bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical Treatment of Chronic Thromboembolic Pulmonary Hypertension
Authors: Rubens Fraser , Wells Phil , Bencze Steven , Bourke Michael 
Published: March 2016

BACKGROUND: There are only limited treatment options for patients with chronic thromboembolic pulmonary hypertension in Canada.OBJECTIVE: To conduct a case‐series study to assess the effectiveness of surgical endarterectomy of the pulmonary artery.DESIGN AND SETTING: Twenty‐one patients with chronic thromboembolic pulmonary hypertension were admittedfor surgery between July 1995 and October 1999. Clinical, laboratory and radiological data were collected for all patients who then underwent pulmonary thromboendarterectomy.MAIN RESULTS: Thirteen men and eight women between 22 and 71 years of age underwent surgery. The main presenting complaint was dyspnea on exertion. Pulmonary vascular resistance ranged from 382 to 1694 dynes·s·cm-5 with a mean of 765±372 dynes·s·cm-5 (normal is less than 180 dynes·s·cm-5) with a mean cardiac index of 2.2±0.9 L/min/m2. Two patients had concomitant tricuspid valve replacement and one patient had coronary bypass grafting. In three cases, the surgery involved a repeat sternotomy. After surgery, there was a significant drop in the pulmonary vascular resistance (208±92 dynes·s·cm‐5, P<0.05) and a concomitant rise in the cardiac index to a mean of 3.1±0.6 L/min/m2 (P<0.05). There was one death in a patient who also had severe chronic obstructive pulmonary disease. Of the remaining patients, all but two showed significant clinical improvement. Spiral computed tomography postsurgery demonstrated improvement in pulmonary perfusion with either complete clearing or significant improvement in the mosaic perfusion pattern. Right ventricular function and pressure on echocardiogram improved in all but two patients.CONCLUSIONS: Pulmonary thromboendarterectomy provides effective treatment for chronic thromboembolic pulmonary hypertension.
TNF‐α Dysregulation in Asthma: Relationship to Ongoing Corticosteroid Therapy
Authors: Waserman Susan , Dolovich Jerry , Conway Mary , Marshall Jean S 
Published: March 2016

BACKGROUND: Tumour necrosis factor‐alpha (TNF‐α) is a major proinflammatory cytokine that is thought to be important in the pathogenesis of asthma. However, alterations in systemic regulation of this cytokine in asthma have not been examined in the context of corticosteroid therapy.OBJECTIVES: To examine the ability of peripheral blood mononuclear cells (PBMC) from three different groups of patients with asthma requiring varying amounts of inhaled corticosteroids (ICS) for clinical control, and to examine cells from age‐ and sex‐matched nonasthmatic patients to produce TNF‐α.DESIGN: All patients with asthma had a positive methacholine challenge test. ′High dose′ ICS patients with asthma required ICS greater than or equal to 800 µg/day. ′Medium dose′ patients with asthma were on less than or equal to 500 µg/day of ICS, whereas ′no ICS′ patients with asthma had received no ICS for at least three months. Each patient with asthma was examined in parallel with an age‐ and sex‐matched, nonasthmatic, nonatopic control subject. Cells were cultured (with or without the addition of potential stimulators phytohemagglutinin, lipopolysaccharide, formyl‐methionine‐leucine‐phenylalanine or antihuman CD3), and TNF‐α production was assessed by ELISA.MAIN RESULTS:PBMC from both high dose ICS (n=8) and no ICS (n=11) patients with asthma produced more than twice the amount of TNF‐α than cells from matched nonasthmatic control patients (P<0.01) when cultured alone or in the presence of each stimulus (P<0.05). In contrast, there was no significant difference in TNF‐α production between medium dose ICS patients with asthma and control patients. A group of asymptomatic atopic patients (n=6) did not have an increased level of TNF‐α production.CONCLUSIONS: Increases in TNF‐α production within the PBMC compartment can be observed in both patients with asthma receiving high dose ICS and in a group of patients with mild asthma receiving no ICS therapy, but not in patients with asthma receiving a medium dose of ICS or atopic patients.
Pharmacokinetic Interaction between Zidovudine and Trimethoprim/sulphamethoxazole in HIV‐1 Infected Children
Authors: Dallas Shannon , Read Stanley E , King Susan , Koren Gideon , Bendayan Reina 
Published: March 2016

