bluuebunny/crossref_metadata_2025_split huggingface dataset:
Utility of Gastric Aspirates in Screening for Pulmonary Tuberculosis in High Risk Subjects: The Manitoba Experience
Authors: Bahammam A , Choudhri SH , Long R 
Published: March 2016

BACKGROUND: Although gastric aspirates (GA) are one of the recommended screening procedures for asymptomatic individuals at high risk for developing tuberculosis (TB), little data exist on the utility of GA for this indication.OBJECTIVE: To determine the utility of GA as a screening tool in asymptomatic subjects who are at high risk for developing pulmonary TB.PATIENTS AND METHODS: The study population’s clinical, radiographical and Mantoux skin test findings were correlated with a laboratory database of all patients who underwent GA in 1994. Subjects included in the study were those at high risk of developing TB, ie, immigrants placed under surveillance for TB postlanding in Canada (surveillance foreign‐born), other foreign‐born individuals from high prevalence countries, Status Indians and close contacts of patients with active pulmonary TB.RESULTS: Four hundred and twelve GAs were performed in 318 patients. Complete data were available in 243 patients. Canadian‐born persons who were not Status Indians and foreign‐born persons from nonendemic areas (n=37) were excluded. The remaining 206 patients had 261 GAs performed (1.27±0.7 per subject). This group consisted of surveillance foreign‐born (n=57), other foreign‐born (n=110) and Status Indians (n=39). Fifty‐three (26%) were symptomatic and 153 (74%) were asymptomatic. Ninety‐eight had a normal chest radiograph, and 108 had an abnormal chest radiograph. Fourteen subjects (26%) in the symptomatic group had Mycobacterium tuberculosis isolated from their GA versus one (0.65%) in the asymptomatic group (P<0.001). One subject (1%) in the normal chest radiograph group versus 14 (12%) in the abnormal chest radiograph group (P=0.005) had M tuberculosis isolated from their GA. Thirty‐six subjects were both symptomatic and had abnormal chest radiographs. In this group, 12 (33%) had M tuberculosis isolated from their GA, while none of the patients who were asymptomatic and had normal chest radiographs had a positive M tuberculosis culture. There was no difference in the yield of GA between Mantoux skin test‐positive and Mantoux skin test‐negative groups.CONCLUSIONS: GAs have a low yield when used to screen asymptomatic high risk subjects. The results suggest that screening of asymptomatic individuals or those with normal chest radiographs may not be warranted. This will spare many asymptomatic subjects the discomfort of undergoing the procedure and produce a significant cost saving.
Antibiotic and Oral Contraceptive Drug Interactions: Is There a Need for Concern?
Authors: Zhanel George G , Siemens Shannon , Slayter Kathryn , Mandell Lionell 
Published: March 2016

OBJECTIVE: To assess the clinical significant of antibiotic and oral contraceptive drug interactions.DATA SELECTION: MEDLINE search from 1975 to 1998 (September) inclusive. Search terms ‘antitiobic’, ‘oral contraceptive’ and ‘pregnancy’ were included. Published papers as well as references from these papers were reviewed. Papers documenting mechanistic interactions between antibiotics and oral contraceptives were included.DATA EXTRACTION: Studies reporting oral contraceptive pharmacokinetics, mechanisms, incidence, implicated antibiotics and clinical consequences of antibiotic/oral contraceptive drug interactions.DATA SYNTHESIS: Reports of oral contraceptive failure seem to be most numerous in women using preparations containing 30 μg of ethinylestradiol and 150 μ g of levonorgestrel. Rifampin is the only antibiotic that has been reported to reduce plasma estrogen concentrations. When taking rifampin, oral contraceptives cannot be relied upon and a second method of contraception is mandatory. Amoxicillin, ampicillin, griseofulvin, metronidazole and tetracycline have been associated with contraceptive failure in three or more clinical cases. When these agents are used, the clinician should discuss the available data with the patient and suggest a second form of birth control. Other antibiotics are most likely safe to use concomitantly with oral contraceptives.CONCLUSIONS: Rifampin is the only antibiotic to date that has been reported to reduce plasma estrogen concentrations. Oral contraceptives cannot be relied upon for birth control while taking rifampin.
Prevalence of Gastroesophageal Reflux in Infants with Recurrent Brief Apneic Episodes
Authors: Sheikh Shahid , Stephen Thomas C , Sisson Barbara 
Published: March 2016

