have pain at one week: women; those with pain present longer than 48 h before ED visit; those with a high discharge pain rating; those who were taking analgesics; and those who had pain of musculoskeletal origin. Both the attitudes and beliefs about pain and the treatment of pain while in the ED or on discharge were unrelated to the presence of residual pain at one week. An examination of the same factors in relation to the return to normal activities found that they were similar, with the exception that admission and not discharge pain intensity was predictive of not returning to normal activities.CONCLUSIONS: More than one‐third of patients presenting to the ED with pain do not experience resolution of their pain. Women presenting with severe musculoskeletal pain of more than a week in duration are less likely to have resolution of their pain and to return to normal activities within a week of the ED visit.
A Systematic Review of Risk Factors Associated with Near‐Fatal and Fatal Asthma
Authors: Alvarez GG , Schulzer M , Jung D , FitzGerald JM 
Published: March 2016

BACKGROUND: Asthma mortality and morbidity continue to be a serious global problem. Systematic reviews provide an opportunity to review risk factors in detail.OBJECTIVE: To review all of the literature for risk factors associated with near‐fatal asthma (NFA) and fatal asthma (FA).METHODS: A literature search from 1960 to January 2004 in MEDLINE and EMBASE was conducted. Studies were included based on the following criteria: NFA was defined as an asthma exacerbation resulting in respiratory arrest requiring mechanical ventilation or a partial pressure of CO2 of at least 45 mmHg or asthma resulting in death (FA); the study reported the number of cases (NFA and/or FA) and asthmatic controls; there was explicit reporting of risk factors; cases that were adult and pediatric in nature; and all study types. Studies that included patients with chronic obstructive pulmonary disease were excluded.RESULTS: Four hundred and three articles were identified, of which 27 met the inclusion criteria. Increased use of medications such as beta‐agonists via metered dose inhalers (OR=1.67, 95% CI 0.99 to 2.84, P=0.057) and nebulizers (OR=2.45, 95% CI 1.52 to 3.93, P=0.0002), oral steroids (OR=2.71, 95% CI 1.34 to 5.51, P=0.006) and oral theophylline (OR=2.02, 95% CI 1.03 to 3.98, P=0.04) and a history of hospital (OR=2.62, 95% CI 1.04 to 6.58, P=0.04) and/or intensive care unit (OR=5.14, 95% CI 1.91 to 13.86, P=0.001) admissions and mechanical ventilation (OR=6.69, 95% CI 2.80 to 15.97, P=0.0001) due to asthma were predictors of NFA and FA. Prior emergency department assessment did not confer a greater risk of NFA and FA (OR=1.13, 95% CI 0.43 to 2.92, P=0.810).The use of inhaled corticosteroids (ICS) measured in a dose‐independent fashion (did the patient take ICS previously; yes or no) inferred equivocal risk of NFA and FA (OR=1.31, 95% CI 0.83 to 2.05, P=0.25). However, two studies measured the use of ICS in a dose‐dependent fashion (ie, measured the number of prescriptions filled within the previous six to 12 months). Both studies showed a trend toward a protective effect against FA. One study showed that the premature cessation of ICS can hasten death.CONCLUSIONS: In the present study, risk factors of NFA and FA have been more accurately defined. Clinicians should identify patients with these characteristics to reduce their risk of NFA and FA. Further research should focus on quantifying the impact of risk factors on asthma deaths.
Enhanced Surveillance of non‐O157 Verotoxin‐Producing Escherichia coli in Human Stool Samples from Manitoba
Authors: Thompson Laura H , Giercke Sandra , Beaudoin Carole , Woodward David , Wylie John L 
Published: March 2016

BACKGROUND: Relatively few enhanced surveillance studies have been undertaken to investigate the extent to which verotoxin‐producing non‐O157 serotypes of Escherichia coli occur in stool samples received for the detection of verotoxin‐producing organisms.OBJECTIVES: To describe the prevalence, molecular and epidemiological characteristics, and geographical patterns associated with non‐O157 verotoxin‐producing E coli (VTEC) in Manitoba.RESULTS: Thirty‐two VTEC isolates consisting of 10 serogroups and 13 different serotypes were isolated over a 22‐month period. Twenty‐three isolates (71.8%) possessed verotoxin‐encoding gene stx1 only, five isolates (15.6%) possessed stx2 only, two isolates (6.3%) possessed both stx1 and stx2, and two isolates (6.3%) possessed stx2c. Only three instances of indistinguishable pulsed‐field gel electrophoresis patterns were identified. The age of the individuals from whom non‐O157 VTEC were isolated ranged from eight months to 87 years. Mean and median ages were 30 and 22 years of age, respectively. Some areas of the province appeared to experience a higher than expected number of non‐O157 E coli in comparison with the number of stools that were received from these areas.CONCLUSIONS: The present study demonstrated a large number of infections associated with non‐O157 VTEC in Manitoba. Most non‐O157 cases appear to result from sporadic infections, and these occur typically in rural areas. Continued enhanced surveillance is necessary to understand the temporal patterns of non‐O157 VTEC and the underlying epidemiological factors driving these patterns.
Risk Factors for New‐Onset Diabetes Mellitus in Patients Receiving Protease Inhibitor Therapy
Authors: Hughes Christine A , Cashin Richard P , Eurich Dean T , Houston Stan 
Published: March 2016

