bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for Common Respiratory Diseases among Israeli Adolescents
Authors: Dayan Yaron Bar , Elishkevits Keren , Goldstein Liav , Goldberg Avishay , Fichler Michel , Ohana Nisim , Levi Yehezkel , Dayan Yosefa Bar 
Published: March 2016

BACKGROUND: Respiratory diseases are responsible for a significant proportion of serious morbidity among adolescents. There are few reports on the prevalence of common respiratory disorders in this population. The previous studies focused on specific diseases and screened relatively small samples.OBJECTIVE: To define the prevalence of different common respiratory disorders among 17‐year‐old Israeli conscripts.DESIGN: All 17‐year‐old Israeli nationals are obliged by law to appear at the Israel Defense Forces recruiting office for medical examination. Respiratory disease specialists evaluated and classified nominees with suspected respiratory disorders.RESULTS: A high prevalence of respiratory morbidity was found among 94,805 17‐year‐old conscripts (61.5% male, 39.5% female). The most prevalent diagnosis was asthma (in 8% of male and 6.8% of female subjects). Fifty‐five per cent of the asthma patients suffered from moderate to severe disease. The prevalence of chronic obstructive pulmonary disease was 0.03% for the male and 0.01% for the female subjects. A difference in morbidity patterns between male and female adolescents was noted, particularly in the prevalence of chest deformation and spontaneous pneumothorax.CONCLUSIONS: The most prevalent respiratory disorder among 17‐year‐old Israeli conscripts was asthma. One‐half of the asthma patients in this study suffered from moderate to severe disease. The prevalence of other respiratory disorders was much lower.
The Use of Clinical Practise Guidelines for Community‐Acquired Pneumonia in Hospitals in Atlantic Canada
Authors: Campbell Samuel G 
Published: March 2016

BACKGROUND: Clinical practice guidelines (CPGs) have been shown to improve the care of patients presenting to hospital with community‐acquired pneumonia (CAP) and are considered the ′standard of care′. The extent of adoption of CPGs in Canada is unclear.OBJECTIVE: To determine the use of CPGs by hospitals in Atlantic Canada (Newfoundland, Nova Scotia, New Brunswick, Prince Edward Island).METHODS: Telephone survey of all hospitals listed in the Canadian Medical Directory as being situated in Atlantic Canada. Hospitals were included if they had all three of the following: an emergency department, x‐ray facilities and acute care inpatient beds.RESULTS: Of 143 hospitals, 93 were included for analysis. Of these, 41 (44.1%) used CAP CPGs. Hospitals were less likely to be using CAP CPGs if they were smaller, rural or community hospitals, or if they did not have an intensive care unit. Of the four provinces, New Brunswick had the most hospitals using CAP CPGs (73.1%), while Newfoundland had the least (17.2%).CONCLUSIONS: Although larger teaching hospitals are using CAP CPGs, the degree of adoption of CPGs in smaller hospitals in Atlantic Canada is low. Efforts to produce standard CPGs that can be adapted to different sites, as well as implementation strategies, are indicated.
Recovery of Cephalosporin Resistant Escherichia coli and Salmonella from Pork, Beef and Chicken Marketed in Nova Scotia
Authors: Forward Kevin R , Matheson Katherine M , Hiltz Margot , Musgrave Heather , Poppe Cornelius 
Published: March 2016

BACKGROUND: Antimicrobial use in farm animals is a potentially important contributor to the emergence of antimicrobial resistance. Resistant Salmonella may lead to serious human infections and resistant Escherichia coli may transfer plasmid‐encoded resistance genes to other pathogens.OBJECTIVE: To determine the prevalence of E coli and Salmonella species resistant to the third generation of cephalosporins in retail meat products in Halifax, Nova Scotia in 2002.METHODS: Ground beef, ground pork and chicken wings were tested for E coli and Salmonella. E coli were selected on ceftriaxone‐containing media. Beta‐lactamases were characterised by isoelectric focusing, polymerase chain reaction and sequencing. Pulsed field gel electrophoresis was performed to determine the relationship of strains. The transferability of plasmids and location of resistance genes was also determined.RESULTS: Forty‐three of 75 packages of chicken wings contained ceftriaxone‐resistant E coli; 42 of these contained beta‐lactamases with isoelectric points at approximately 8.7. Six of seven CMY primer amplicons that were sequenced contained plasmid‐mediated Citrobacter freundii‐derived blaCMY‐2; the other contained a CMY‐2‐like beta‐lactamase. Pulsed field gel electrophoresis patterns demonstrated that strains were not clonal in nature. Four chicken samples contained Salmonella, one of which contained blaCMY‐2‐mediated resistance and an E coli bearing the same gene, but on different plasmids. Four of 100 beef samples contained blaCMY‐2‐bearing E coli; none contained Salmonella. Two of 75 pork samples contained ceftriaxone resistant E coli, one of which encoded for CMY‐2. One susceptible Salmonella strain was recovered from pork.CONCLUSIONS: Chicken from retail outlets located in Halifax, Nova Scotia, commonly contained blaCMY‐2‐bearing E coli. The relationship antibiotics used in food‐producing animals and its effect on resistance of commensals and pathogens needs to be determined.
Should University Students Be Vaccinated against Meningococcal Disease in Canada?
Authors: De Wals Philippe 
Published: March 2016