OBJECTIVE: To evaluate the effect of the antimicrobial agent trimethoprim/sulphamethoxazole (TMP/SMX) on the pharmacokinetic properties of the antiretroviral drug zidovudine (ZDV).DESIGN: This single dose, open label, crossover study involved the oral administration of ZDV (150 mg/m2) alone and in combination with oral TMP/SMX (2.5 mg/kg) on two separate occasions. Serial blood samples (0 to 8 h) were collected, and concentrations of ZDV and its glucuronide metabolite were quantified using a radioimmunoassay. ZDV pharmacokinetics were determined by noncompartmental analysis.PATIENTS AND SETTING: Six HIV‐1 infected children aged four months to five years were recruited from the HIV clinic at The Hospital for Sick Children, Toronto, Ontario. Only three patients completed both study phases and were included in the pharmacokinetic analysis.MAIN RESULTS: With TMP/SMX therapy, no statistically significant changes were observed in ZDV pharmacokinetic parameters. However, there was a trend towards increased ZDV half‐life and area under the concentration versus time curve, as well as decreased apparent oral clearance. Similarly, a trend towards an increased half‐life of the ZDV‐glucuronide metabolite was also observed.CONCLUSION: The changes in ZDV pharmacokinetics in the presence of TMP/SMX did not reach statistical significance, most likely due to the limited number of patients involved. Despite the limited data, a possible interaction between ZDV and TMP/SMX in young HIV‐1 infected children should be considered, and patients may require close clinical monitoring.
Intravenous Sedation for Control of Distress during Lumbar Punctures for Pediatric Cancer Patients
Authors: Ellis Jacqueline , McCarthy Patricia , Gosselin Pierre , Splinter William 
Published: March 2016

OBJECTIVE: To compare the sedative and amnestic effects, the rapidity of recovery, and the adverse effects of midazolam and propofol for intravenous sedation. The focus of this paper is the effects of intravenous sedation on distress, the acceptability to parents of this intervention for helping their children cope with painful procedures and the utility of an intravenous sedation program administered by an anesthetist.PATIENTS AND METHODS: Twenty six children were randomly assigned to intravenous sedation with either midazolam or propofol as the first drug received. Self‐report measures of anxiety and fear were assessed before and 30 min after the lumbar puncture (LP). Self‐report of pain was also assessed 30 min post‐LP. The children were videotaped during the LP, and the tapes were coded for pain and negative emotion using the Emotion Facial Action Coding System. One parent completed the acceptability questionnaire while the child was in the recovery room.RESULTS: Only three children indicated pain on the Visual Analogue Scale, and two children had facial expressions indicative of pain during the LP. Fear and anxiety differed as a function of procedure order, and children were more fearful and anxious before the first sedated LP than the second. Intravenous sedation was highly acceptable to parents, and neither drug was considered superior.CONCLUSIONS: Intravenous sedation with either propofol or midazolam, in combination with analgesia, was effective for alleviating pain and emotional distress associated with LPs. Although children were told that the sedation would make them relaxed and sleepy, they remained somewhat fearful until they experienced a comfortable LP. The benefits of an anesthetist‐administered intravenous sedation program are discussed.
How Nova Scotia General Practitioners Choose Antibiotics for the Empirical Treatment of Community‐Acquired Pneumonia
Authors: Pendergrast Jacob , Marrie Thomas J 
Published: March 2016