BACKGROUND: Metabolic complications including diabetes mellitus (DM) have been associated with protease inhibitor (PI) therapy. Risk factors for the development of DM are not well‐defined.OBJECTIVES: To determine risk factors for the development of new‐onset DM in patients initiated on PI therapy.METHODS: A retrospective cohort study was conducted to identify predictors of developing DM in subjects started on PI therapy between January 1997 and January 2003. Diabetes cases were defined as physician documentation of DM in the outpatient medical chart and/or those subjects receiving an antidiabetic agent. Logistic regression was used to examine the relationship between new‐onset DM and demographic characteristics, and between new‐onset DM and total treatment days with PI therapy. Body mass index could not be entered into the model due to missing height measurements.RESULTS: A total of 496 subjects on PI therapy were included, of which 18 (3.6%) developed DM. The mean age of the subjects was 43.4±9.4 years (range 19 to 77) and the mean duration of therapy was 3.0±1.9 years (range 0.17 to 7.9). In the multivariate model, older subjects were more likely to develop DM (OR 1.12, 95% CI 1.05 to 1.19; P=0.001). This corresponds to a 12% increased risk of DM for each one‐year increase in age. Subjects that weighed more had an increased risk (OR 1.06, 95% CI 1.03 to 1.10; P=0.001), as did those belonging to a non‐Aboriginal minority group when compared with Caucasians (OR 6.67, 95% CI 1.56 to 28.41; P=0.01). A longer duration of PI therapy was also significantly associated with developing DM (OR 1.52, 95% CI 1.07 to 2.17; P=0.02).CONCLUSION: A longer duration of PI therapy is associated with an increased risk of developing DM. As with HIV‐negative subjects, demographic characteristics such as age, weight and ethnicity were important predictors of developing DM in the present study.
Vibrio vulnificus Septicemia after Handling Tilapia Species Fish: A Canadian Case Report and Review
Authors: Vinh Donald C , Mubareka Samira , Fatoye Bunmi , Plourde Pierre , Orr Pamela 
Published: March 2016

BACKGROUND: Vibrio vulnificus can cause a necrotizing soft tissue infection or primary septicemia; these infections are collectively known as vibriosis. This bacterium is commonly found within molluscan shellfish. Primary septicemia is often fatal, principally affecting persons with chronic liver disease.CASE PRESENTATION: A fatal case of V vulnificus sepsis that developed in a patient with chronic hepatitis B and chronic renal failure is reported. Diagnosis was made by isolation of the pathogen by blood culture. Upon further questioning, the patient′s family recounted that the patient had handled and ingested Tilapia species fish in the hours preceding the patient′s presentation. Despite treatment with doxycycline and cefotaxime, in conjunction with supportive care in the intensive care unit, the patient died on day 7 from multiple organ dysfunction.CONCLUSION: The present case highlights the need to consider V vulnificus in the microbiological differential diagnosis when a person presents with sepsis and bullous cutaneous lesions. The importance of educating patients with liver disease (and certain other chronic diseases) about the need to be cautious when handling or consuming seafood is underscored.
The Association ofHelicobacter pyloriInfection and Nonsteroidal Anti-Inflammatory Drugs in Peptic Ulcer Disease
Authors: Zapata-Colindres Juan Carlos , Zepeda-Gómez Sergio , Montaño-Loza Aldo , Vázquez-Ballesteros Edgar , de Jesús Villalobos José , Valdovinos-Andraca Francisco 
Published: March 2016