OBJECTIVE: To evaluate the benefit and costs of vaccination of university students against invasive meningococcal disease (IMD) in Canada.METHODS: Published studies were reviewed and a simulation model was used.RESULTS: IMD risk seems to be of low magnitude, but consequences can be dramatic. Over a 10‐year period, IMD risk reduction would be slightly greater using a monovalent C conjugate vaccine than a quadrivalent polysaccharide vaccine. From a societal perspective, costs per quality‐adjusted life‐years gained would be between $135,000 and $698,000, according to epidemiological scenarios and with vaccine purchase prices between $35 and $50 per dose.CONCLUSIONS: Economic indices exceed proposed criteria for cost effective public health programs, but from the perspective of students and parents, the cost of vaccination might be worth the benefit.
EMLA Cream is an Effective Topical Anesthetic for Bronchoscopy
Authors: Sohmer Benjamin , Bryson Gregory L , Bencze Steven , Scharf Maria Mouroukas 
Published: March 2016

BACKGROUND: EMLA cream (AstraZeneca Inc, Canada) (1:1 eutectic mixture of lidocaine 2.5% and prilocaine 2.5%) has traditionally been used for topical anesthesia of the skin. Recent reports of EMLA′s use for anesthesia of the oral mucosa suggest an application in topical anesthesia for bronchoscopy.OBJECTIVES: To evaluate the amount of local anesthetic administered during bronchoscopy; to assess the time required to obtain topical anesthesia; to assess the quality of the topical anesthesia as described by bronchoscopists; and to document any complications.METHODS: Fifty‐seven unpremedicated patients had 4 mL of EMLA cream applied to the posterior third of their tongues on arrival in the bronchoscopy suite. Liquid lidocaine was applied through the bronchoscope for laryngeal anesthesia.RESULTS: The mean time from the application of EMLA cream to insertion of the bronchoscope was 5.10±0.48 min. Fifty‐six patients (98.2%) required no supplemental anesthesia. Bronchoscopy conditions were described as ′excellent′ in 55 cases (96.5%) and ′good′ in the remaining two cases (3.5%).CONCLUSIONS: EMLA is an effective alternative for oropharyngeal topical anesthesia that is well‐tolerated by patients.
Rates and Patterns of Chronic Obstructive Pulmonary Disease Exacerbations
Authors: Nunes de Melo Magda , Ernst Pierre , Suissa Samy 
Published: March 2016

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (COPD) are believed to be a common occurrence in patients with COPD and are known to be associated with considerable morbidity.OBJECTIVE: To describe the frequency of treated COPD exacerbations in a large population‐based cohort.SUBJECTS AND METHODS: A cohort of newly treated patients with COPD was formed from the administrative databases of Saskatchewan Health. The outcome was the occurrence of all moderate or severe exacerbations from 1990 to 1999. Exacerbations were defined in three ways: dispensing of a prescription for a systemic antibiotic; dispensing of both a prescription for an antibiotic and a prescription for an oral corticosteroid on the same day; and requiring a hospitalization with a primary discharge diagnosis of COPD.RESULTS: There were 5645 patients who entered the COPD cohort between 1990 and 1997, of whom 4453 experienced at least one exacerbation requiring treatment during follow‐up. The overall rate of acute exacerbations was 1.12/person‐year. It was constant across all age groups, and was similar in both men and women (1.13/person‐year versus 1.11/person‐year, respectively). The rate of exacerbations was highest in the first trimester of therapy for the disease (1.39/person‐year) and stabilized thereafter at 1.04 exacerbations/person‐year.CONCLUSIONS: The results indicate that in a population‐based cohort of patients with COPD, the average rate of exacerbations was 1.12/person‐year. Men and women had similar rates of exacerbations.
Tuberculous Lymphadenitis in Manitoba: Incidence, Clinical Characteristics and Treatment
Authors: Cook Victoria J , Manfreda Jure , Hershfield Earl S 
Published: March 2016

