bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gastric Biopsies: The Gap between Evidence-Based Medicine and Daily Practice in the Management of GastricHelicobacter pyloriInfection
Authors: El-Zimaity Hala , Serra Stefano , Szentgyorgyi Eva , Vajpeyi Rajkumar , Samani Amir 
Published: March 2016

BACKGROUND: Many consider histology to be the gold standard forHelicobacter pyloridetection. Because the number and distribution ofH pyloriorganisms vary, particularly in patients taking proton pump inhibitors (PPIs), the American Gastroenterological Association recommends discontinuing PPIs two weeks before endoscopy, and taking biopsies from both the body and antrum.OBJECTIVE: To assess the influence of clinical practice on the histopathological detection ofH pyloriinfection.METHODS: Electronic patient records were evaluated for the sites of gastric sampling and PPI use at endoscopy. One hundred fifty cases with biopsies taken from both antrum and body were randomly selected for pathological re-review with special stains. The gastric regions sampled,H pyloridistribution and influence of clinical factors on pathological interpretation were assessed.RESULTS: Between 2005 and 2010, 10,268 biopsies were taken to detectH pylori. Only one region was sampled in 60% of patients (antrum 47%, body 13%). Re-review of biopsies taken from both antrum and body indicated that the correct regions were sampled in only 85 (57%) patients. Of these, 54 wereH pyloripositive and 96 wereH pylorinegative.H pyloriwas present in the antrum in only 15% of the patients and body only in 21%. Of 96H pylori-negative patients, two were reinterpreted as positive. Forty-seven per cent of patients were taking PPIs at endoscopy, contributing to both false-negative and false-positive diagnoses.CONCLUSION: Despite national and international guidelines for managingH pyloriinfection, the American Gastroenterological Association guidelines are infrequently adhered to, with PPIs frequently contributing to false diagnosis; sampling one region only increases the likelihood of missing active infection by at least 15%.
Ten‐Year Review of Candidemia in a Canadian Tertiary Care Centre: Predominance of Non‐albicans Candida Species
Authors: Al-Rawahi Ghada N , Roscoe Diane L 
Published: March 2016

OBJECTIVE: To review the epidemiology and associated risk factors for candidemia at a tertiary care centre, in view of recent reports on the changing epidemiology of bloodstream infection due to Candida species.METHODS: Between January 2000 and December 2009, patients with blood culture samples positive for Candida species were identified using the microbiology laboratory information system. Patient data were collected by retrospective chart review of clinical characteristics including demographic data, underlying medical diagnoses and risk factors.RESULTS: A total of 266 candidemia episodes were included in the final analysis. Fifty‐nine per cent of these episodes occurred in males and 51% were in patients >60 years of age. The most common risk factor for candidemia was previous antibiotic use (85%). The most frequent species was Candida albicans (49%), followed by Candida glabrata (30%). C albicans was the predominant species in all study years with the exception of 2002, in which C glabrata was more frequent. The likelihood of recovering a non‐albicans Candida species was found to be significantly associated with previous antifungal therapy (P=0.0004), immunosuppressive therapy (P=0.002), abdominal surgery (P=0.003) and malignancy (P=0.05). Mixed candidemia was found in 10 episodes (4%); 80% grew C albicans and C glabrata. Risk factors for mixed candidemia were not significantly different from those with monomicrobial candidemia.CONCLUSION: C albicans remains the most commonly isolated species in this setting, consistent with findings from other Canadian centres. However, non‐albicans Candida species were overall predominant. Mixed‐species candidemia does not appear to be more prevalent in patients with identified risk factors.
Combination of Culture, Antigen and Toxin Detection, and Cytotoxin Neutralization Assay for Optimal Clostridium difficile Diagnostic Testing
Authors: Alfa Michelle J , Sepehri Shadi 
Published: March 2016