BACKGROUND: Apnea in an infant can be a diagnostic dilemma for the treating pediatrician. It is suggested that in some infants, gastroesophageal reflux (GER) might be a factor in the pathogenesis of apnea, although its role as a cause of apnea is still controversial.OBJECTIVE: To evaluate the prevalence of GER in infants presenting with recurrent brief apneic periods.PATIENTS AND METHODS: A retrospective review of the medical records of all the infants who underwent prolonged esophageal pH studies for brief apneic episodes (n=105) at the Kosair Children’s Hospital in the six years from January 1992 to December 1997 was performed. Infants presenting with apparent life‐threatening episodes were excluded.RESULTS: Of 105 infants, 72 (68.6%) were younger than two months of age and 22 (21%) were born preterm. Fifty of 105 infants (47.6%) had positive esophageal pH studies for acid reflux. Among infants with positive pH studies, only 21 (42%) had associated gastrointestinal or feeding complaints.CONCLUSION: GER is present in a large number of infants presenting with brief apneic episodes. Though the relationship between the two is still not fully established, GER may be a significant risk factor for such apneic episodes in infants.
Spectroscopic Approach to Capillary‐Alveolar Membrane Damage Induced Acute Lung Injury
Authors: Wang Jing , Oppenheimer Luis , Fata Paola , Pintin Julio , Stimpson Ross , Mantsch Henry H 
Published: March 2016

BACKGROUND: Acute (or adult) respiratory distress syndrome (ARDS) is often associated with a high mortality rate in the critical care population. The term acute lung injury (ALI), a primitive phase of ARDS, was introduced by the European and American consensus groups to provide early diagnoses of ARDS. The pathophysiological characterization of ALI/ARDS – an increased pulmonary capillary‐alveolar membrane barrier permeability – is generally not included in current intensive care unit diagnosis criteria.OBJECTIVES: To apply the infrared (IR) spectroscopic technique, in combination with the administration of hydroxyethyl starch (HES), to patients with ALI and ARDS.PATIENTS AND METHODS: This retrospective study involved 67 patients from the intensive care unit at the Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba. The methodology was based on the IR spectroscopic determination of HES in patient’s bronchial washing fluid. Exaggerated infiltration of HES into the alveolar space was taken as evidence of damage to the pulmonary capillary‐alveolar membrane, which in turn provided a diagnosis of ALI/ARDS.RESULTS: The accuracy of determining pulmonary HES leakage in severe lung injury (Partial pressure of arterial oxygen/fraction of inspired oxygen [PaO2/FiO2] less than 100 mmHg [n=10]), was 100%. The subgroups with PaO2/FiO2 between 100 and 200 mmHg (n=23), and PaO2/FiO2 between 200 and 300 mmHg (n=22), 56.5% and 77.3%, respectively, showed IR positive for HES leakage.CONCLUSIONS: The proposed IR bronchial washing assay is very sensitive in determining the pulmonary HES leakage in severe lung injury. It is also suitable for evaluating pulmonary leakage at an early phase of the injury, a fact that is particularly important for supportive treatment. The method is advantageous because no radioactive tracers are employed, little sample preparation is required, and it is rapid and minimally invasive, making it convenient to use in the critical care environment.
Inhaler Education for Hospital‐Based Pharmacists: How Much Is Required?
Authors: Jackevicius Cynthia Anne , Chapman Kenneth R 
Published: March 2016

OBJECTIVE: To compare the effectiveness of a more intensive educational intervention with a less intensive intervention on the ability of hospital pharmacists to be prepared to educate patients regarding inhaled device technique.DESIGN: Randomized controlled trial. Inhaler technique and knowledge were assessed pre‐education, immediately after and three months after education by a research assistant blinded to the educational allocation.SETTING: Tertiary hospital pharmacy department.POPULATION STUDIED: Hospital‐based pharmacists.INTERVENTION: A 1 h ‘hands‐on’ session with feedback (more intense education, MIE) or written materials describing inhaler use (less intense education, LIE).MAIN RESULTS: The change in overall score from pre‐education to early posteducation for MIE was greater than for LIE (mean [95% CI]) (2.64 [1.27 to 4.01] versus 1.26 [0.05 to 2.47], P<0.001). Assessment scores improved for all device demonstrations and general knowledge. The change in score from the pre‐education to the late posteducation period was only slightly higher in the MIE group than the LIE group, a difference that was not statistically significant (1.78 [0.82 to 2.74] versus 1.22 [0.06 to 2.39], P=0.09). Scores in both groups were lower in the late posteducation period compared with the early posteducation period. Greater increases in total score in the immediate posteducation period were associated with a low baseline score and the MIE intervention.CONCLUSION: Individual coaching in inhaler technique produces greater improvement in inhaler knowledge among hospital pharmacists than provision of written materials. However, the advantage of the more intensive intervention was short‐lived, with little advantage evident in three months.
Neonatal and Maternal Postpartum Bacteroides Bacteremia
Authors: Zaker Nahid , Lertzman Joy , Embree Joanne 
Published: March 2016