BACKGROUND: Tuberculous lymphadenitis (TBL) is an important form of extrapulmonary tuberculosis (TB). Recent studies have shown an increase in TBL in Canada.OBJECTIVES: To determine the incidence of TBL in Manitoba and to identify the characteristics associated with its presentation, diagnosis and treatment.METHODS: Population data from the Manitoba Health Population Registry, the First Nations and Inuit Health Branch of Health Canada, and Statistics Canada were used to calculate incidence. Case characteristics and outcomes were determined by a systematic, retrospective review of all cases between January 1, 1990 and December 31, 2000.RESULTS: One‐hundred forty seven cases of TBL were identified during the study period; 77% confirmed by culture; 68% women. TBL was found in Canadian‐born/nonstatus Aboriginal (12%), status Aboriginal (29%) and foreign‐born (59%) populations. Incidence of TBL was 1.17 per 100,000 person years (95% CI 0.98 to 1.36). The highest incidence was in status Aboriginals over 65 years (16.85 per 100,000 person years; 95% CI 3.37 to 30.33). TBL is seen most often in Western Pacific women. The most common presentation was a single, enlarged cervical node (80%). No atypical mycobacterium was found. Drug resistance occurred in 13% of cases and only in the foreign‐born. Cure rates (81%) were influenced by comorbidity and burden of TB disease. Relapse occurred in 8.1 per 1000 person years of follow‐up (95% CI 1.7 to 23.7).CONCLUSIONS: Respiratory physicians, who manage the majority of TB disease in Canada, need to remain aware that TB is an important and treatable cause of enlarged lymph nodes.
Fractional Analysis of Th2‐Type Cytokines in Sequential Samples of Induced Sputum
Authors: Taha Rame , Hamid Q , Olivenstein Ron 
Published: March 2016

BACKGROUND: Recent studies have demonstrated the usefulness of induced sputum in detecting the expression of Th2‐type cytokines in asthmatics and have shown that the profile of inflammatory cells in induced sputum differs with time.OBJECTIVE: To determine whether the duration of sputum induction also affects the expression of Th2‐type cytokines in induced sputum.METHODS: Induced sputum was collected from eight atopic asthmatics at two separated intervals (5 min each) during a 15 min sputum induction, and each sample was examined separately for cytokine expression and inflammatory cells. Using immunocytochemistry, interleukin (IL)‐4 and IL‐5 immunoreactivity, T lymphocytes (CD3), eosinophils (major basic protein), neutrophils (elastase), epithelial cells and macrophages (CD68) were compared in the induced sputum obtained from the 0 min to 5 min and the 10 min to 15 min samples.RESULTS: The number of immunoreactive‐positive cells expressing IL‐4 and IL‐5 were significantly higher in the 10 to 15 min induced sputum sample than in the 0 min to 5 min induced sputum sample (P<0.05). The number of eosinophils was also significantly higher in the 10 min to 15 min sample than in the 0 min to 5 min sample (P<0.05). In contrast, the number of neutrophils was significantly higher in the 0 min to 5 min sample than in the 10 min to 15 min sample (P<0.01); T lymphocytes, macrophages and epithelial cells did not differ between the two samples.CONCLUSION: This study demonstrates that the duration of sputum induction significantly affects the profile of inflammatory cells and Th2‐type cytokine expression, and underscores the need for the standardization of induced sputum procedure.
Chronic Neuropathic Pain in Spinal Cord Injury: The Patient′s Perspective
Authors: Henwood Penelope , Ellis Jacqueline A 
Published: March 2016

BACKGROUND: Chronic neuropathic pain (CNP) in spinal cord injury (SCI) is recognized as severely compromising, in both adjustment after injury and quality of life. Studies indicate that chronic pain in SCI is associated with great emotional distress over and above that of the injury itself. Currently, little is known about the SCI patient′s perception of the impact of living with chronic neuropathic pain.OBJECTIVES: The purpose of this study was to explore the experience of CNP in SCI patients in relation with physical, emotional, psychosocial, environmental, informational, practical and spiritual domains, and to identify effective and ineffective pain coping strategies.METHODS: Three focus groups were conducted that included 24 SCI individuals living in the community. Participants were selected to maximize variation in terms of type of SCI, Frankel classification, years since onset of SCI, age and sex. The sessions were audiotaped and tapes were transcribed. A qualitative analysis of data involved a constant comparison approach, in which categories and themes were identified.RESULTS: Many complex themes emerged including: nature of pain; coping as process and product; medication failure; and the impact of CNP on physical, cognitive, emotional, interpersonal, social and life activities.CONCLUSIONS: Medication failure was identified as a common outcome, while strategies including use of warm water, swimming, increased activity and distraction provided temporary pain relief. Learning to live with the pain appeared to be related to acceptance of pain, which in turn seemed to facilitate adjustment. Further research is warranted to determine the process by which SCI patients learn to live with CNP and coping strategies that facilitate adjustment to CNP in SCI patients.
West Nile Virus Infection in the Intensive Care Unit: A Case Series and Literature Review
Authors: Fan Eddy , Needham Dale M , Brunton James , Kern Ralph Z , Stewart Thomas E 
Published: March 2016