BACKGROUND: There has been a growing interest in developing an appropriate laboratory diagnostic algorithm for Clostridium difficile, mainly as a result of increases in both the number and severity of cases of C difficile infection in the past decade. A C difficile diagnostic algorithm is necessary because diagnostic kits, mostly for the detection of toxins A and B or glutamate dehydrogenase (GDH) antigen, are not sufficient as stand‐alone assays for optimal diagnosis of C difficile infection. In addition, conventional reference methods for C difficile detection (eg, toxigenic culture and cytotoxin neutralization [CTN] assays) are not routinely practiced in diagnostic laboratory settings.OBJECTIVE: To review the four‐step algorithm used at Diagnostic Services of Manitoba sites for the laboratory diagnosis of toxigenic C difficile.RESULT: One year of retrospective C difficile data using the proposed algorithm was reported. Of 5695 stool samples tested, 9.1% (n=517) had toxigenic C difficile. Sixty per cent (310 of 517) of toxigenic C difficile stools were detected following the first two steps of the algorithm. CTN confirmation of GDH‐positive, toxin A‐ and B‐negative assays resulted in detection of an additional 37.7% (198 of 517) of toxigenic C difficile. Culture of the third specimen, from patients who had two previous negative specimens, detected an additional 2.32% (12 of 517) of toxigenic C difficile samples.DISCUSSION: Using GDH antigen as the screening and toxin A and B as confirmatory test for C difficile, 85% of specimens were reported negative or positive within 4 h. Without CTN confirmation for GDH antigen and toxin A and B discordant results, 37% (195 of 517) of toxigenic C difficile stools would have been missed. Following the algorithm, culture was needed for only 2.72% of all specimens submitted for C difficile testing.CONCLUSION: The overview of the data illustrated the significance of each stage of this four‐step C difficile algorithm and emphasized the value of using CTN assay and culture as parts of an algorithm that ensures accurate diagnosis of toxigenic C difficile.
Group a Rotaviruses in Children with Gastroenteritis in a Canadian Pediatric Hospital: The Prevaccine Era
Authors: Chetrit Estelle , L’Homme Yvan , Sohal Jagdip Singh , Quach Caroline 
Published: March 2016

BACKGROUND: A publicly funded, group A rotavirus (RVA) vaccination program was implemented in Quebec in November 2011.OBJECTIVES: To evaluate trends in RVA infections and describe circulating genotypes before the implementation of a publicly funded vaccination program.METHODS: The Montreal Children’s Hospital (Montreal, Quebec) virology laboratory database was reviewed for RVA ELISA performed between July 2006 and June 2011. A five‐week moving average was used to follow the proportion of positive RVA ELISA test results. A season was defined as starting with the first two and ending with the final two consecutive weeks in which the percentage of specimens testing positive for RVA was ≥10%. Duplicate tests were excluded. A random sample of 39 RVA‐positive fecal samples from the final season (2010/2011) was genetically characterized: VP4, VP6, VP7 and NSP4 gene segments were genotyped using sequence analysis.RESULTS: Of the 3403 nonduplicate tests, 433 were RVA positive: 15.1% (2006/2007) to 9.3% (2010/2011) of the samples were positive during the study period, with a proportionally larger decrease in the percentage of positive tests compared with the decrease in the number of tests performed. The most common RVA strain types detected were G9P[8]I1 (n=19) and G1P[8]I1 (n=14), followed by G2P[4]I2 (n=4), G3P[6]I1 (n=1) and G4P[8]I2 (n=1). Mixed RVA infection was observed in two samples.CONCLUSION: Before the implementation of the vaccination program, the proportion of positive RVA tests had already begun to steadily decline. The present study was the first to report the genetic makeup of human RVA collected from a Canadian hospital based on the genotyping of four gene segments. The present study provided a baseline with which to monitor the impact of the universal vaccination program.
Transcervical Intrauterine Levobupivacaine or Lidocaine Infusion for Pain Control during Endometrial Biopsy
Authors: Kosus Nermin , Kosus Aydın , Demircioglu Ruveyda I , Simavli Serap A , Derbent Aysel , Keskin Esra Aktepe , Turhan Nilgun O 
Published: March 2016