OBJECTIVE: A unique case of Bacteroides fragilis bacteremia in a mother and her infant prompted a review of these infections in neonates and postpartum mothers during a five‐year period at two institutions in Winnipeg, Manitoba. The purpose was to determine the frequency of these infections and ascertain commonly associated factors.METHODS: Infants and postpartum mothers diagnosed with bacteroides bacteremia were identified from laboratory records in both hospitals, and their medical charts were retrospectively reviewed.RESULTS: Bacteroides species were isolated in 10 maternal and four neonatal blood cultures. This represented 8.1% of the positive maternal and 1.2% of the positive neonatal blood cultures obtained during the review. The incidence of maternal infection was 2.56/10,000 deliveries, while that of neonatal infection was 1.03/10,000 live births. Postpartum fever and emergency caesarean section were often noted with maternal postpartum bacteroides bacteremia, while fetal distress, low Apgar scores and respiratory distress were frequent in neonatal bacteremia.CONCLUSION: Postpartum bacteroides bacteremia should be suspected among women with postpartum fever after emergency caesarean section. However, the occurrence of postpartum fever following emergency caesarian section is not necessarily associated with neonatal bacteroides bacteremia. Neonatal bacteroides bacteremia may not be readily suspected on clinical grounds, so clinicians should ensure that the laboratory procedures routinely used to evaluate neonatal bacteremia at their institutions reliably detect these organisms.
Determinants of Tuberculin Reactivity among Health Care Workers: Interpretation of Positivity following BCG Vaccination
Authors: Mckay Andrew , Kraut Allen , Murdzak Carol , Yassi Annalee 
Published: March 2016

OBJECTIVE: To determine the extent to which a history of Bacille Calmette‐Guerin (BCG) vaccination influences the likelihood of positive tuberculin skin test (TST) results.DESIGN: Cross‐sectional survey using a hospital‐based tuberculosis surveillance program.SETTING: Health Sciences Centre, a tertiary care hospital in Winnipeg, Manitoba.METHODS: The 476 health care workers (HCWs) who had TST as part of the surveillance program between 1993 and 1997 constituted the study population. The two‐step test was done in 91% of the participants who did not have a positive initial test, defined as 10 mm or greater of induration. Data were gathered through chart review supplemented by a short questionnaire administered to the HCWs.MAIN RESULTS: One hundred and thirty‐eight HCWs (29%) had a positive TST. In a stepwise, multiple logistic model controlling for age, sex, job title, work area, age of receiving BCG, time since BCG and duration of employment, only a history of BCG vaccination (odds ratio [OR] 22; 95% CI 12 to 41) and birth outside of Canada (OR 2.6; 95% CI 1.4 to 5.8) were significantly associated with a positive TST. When the definition of a positive TST was modified by increments of 1 mm, from 10 mm up to 20 mm of induration in BCG recipients, BCG was associated with positive reactions with indurations up to 19 mm but not 20 mm or greater. The OR declined with each increment. Of the 84 HCWs who were documented to have at least 20 years between BCG vaccination and testing, 41 (49%) had positive reactions.CONCLUSIONS: BCG vaccination can produce lasting tuberculin reactivity, and indurations of 19 mm or less may be due to the effects of the vaccine.
Health Care Costs Associated with Acute Asthma: A Prospetive Economic Analysis
Authors: Behbehani Naser Awadh , Grunfeld Anton , FitzGerald J Mark 
Published: March 2016