OBJECTIVE: To gain an understanding of how physicians in general practice choose antibiotics for the empirical treatment of community‐acquired pneumonia (CAP).DESIGN: Questionnaire with three sample cases of CAP and a knowledge assessment (mailed to half of the physicians).POPULATION STUDIED: Nova Scotia family physicians.RESULTS: One hundred and eighty‐four of the 841 (21.9%) physicians who were mailed a questionnaire responded. A knowledge assessment showed satisfactory knowledge except in two areas ‐ an overestimation of the prevalence of penicillin‐resistant Streptococcus pneumoniae in Nova Scotia and the view that ciprofloxacin was an effective antibiotic for the treatment of CAP (42% of physicians). As the complexity of the case increased, there was decreasing consensus regarding the choice of antibiotic therapy and a decline in prescribing according to guidelines for the treatment of CAP. Also, as the complexity of the cases increased, it became increasingly difficult to discern a decision‐making strategy. For the simplest case ‐ a 17‐year‐old male with presumed Mycoplasma pneumoniae pneumonia ‐ physician factors (age, family practice training), desire to target specific pathogens, and concern with resistance and side effects affected the choice of antibiotic. However, for the most complex case ‐ a 45‐year‐old female with severe pneumonia ‐ familiarity with such a case was the only significant factor and led to treatment with a combination of antibiotics designed to treat both typical and atypical pathogens.CONCLUSIONS: For uncomplicated cases of CAP, physician factors, desire to treat specific pathogens and concern with resistance affect the choice of antibiotic therapy. For complex cases, familiarity with such cases was the only factor that influenced choice of antibiotic therapy.
Predictors for Multiple Hospital Admissions in Children with Asthma
Authors: Gürkan Fuat , Ece Aydin , Haspolat Kenan , Derman Orhan , Bosnak Mehmet 
Published: March 2016

BACKGROUND: Asthma is one of the most frequent causes of preventable hospital admissions among children.OBJECTIVES: To identify preventable risk factors for future hospital admissions. Some of the environmental and patient characteristics of children who were hospitalized more than once with an acute asthma attack were investigated.DESIGN, SETTING AND PATIENTS: An analysis was performed of 140 children with asthma, aged three to 15 years, admitted to the Department of Pediatrics at Dicle University Hospital, Diyarbakir, Turkey, over three years, followed for a maximum of 48 months. Associations between hospital admissions and probable predictors (clinical findings, laboratory studies and a detailed case history) were analyzed.RESULTS: The asthma admissions were higher in boys than in girls (male to female ratio 1.86). Of 140 children, 30 (21.4%) had multiple admissions, defined as a mean of more than one admission per year during the follow‐up period. The following factors were associated significantly with the frequency of hospital admission for asthma attacks when analyzed using a X2 test: indoor cigarette smoking (odds ratio [OR] 2.55), maternal smoking (OR 4.05), symptoms of dermal atopy (OR 2.96), symptoms of allergic conjunctivitis (OR 2.68), age less than five years (OR 5.12) and use of inhaled corticosteroids during the follow‐up (OR 0.37). With multivariate logistic regression analysis, among other factors, only maternal smoking (r=0.29, P=0.017) and age less than five years (r=‐0.32, P=0.012) were significant effective factors for the multiple hospital admissions. No significant association with the frequency of hospital admission was found for sex, serum total immunoglobulin E, history of frequent upper respiratory tract infections or number of family members.CONCLUSIONS: Prevention of indoor smoking, especially maternal smoking, may be effective in decreasing hospital admissions in children with asthma. Children less than five years of age are more likely to be hospitalized than are children five years of age or greater.
Hospital Room or Treatment Room for Pediatric Inpatient Procedures: Which Location Do Parents and Children Prefer?
Authors: Fanurik Debra , Schmitz Michael L , Reach Kelle , Haynes Katherine , Leatherman Isabel 
Published: March 2016

OBJECTIVE: The acute pain management guidelines put forth by the Agency for Health Care Policy and Research recommend that inpatient pediatric procedures be performed in a treatment room rather than in a child′s hospital room. However, hospitals vary widely in their use of treatment rooms for pediatric procedures. Because there has been little empirical investigation of this clinical issue, the present study explores the preferences of parents and children regarding the performance site of inpatient procedures.SUBJECTS AND METHODS: One hundred and sixty parents of hospitalized children three to 14 years of age were interviewed about previous experience with medical procedures, procedure site preference (treatment room or hospital room) and reasons for room preference. Children five years of age and older were also asked for their preferences regarding the procedure site.RESULTS: The hospital room was preferred by the majority of parents and children for minor procedures (blood test, intravenous insertion, bandage change) for reasons consisting primarily of the child′s emotional or physical comfort, convenience and difficulties moving the child due to motor impairment or medical condition. The treatment room was generally selected for more invasive procedures (lumbar punctures, bone marrow aspirations, bladder catheterizations) due to concerns for the privacy of the child and roommate, and the need for special equipment or supplies.CONCLUSIONS: Results suggest that parents and children may prefer the hospital room or treatment room for a variety of different reasons. More research is needed in this area to develop better guidelines regarding the performance of inpatient pediatric procedures.
Opioid Tolerance and Physical Dependence: Role of Spinal Neuropeptides, Excitatory Amino Acids and Their Messengers
Authors: Jhamandas Khem , Powell Kelly , Quirion Remi , Milne B 
Published: March 2016