BACKGROUND: West Nile virus (WNV) is a rapidly spreading infectious disease in North America. Critical care issues related to WNV are not well described.OBJECTIVES: Three cases of severe WNV meningoencephalitis with flaccid paralysis are reported and relevant critical care issues are highlighted.METHODS: Case series and a review of the literature.RESULTS: Three patients with WNV meningoencephalitis and flaccid paralysis were admitted to the authors′ academic, tertiary‐care intensive care unit (ICU) in the late summer of 2002. All three patients were middle‐aged or elderly and presented with a febrile illness that preceded or coincided with their neurological symptoms. Confirmation of WNV infection was problematic because each patient had at least one initial negative serum serology test. Radiological testing yielded nonspecific results. Serial electroencephalograms were consistent with severe toxic metabolic encephalopathy in all cases. All patients had a severe, diffuse axonal polyneuropathy demonstrated by nerve conduction studies and electromyography. Prolonged mechanical ventilation resulted in ICU lengths of stay of 44 to 118 days. At one point, 21% of the ICU beds were dedicated for these patients. All three patients died in hospital ‐‐ two following the withdrawal of life support. One patient demonstrated resolving encephalitis and was discharged from the ICU after a 118‐day ICU stay, but later died in a step‐down unit.CONCLUSIONS: The management of WNV‐related critical illness creates challenges in making a timely and accurate diagnosis, and predicting patient morbidity and mortality. As a consequence, end‐of‐life discussions with families are especially difficult. The prolonged ICU length of stay and growing incidence of this disease may challenge limited critical care resources.
Vagus Nerve Stimulation Affects Pain Perception in Depressed Adults
Authors: Borckardt Jeffrey J , Kozel F Andrew , Anderson Berry , Walker Angela , George Mark S 
Published: March 2016

BACKGROUND: Previous research suggests that vagus nerve stimulation (VNS) affects pain perception in epilepsy patients, with acute VNS decreasing pain thresholds and chronic VNS treatment increasing pain thresholds. However, no studies have investigated the effects of VNS on pain perception in chronically depressed adults, nor have controlled, systematic investigations been published on the differential effects of certain VNS device parameters on pain perception.OBJECTIVES: The present study tried to replicate the results of previous research showing acute pronociceptive effects of VNS and determine the effects of various device parameter settings on pain tolerance. The present study also investigated the relationship among patients′ levels of depression, duration of VNS treatment and VNS‐induced changes in pain perception.METHODS: A thermal pain challenge task was used to determine pain tolerance during VNS device activation using different combinations of VNS device parameter settings within subjects undergoing VNS therapy for chronic depression.RESULTS: Significant pronociceptive effects were found for acute VNS activation. Individual differences were found with respect to the VNS settings associated with the largest changes in pain perception. Severity of depression was inversely related to baseline pain tolerance, but depression severity was unrelated to VNS‐induced acute changes in pain tolerance, as was the length of time participants had been undergoing VNS treatment.CONCLUSIONS: VNS appears to affect pain perception in depressed adults. Different VNS parameter settings may be associated with unique effects from patient to patient. More studies are needed to determine the long‐term effects of VNS on pain perception.
Interpretation of Transbronchial Lung Biopsies from Lung Transplant Recipients:Inter‐ and Intraobserver Agreement
Authors: Stephenson Anne , Flint Julia , English John , Vedal Sverre , Fradet Guy , Chittock Dean , Levy Robert D 
Published: March 2016