BACKGROUND AND AIM: Peptic ulcer disease (PUD) affects 10% of the world population.Helicobacter pyloriinfection and the use of a nonsteroidal anti-inflammatory drug (NSAID) are the principal factors associated with PUD. The aim of the present study was to evaluate a cohort of patients with PUD and determine the association betweenH pyloriinfection and NSAID use.PATIENTS AND METHODS: The medical charts of patients with endoscopic diagnosis of PUD were retrospectively reviewed from September 2002 to August 2003. Patients were divided into three groups according to ulcer etiology:H pyloriinfection (group 1); NSAID use (group 2); and combinedH pyloriinfection and NSAID use (group 3).RESULTS: One hundred two patients were evaluated: 36 men (35.3%) and 66 women (64.7%). Forty patients hadH pyloriinfection, 43 had used NSAIDs and 15 had combinedH pyloriinfection and NSAID use; four patients with ulcers secondary to malignancy were excluded. The frequency of women was significantly higher in group 2 (P=0.01). The mean age of patients in group 1 was significantly lower than in the other two groups (P=0.003). PUD developed earlier in group 3 than in group 2 (5.0±4.7 months versus 1.4±2.1 months, respectively, P=0.018). Thirty-two patients (32.7%) had bleeding peptic ulcer. Group 2 had a higher risk of bleeding peptic ulcer than the other two groups (P=0.001).CONCLUSIONS: The development of PUD was observed earlier in the combinedH pyloriand NSAID group than in patients with only NSAID use. This suggests a synergic effect between the two risks factors in the development of PUD.
Predictors of Loss of Asthma Control Induced by Corticosteroid Withdrawal
Authors: Belda Jose , Parameswaran Krishnan , Lemière Catherine , Kamada Dennis , O′Byrne Paul M , Hargreave Frederick E 
Published: March 2016

BACKGROUND: Asthma guidelines recommend reducing the dose of inhaled corticosteroids after establishing control.OBJECTIVE: To identify predictors of loss of control and the kinetics of symptoms, and inflammatory and physiological measurements when inhaled corticosteroids are reduced in patients with stable asthma.PATIENTS AND METHODS: In a single‐blind study, the daily dose of inhaled corticosteroid was reduced by one‐half at intervals of 20±2 days in 17 adults with controlled asthma until loss of asthma control occurred or until the corticosteroid was replaced with placebo for 20 days. The patients recorded symptoms and peak expiratory flow each day, and forced expiratory volume in 1 s (FEV1), the provocative concentration of methacholine causing a 20% fall in FEV1 (PC20), exhaled nitric oxide, and eosinophils in sputum and blood were measured every 10 days. A loss of asthma control was defined as a worsening of the symptoms score of at least 20%, and either a decrease in FEV1 of at least 15% or a decrease in PC20 of at least fourfold.RESULTS: Two patients had a respiratory infection and were withdrawn from the study. In eight patients, asthma became uncontrolled after a mean of 33 days (range 13 to 48 days). This was accurately reflected by a worsening of all parameters. The first parameter to change was the sputum eosinophil percentage (20 days before the loss of asthma control). Significant changes in exhaled nitric oxide, FEV1 and methacholine PC20 were observed only when the symptoms became uncontrolled. A high blood eosinophil count at baseline (risk ratio of 2.5, 95% CI 1.0 to 6.5) and an increase in sputum eosinophil count after the reduction of corticosteroids were predictors of loss of asthma control.CONCLUSION: In patients whose asthma is controlled on inhaled corticosteroid, it is prudent not to reduce the dose further if the blood eosinophils are increased or if the sputum eosinophils increase by as little as 1% after the reduction of corticosteroids.
Acute Management and Secondary Prophylaxis of Esophageal Variceal Bleeding: A Western Canadian Survey
Authors: Cheung Justin , Wong Winnie , Zandieh Iman , Leung Yvette , Lee Samuel S , Ramji Alnoor , Yoshida Eric M 
Published: March 2016

BACKGROUND: Acute esophageal variceal bleeding (EVB) is a major cause of morbidity and mortality in patients with liver cirrhosis. Guidelines have been published in 1997; however, variability in the acute management and prevention of EVB rebleeding may occur.METHODS: Gastroenterologists in the provinces of British Columbia, Alberta, Manitoba and Saskatchewan were sent a self-reporting questionnaire.RESULTS: The response rate was 70.4% (86 of 122). Intravenous octreotide was recommended by 93% for EVB patients but the duration was variable. The preferred timing for endoscopy in suspected acute EVB was within 12 h in 75.6% of respondents and within 24 h in 24.6% of respondents. Most (52.3%) gastroenterologists do not routinely use antibiotic prophylaxis in acute EVB patients. The preferred duration of antibiotic therapy was less than three days (35.7%), three to seven days (44.6%), seven to 10 days (10.7%) and throughout hospitalization (8.9%). Methods of secondary prophylaxis included repeat endoscopic therapy (93%) and beta-blocker therapy (84.9%). Most gastroenterologists (80.2%) routinely attempted to titrate beta-blockers to a heart rate of 55 beats/min or a 25% reduction from baseline. The most common form of secondary prophylaxis was a combination of endoscopic and pharmacological therapy (70.9%).CONCLUSIONS: Variability exists in some areas of EVB treatment, especially in areas for which evidence was lacking at the time of the last guideline publication. Gastroenterologists varied in the use of prophylactic antibiotics for acute EVB. More gastroenterologists used combination secondary prophylaxis in the form of band ligation eradication and beta-blocker therapy rather than either treatment alone. Future guidelines may be needed to address these practice differences.
An Evaluation of Extended Incubation Time with Blind Subculture of Blood Cultures in Patients with Suspect Endocarditis
Authors: Forward Kevin R 
Published: March 2016