Chronic opioid treatment results in the development of tolerance and physical dependence. The mechanisms underlying opioid tolerance and/or physical dependence are unclear. Recent studies suggest that opioid receptor or nociceptive, neural network‐based adaptations contribute to this phenomenon. At the spinal level, the genesis of tolerance and physical dependence is associated with increased excitatory amino acid activity expressed through N‐methyl‐D‐aspartate receptors in the dorsal horn. However, recent evidence also implicates spinal neuropeptide transmitters such as calcitonin gene‐related peptide (CGRP) and substance P in the development of opioid tolerance. Long term spinal morphine treatment increases CGRP‐like immunostaining in the dorsal horn, and coadministration of morphine with CGRP8-37, a competitive CGRP1 receptor antagonist, prevents this response as well as loss of the analgesic potency. CGRP8-37, like N‐methyl‐D‐aspartate receptor antagonists, has the potential to restore morphine potency in experimental animals who are already tolerant to the opioid agonist. Recent evidence suggests that the effects of excitatory amino acid and neuropeptide receptor activity may be expressed through the generation of messengers such as nitric oxide and prostanoids. Agents that inhibit the synthesis of nitric oxide and prostanoids have the potential to inhibit and reverse spinal opioid tolerance, suggesting that this phenomenon may be expressed through the activity of these mediators. Nociceptive transmission in the dorsal horn of the spinal cord also involves activity of a number of other mediators including morphine modulatory neuropeptides, neuropeptide FF and neuropeptide SF. The role of these mediators and their relationship with other factors implicated in tolerance remain to be determined.
Swelling of the Leg, Deep Venous Thrombosis and the Piriformis Syndrome
Authors: Bustamante Sara , Houlton Peter G 
Published: March 2016

BACKGROUND: The piriformis syndrome, which was first described 60 years ago, is a well recognized cause of sciatica, leg pain and low back pain, due to the entrapment of the sciatic nerve in the piriformis and other rotator muscles. Very few complications relating to this syndrome have been described.AIMS: To discuss how the piriformis syndrome may cause venous engorgement in the lower limb, and how the piriformis syndrome should be included as a possible cause of acute deep venous thrombosis in a not initially swollen leg. Both complications can occur independently.METHODS: Two cases of swelling of the leg and acute deep venous thrombosis independently associated with the piriformis syndrome are presented.CONCLUSIONS: Swelling of the leg and deep venous thrombosis are possible complications of the piriformis syndrome that occur due to entrapment of nerves and vessels within the leg, secondary to a severe spasm and hypertrophy of the piriformis and other rotator muscles.
Beliefs and Behaviours of Parents Regarding Antibiotic Use by Children
Authors: Bagshaw Sean M , Kellner James D 
Published: March 2016

OBJECTIVE: To determine parents′ beliefs and behaviours about antibiotic use by their children in the ambulatory setting.DESIGN: Cross‐sectional survey, where a self‐administered questionnaire was completed by adult caregivers of children before the medical assessment of the child.SETTING: Three paediatric acute care settings (paediatric emergency department [PED], group paediatric practice and after hours walk‐in medical clinic).POPULATION STUDIED: Adult caregivers (n=114; 76% mothers, 19% fathers and 4% other caregivers) of children brought for acute care were surveyed.MAIN RESULTS: Forty‐one caregivers completed the survey in the PED, 37 in the paediatric office and 36 in the walk‐in clinic. They believed that antibiotics were appropriate for ear infections (86%), pharyngitis (77%), bronchitis (49%), sinus colds (20%), cough (12%), colds (8%) and influenza (8%). Sixty‐eight per cent of children had received antibiotics in the previous year. Thirteen per cent of caregivers reported previously requesting an antibiotic for their child, 18% believed a previous antibiotic prescription had been unnecessary and 19% had not complied with prescriptions in the past. Concerns about antibiotic use included antibiotic resistance (50%), harm to the immune system (40%), adverse effects (28%) and lack of efficacy (19%).CONCLUSIONS: In this population, parental knowledge and understanding of indications for antibiotics and their adverse effects were good; however, incorrect beliefs and disagreements with physicians did occur. To improve patterns of antibiotic use by children, it will be necessary to understand parents′ beliefs, behaviours and information sources better so that misconceptions and disagreements with caregivers can be addressed appropriately.
Population‐Based Surveillance of Invasive Group A Streptococcal Disease in British Columbia: 1996‐1998
Authors: Bjornson Gordean L , Scheifele David W , Bell Alison , King Arlene 
Published: March 2016