BACKGROUND: Transbronchial lung biopsy results are crucial for the management of lung transplant recipients. Little information is available regarding the reliability and reproducibility of the interpretation of transbronchial lung biopsies.OBJECTIVE: To examine the inter‐reader variability between two lung pathologists with expertise in lung transplantation.METHODS: Fifty‐nine transbronchial lung biopsy specimens were randomly selected. Active infection had been excluded in all cases. The original interpretations (as per the Lung Rejection Study Group) for acute rejection grade included 19 biopsies scored as A0 (none), 14 scored as A1 (minimal), 12 as A2 (mild), 11 as A3 (moderate) and three as A4 (severe). The pathologists worked independently without clinical information or knowledge of the original interpretation. The specimens were graded using the Lung Rejection Study Group criteria for acute rejection (grades A0 to A4), airway inflammation (grades B0 to B4) and bronchiolitis obliterans (C0 absent and C1 present). Between‐reader agreement for each category was analyzed using a Kappa statistic.RESULTS: Because many transplant specialists initiate augmented immunosuppression with biopsy grades of A2 or higher, results for each reader were dichotomized as A0/A1 versus A2/A3/A4. Using this dichotomy, there was only moderate agreement (kappa 0.470, P<0.001) between readers. For categories B and C, the results were dichotomized for the absence or presence of airway inflammation and bronchiolitis obliterans, respectively. The level of agreement between readers was fair for category B (kappa 0.333, P=0.014) and poor for category C (kappa 0.166, P=0.108). The intrareader agreement for acute rejection was substantial (kappa 0.795, P=0.0001; kappa 0.676, P=0.0001).CONCLUSIONS: Because the agreement between expert pathologists is only modest, optimum clinical decision‐making requires that transbronchial lung biopsy results be used in an integrated clinical context.
Chest Tube Drainage Under Radiological Guidance for Pleural Effusion and Pneumothorax in a Tertiary Care University Teaching Hospital: Review of 51 Cases
Authors: Cantin Luce , Chartrand-Lefebvre Carl , Lepanto Luigi , Gianfelice David , Rabbat Antoine , Aubin Benoît , Perreault Pierre , Déry Renée , Lafortune Michel 
Published: March 2016

BACKGROUND: Chest tube drainage under radiological guidance has been used with increasing frequency as a treatment option for pleural effusions and pneumothoraxes.OBJECTIVE: To evaluate the safety and usefulness of pleural drainage under radiological guidance for pleural effusion and pneumothorax in a tertiary care university teaching hospital.METHODS: A retrospective study of cases of chest tube placement under radiological guidance over a 12‐month period in a university hospital.RESULTS: Fifty‐one percutaneous pigtail catheter drainage cases were reviewed (30 patients). Forty‐six (90%) chest tubes were inserted as a first‐line treatment. The overall success rate of radiological drainage was 88%. Specific success rates were 92%, 85% and 91% for loculated pleural effusion, pneumothorax and empyema, respectively. The complications were few and minor.CONCLUSIONS: Pigtail catheter insertion under radiological guidance is a useful procedure for the treatment of sterile pleural effusion, empyema and pneumothorax. This technique can be used as a first‐line procedure in the majority of cases.
Increased Expression of the Calcium‐Activated Chloride Channel in Hclca1 in Airways of Patients with Obstructive Chronic Bronchitis
Authors: Hauber Hans-Peter , Bergeron Celine , Tsicopoulos Anne , Wallaert Benoit , Olivenstein Ron , Holroyd Kenneth J , Levitt Roy C , Hamid Qutayba 
Published: March 2016

BACKGROUND: Interleukin (IL)‐9 and its effect on enhancing the human calcium‐activated chloride channel 1 (hCLCA1) expression have been shown to induce mucin production. Increased expression of hCLCA1 may, in turn, contribute to mucus overproduction in chronic obstructive pulmonary disease (COPD) with a chronic bronchitis (CB) phenotype.OBJECTIVE: To determine the expression of IL‐9, IL‐9 receptor (IL‐9R), hCLCA1 and mucoglycoconjugates in COPD.METHODS: Bronchial biopsies were obtained from six patients with obstructive CB and six healthy control subjects. IL‐9, IL‐9R and hCLCA1 expression were detected using immunohistochemistry. Additionally, in situ hybridization was performed to determine the expression of hCLCA1 messenger RNA. Mucin production was assessed using periodic acid‐Schiff staining.RESULTS: There was a significantly higher number of IL‐9 immunoreactive cells in the submucosa of patients with COPD than that of healthy control subjects (P<0.05). Also, a significant increase in the expression of IL‐9R, hCLCA1 (protein and messenger RNA) and mucin (periodic acid‐Schiff‐positive cells) was noted in the bronchial epithelium of patients with COPD compared the control subjects (P<0.05).CONCLUSIONS: Increased expression of IL‐9, IL‐9R and hCLCA1 in the bronchial mucosa of patients with obstructive CB suggests that mucus overproduction in this disease may be, at least in part, due to hCLCA1.