OBJECTIVE: To determine the direct and indirect costs associated with the care of acute asthma in an adult teaching hospital.DESIGN: A prospective, cost identification study.PATIENTS AND METHODS: Patients aged 15 to 55 years presenting with acute asthma. Consecutive emergency department visits for asthma at Vancouver Hospital and Health Sciences Centre over six months were prospectively monitored. The duration of hospital stay, physician?s care, laboratory procedures and medication given were recorded. Time lost from work or school was determined by follow‐up telephone calls. The costs were calculated in 1997 Canadian dollars.RESULTS: One hundred and forty‐nine patients made 195 emergency department visits over the six‐month study. Twenty‐eight (14%) of these visits led to hospital admissions. The total cost associated with the care of these patients was $250,570. The median (standard deviation in brackets) direct medical costs associated with each emergency department visit and hospital day were $324.00 (±52.00) per visit, and $677.00 (±76.00) per day, respectively.CONCLUSION: The present study provides a more accurate estimation of the operational cost of managing asthma in a teaching hospital setting than previous studies. The data presented in this study can be used in future cost effectiveness and cost‐benefit studies in acute asthma, particularly where these studies involve specific intervention such as asthma education. More studies, which include children with asthma and patients treated outside of the hospital setting, are needed.
Hospitalization due to Adverse Drug Reactions and Drug Interactions before and after HAART
Authors: Foisy Michelle M , Gough Kevin , Quan Corinna M , Harris Kevin , Ibanez Dominique , Phillips Anne 
Published: March 2016

OBJECTIVE: To characterize and compare the rates of adverse drug reactions (ADRs) and interactions on admission in two, one‐year periods: pre‐highly active antiretroviral therapy (HAART) (phase 1) and post‐HAART (phase 2).DESIGN: Retrospective chart review.SETTING:University‐affiliated tertiary care centre.POPULATION STUDIED: HIV‐positive patients admitted to hospital.MAIN RESULTS: In phase 1, 436 of 517 admissions, and, in phase 2, 323 of 350 admissions were analyzed. Over 92% of patients were male, with a mean age of 38 years. Significant differences (P<0.05) in the mean length of stay (12.08 versus 10.02 days), the CD4 counts (99.25 versus 129.45) and the number of concurrent diseases (4.20 versus 3.63) were found between phase 1 and 2, respectively. The mean number of medications taken (5.52 versus 5.94) and the rates of hospitalization with ADRs (20.4% versus 21.4%) or interactions (2.5% versus 2.16%) were similar between the two phases. Antiretrovirals were more common in ADR admissions post‐HAART (21.3% versus 36.2%), while antiparasitics, psychotherapeutics and antineoplastics were more common pre‐HAART. Other classes of drugs involved in both phases were sulphonamides, narcotics, ganciclovir, foscarnet, antimycobacterials and antifungals. ADR causality was possible or probable in more than 80% of cases. Over 60% of ADRs were grades 3 to 4, and about 85% were either the main or contributing reason for admission. About 65% of patients had at least partial recovery at the time of discharge. In phases 1 and 2, 8.9% and 2.9% of admissions,respectively, with ADRs were fatal.CONCLUSIONS: Although hospitalizations with ADRs and interactions were similar in both phases, HAART therapy has had a significant impact on the incidence and nature of ADRs at St Michael?s Hospital, Wellesley Central Site, Toronto, Ontario.
Varicella Susceptibility in a Canadian Population
Authors: Ratnam Sam 
Published: March 2016

OBJECTIVE: To determine susceptibility to varicella zoster virus (VZV) infection among children, pregnant women and health care workers in Newfoundland.DESIGN: Cohort and cross‐sectional, province‐wide, population‐based seroprevalence study.STUDY POPULATION AND METHODS: A cohort of 586 children aged one year, a cross‐sectional group of 1135 school children aged five to 15 years, 3643 pregnant women aged 15 to 45 years, and 5386 persons in health care settings aged 15 to 55 years. Susceptibility to varicella was determined by enzyme immunoassay based on serum antibody to VZV.RESULTS: Among the cohort of 586 children, 565 (96.4%) did not have detectable VZV antibody at one year of age. The proportion with VZV antibody increased thereafter to 12.8% and 33.9%, respectively, at age two and four years, indicating the extent of exposure to VZV at these ages. Among the 1135 school‐age children, the proportion testing positive for VZV antibody increased from 44% at five years of age to 88.9% at 15 years of age, indicating the cumulative incidence of varicella in this age group. Among pregnant women, 92.1% tested positive for VZV antibody, and the corresponding figure for the health care group was 93.1%. In both groups, the proportion testing positive for VZV antibody increased with advancing age, from 89.6% for the 15‐ to 19‐year age group to 96.5% for those over the age of 40 years.CONCLUSIONS: The risk of VZV infection increases steadily from one year of age, reaching a peak during school years. The study data support the recent Canadian recommendation to vaccinate any person older than 12 months of age who is susceptible to VZV. Among the adult population, the proportion susceptible will be under 10% for the foreseeable future, and for those at risk, selective vaccination based on their immune status would be a cost effective approach.
Protective Effects of Fluticasone on Allergen‐Induced Airway Responses and Sputum Inflammatory Markers
Authors: Parameswaran Krishnan , Inman Mark D , Watson Rick M , Morris Marilyn M , Efthimiadis Ann , Ventresca Pietro G , Lam Raymond , O′Byrne Paul M , Hargreave Frederick E 
Published: March 2016