OBJECTIVE: To identify and describe all cases of invasive group A streptococcal (GAS) infection occurring in British Columbia during a two‐year period.DESIGN: Active, laboratory‐based surveillance with supplemental case description.SETTING: Forty community and regional hospitals and the provincial laboratory participated, encompassing all health regions.POPULATION STUDIED: Entire provincial population from April 1, 1996 to March 31, 1998.MAIN RESULTS: Over the 24‐month surveillance period, 182 eligible cases were identified, yielding a mean annual incidence rate of 2.3/100,000. Patients ranged in age from two to 91 years, with a mean of 39.1 years. Soft tissue infections accounted for 89 of 130 cases (68.5%) with a defined clinical syndrome, 20 of which were necrotizing fasciitis. Injection drug use was described in 55 patients, who, as a group, were younger, more likely to have soft tissue infections and less likely to die of infection than nondrug users. Other risk factors for infection included HIV infection (19 patients); skin damage (26 patients, damage independent of injection drug use); chronic illness (27 patients); and immunosuppresion (three patients). Death from GAS infection occurred in 15 of 131 (11.5%) cases with known outcome, yielding an annual case fatality rate of 1.9/million population. Among necrotizing faciitis cases, the mortality rate was 30%.CONCLUSIONS: Invasive GAS infections are rare in British Columbia and tend to involve persons with chronic illness or prior skin trauma, especially injection drug abuse, which accounted for nearly half of the cases.
The Lung Cancer and Cigarette Smoking Web Page: A Pilot Study in Telehealth Promotion on the World Wide Web
Authors: Grannis Frederic W 
Published: March 2016

BACKGROUND: Diseases caused by tobacco products are the number one preventable health problem.STUDY OBJECTIVES: A pilot study was performed to determine the characteristics of persons searching the World Wide Web (WWW) for information on tobacco‐caused diseases, the type of information sought and the feasibility of meeting informational needs.METHODS: The Lung Cancer and Cigarette Smoking Web Page at the unique reference location <http://www.smokinglungs.com>, created in January 1996, consists of hypertext metafile language files in a ‘frequently asked questions’ format on tobacco‐caused diseases, nicotine dependence and smoking cessation. Links to other Web pages, a counter, e‐mail access and Web forms were included.SETTING: Personal computer.PARTICIPANTS: People browsing the WWW.RESULTS: Between April 1996 and March 1999, there were more than 150,000 hits and 1510 individual e‐mail or form responses; 597 (51.3%) of the respondents were female and 566 (48.7%) were male. They ranged between nine and 79 years of age, with a median of 29 years and a mean of 34 years. The percentage of respondents 20 years old or younger was 34.3%. Five hundred thirteen people resided in 45 American states, and 195 individuals resided in 39 other nations. Students, people with tobacco‐caused diseases, and relatives or friends of persons with tobacco‐caused diseases made up the large majority of correspondents. Smokers represented 40.2% of the respondents, ex‐smokers 34.3% and never‐smokers 25.5%. There were three main types of questions: questions for information on the diagnosis and treatment of lung cancer, for help with smoking cessation and for information on tobacco‐caused diseases from students working on a school‐related project. Images of tobacco‐caused diseases were requested frequently.CONCLUSIONS: An educational WWW page is a potentially important resource in the control of tobacco‐caused diseases because it fosters primary prevention of smoking in young people, facilitating smoking cessation and providing information on the diagnosis and treatment of tobacco‐caused diseases.