BACKGROUND: In a small proportion of patients, bacterial endocarditis is due to organisms that grow slowly and may not be recovered in conventional blood cultures incubated for five days. This has led to recommendations for prolonged incubation and routine subculture of negative cultures.OBJECTIVE: The above‐mentioned approach is evaluated.METHOD: The microbiology of all blood cultures subjected to prolonged incubation and the charts of individuals who had organisms recovered after five days were evaluated to determine their clinical significance.RESULTS: In all, 507 blood cultures were handled using an extended incubation and blind subculture protocol. Fifty‐three blood cultures in 27 patients were positive. Blood cultures were positive after five days in only five cases; patient outcomes were not affected by the results in any of these cases, although several fastidious organisms (ie, Haemophilus paraphrophilus and Haemophilus parainfluenzae) were recovered in the first five days of incubation.CONCLUSION: Prolonged incubation and blood subcultures in patients with suspected endocarditis or infections due to fastidious organisms do not represent a wise use of increasingly scarce resources.
Pain, Health‐Related Quality of Life and Health Care Utilization after Inpatient Surgery: A Pilot Study
Authors: VanDenKerkhof Elizabeth G , Hopman Wilma M , Towheed Tanveer , Wilson Rosemary , Murdoch John , Rimmer Michael , Stutzman Sherri Schmidt , Tod Debbie , Dagnone Vico , Goldstein David H 
Published: March 2016

BACKGROUND: Little is known about pain‐related outcomes in surgical inpatients after discharge from the hospital. An ongoing risk and outcomes monitoring system would provide valuable feedback to improve the quality of patient care.OBJECTIVES: The purpose of the present pilot study was to describe postoperative pain, medication use, health care utilization and health‐related quality of life (HRQOL) immediately and four weeks after surgery; merge clinically captured data with Web‐based follow‐up data; and examine patients’ willingness to complete Web‐based health questionnaires.METHODS: One hundred two consecutive surgical inpatients were approached for participation. Perioperative data were abstracted from the acute pain management service clinical database and linked to follow‐up data captured four weeks postoperatively.RESULTS: Follow‐up questionnaires were completed by 88 participants. Clinical assessment data were successfully linked to Web‐based follow‐up data. Average pain intensity (3.7) four weeks following discharge fell just short of the acute pain management service active pain score of 3.9. At four weeks, all 88 participants reported significantly impaired HRQOL, 36 were still taking pain medications and 15 had visited an emergency room. Two‐thirds of the participants had access to the Internet at home and approximately one‐half were willing to complete on‐line health questionnaires.DISCUSSION: The study indicates that it is feasible to link clinical and research data, and shows a significant burden of pain and reduced HRQOL in the weeks following discharge. This approach to converting clinically captured data into meaningful information about surgical outcomes is valuable in the development of an ongoing risk and outcomes monitoring system.
HIV Testing among Canadian Tuberculosis Cases from 1997 to 1998
Authors: Harris Tara , Panaro Linda , Phypers Melissa , Choudhri Yogesh , Archibald Chris P 
Published: March 2016

BACKGROUND: Recent evidence suggests a global rise in adult tuberculosis (TB) cases associated with HIV/AIDS. The World Health Organization, the United States Centers for Disease Control and Prevention, and the Public Health Agency of Canada advocate universal screening of all TB cases for HIV. The contribution of HIV to the TB burden in Canada remains unclear.METHODS: A retrospective cohort study was conducted of all TB cases reported in Canada from 1997 to 1998. The aim was to determine the proportion of patients that had an HIV test on record, and of these, the number of patients infected with HIV.RESULTS: From 1997 to 1998, 3767 TB cases were reported to the national TB surveillance system. In the present study, 3416 case records (90.7%) were included. The number of cases with a record of an HIV test was 736 (21.5%), and of these, 41.2% were tested within one month of TB diagnosis. Among the 703 cases with known HIV test results, the prevalence of HIV infection was 14.7%. Cases with an HIV test on record were more likely to have one or more risk factors for HIV, and also were more likely to be male, aged 15 to 49 years, of Aboriginal ethnicity, and to have smear‐positive TB and both pulmonary and extrapulmonary disease at the time of diagnosis.DISCUSSION: These results suggest that HIV testing of TB patients is not universal, but rather selective, and is likely based on perceived risk factors for HIV as opposed to TB diagnosis alone.