BACKGROUND: A direct comparison of the protective effects of single and regular doses of inhaled glucocorticoid on allergen‐induced asthmatic responses and inflammation has not been made.OBJECTIVE: To compare the effects of pretreatment with fluticasone 250 µg 30 min before allergen inhalation and two weeks of 250 µg twice daily (last dose 24 h before challenge) with single and regular (twice daily) placebo doses on early and late asthmatic responses, induced sputum cell counts and measures of eosinophil activation at 7 h and 24 h, and methacholine airway responsiveness at 24 h.PATIENTS AND METHODS: Ten mild asthmatic patients were studied in a randomized, double‐blind, placebo controlled crossover study.RESULTS: Regular fluticasone increased the baseline mean provocative concentration of methacholine to cause a 20% fall (PC20) in forced expiratory volume in 1 s (FEV1) from 2.6 to 6.4 mg/mL (P<0.05) and lowered the eosinophil count from 3.1% to 0.4% (P<0.05) compared with regular placebo. Neither single nor regular fluticasone had any effect on the early asthmatic response. Single fluticasone attenuated the late asthmatic response, the mean ± SEM maximum percentage fall in FEV1 (10.8±3.6 compared with single placebo 18.8±3.5, P=0.03), the allergen‐induced increase of airway responsiveness (P<0.05), and the eosinophilia (P<0.005) and activated eosinophils at 7 h (P<0.01) but not at 24 h. Regular fluticasone also attenuated the late asthmatic response (11.1±2.5) compared with regular placebo (19.6±4.5), but this was not statistically significant and did not protect against the induced increase in airway responsiveness or the sputum eosinophilia.CONCLUSION: Two weeks of regular inhaled fluticasone discontinued 24 h before allergen challenge does not offer any additional protection against the early or late asthmatic responses, increased airway responsiveness or sputum eosinophilia compared with a single dose of 250 µg immediately before allergen challenge, despite increasing baseline PC20 and decreasing sputum eosinophilia prechallenge. The significance of the protective effect of a single dose of inhaled steroid before an allergen inhalation and the duration of the protective effect need further investigation.
Outpatient Antibiotic Therapy and Short Term Mortality in Elderly Patients with Chronic Obstructive Pulmonary Disease
Authors: Sin Don D , Tu Jack V 
Published: March 2016

OBJECTIVES: To determine the association between outpatient use of oral antibiotics and 30‐day all‐cause mortality following hospitalization in a group of elderly chronic obstructive pulmonary disease (COPD) patients.DESIGN: A population‐based retrospective cohort study.SETTING: Ontario, Canada.POPULATION STUDIED: All 26,301 patients, 65 years of age or older, who were hospitalized for COPD between 1992 and 1996 in Ontario.METHODS: All elderly patients admitted at least once with a most responsible diagnosis of COPD using the Canadian Institute for Health Information database were identified. They were then linked to the Ontario Drug Benefit database to determine the use of antibiotics within 30 days of the index hospitalization and to the Ontario registered persons database to determine the 30‐day mortality following their index hospitalization.RESULTS: Outpatient use of antibiotics within 30 days before the index hospitalization was associated with a significant reduction in the 30‐day mortality following hospitalization (odds ratio [OR] 0.83, 95% CI 0.75 to 0.92). Use of macrolides had the lowest relative odds for mortality (OR 0.58, 95% CI 0.47 to 0.73), while use of fluoroquinolones had the highest relative odds (OR 0.98, 95% CI 0.84 to 1.15).CONCLUSIONS: Use of antibiotics before hospitalization was associated with a significant reduction in the risk of short term mortality among a group of elderly COPD patients who eventually required hospitalization for their disease. These findings support the early use of antibiotics in COPD patients who experience an acute exacerbation.