BACKGROUND: Endometrial biopsy is a common procedure for the investigation of many gynecological disorders including abnormal uterine bleeding, postmenopausal bleeding, abnormal cytology and infertility. Most women experience some degree of discomfort and pain during the procedure. Pain may occur during dilation of the cervix for insertion of the catheter and during endometrial biopsy, which further aggravates pain by inducing uterine contraction.OBJECTIVES: To determine pain levels during endometrial biopsy by comparing intrauterine instillation of levobupivacaine or lidocaine with placebo in a randomized, double‐blinded trial in pre‐ and postmenopausal women.METHODS: Ninety patients were allocated to either control or experimental groups before endometrial biopsy. The trial medication was intra‐uterine anesthesia, either 5 mL 0.9% saline (control group), or 5 mL 0.5% levobupivacaine or 2% lidocaine (experimental groups). Resident doctors used the same endometrial biopsy technique to minimize the risk of technical variation. All tissue specimens were sent for cytopathological examination. The pathologists, who were blinded to the study solution, analyzed all tissue specimens. The primary outcome measure was pain experienced during the procedure. Pain was assessed using a 10 cm visual analogue pain scale. All observed adverse effects were recorded until the patients were discharged.RESULTS: Pain scores of the intrauterine lidocaine and levobupivacaine groups were found to be significantly lower than the control group. There was no difference between the levobupivacaine and lidocaine groups with regard to pain scores. There was a moderately positive correlation between pain scores and endometrial thickness. No complications were observed due to the procedure. Most of the biopsy results were proliferative and secretory endometrium. Insufficient material causing inconclusive results was observed mostly in the control group.CONCLUSION: Transcervical intrauterine topical instillation of levobupivacaine or lidocaine causes pain relief during endometrial biopsy. However, further studies are needed to evaluate the effectiveness of intra‐uterine anesthesia, to determine optimal concentration, volume and waiting time according to the type of local anesthetic agent, and to assess the applicability of the method to other intrauterine procedures.
Fecal Occult Blood Testing as a Diagnostic Test in Symptomatic Patients is not Useful: A Retrospective Chart Review
Authors: Narula Neeraj , Ulic Diana , Al-Dabbagh Raed , Ibrahim Ali , Mansour Maged , Balion Cynthia , Marshall John K 
Published: March 2016

BACKGROUND: The fecal occult blood test (FOBT) is a screening tool designed for the early detection of colorectal cancer in primary care. Although not validated for use in hospitalized patients, it is often used by hospital physicians for reasons other than asymptomatic screening.OBJECTIVE: To profile the in-hospital use of the FOBT and assess its impact on patient care.METHODS: Patient charts were retrospectively reviewed for all FOBTs conducted over a three-month period in 2011 by the central laboratory supporting the three acute care campuses of Hamilton Health Sciences (Hamilton, Ontario).RESULTS: A total of 229 patients underwent 351 tests; 52% were female and the mean age was 49 years (range one to 104 years). A total of 80 (34.9%) patients had at least one positive test. The most common indications for testing were anemia (51.0%) and overt gastrointestinal bleeding (19.2%). Only one patient had testing performed for asymptomatic colorectal cancer screening. In only 20 (8.7%) cases medications were modified before testing and diet was modified in only 21 (9.2%) cases. Most patients (85.2%) were taking one or more medications that could result in a false-positive result. Only 18 (7.9%) patients had a digital rectal examinations documented, of which seven were positive. All patients with a positive digital rectal examination underwent endoscopic procedures that revealed a source of bleeding. Among 44 patients with overt gastrointestinal bleeding, 12 (27.3%) had endoscopic investigations delayed to await results of the FOBT. Four patients were referred despite a negative FOBT due to a high degree of suspicion of gastrointestinal bleeding.CONCLUSIONS: The FOBT is often used inappropriately in the hospital setting. Confounding factors, such as diet and medication use, which may lead to false positives, are often ignored. Use of the FOBT in-hospital may lead to inappropriate management of patients, increased length of stay and increased direct medical costs. Use of the FOBT should be limited to validated indications only.
Laboratory Personnel Gender and Cold Pressor Apparatus Affect Subjective Pain Reports
Authors: Vigil Jacob M , Rowell Lauren N , Alcock Joe , Maestes Randy 
Published: March 2016

BACKGROUND: There is no standardized method for cold pressor pain tasks across experiments. Temperature, apparatus and aspects of experimenters vary widely among studies. It is well known that experimental pain tolerance is influenced by setting as well as the sex of the experimenter. It is not known whether other contextual factors influence experimental pain reporting.OBJECTIVES: The present two‐part experiment examines whether minimizing and standardizing interactions with laboratory personnel (eg, limiting interaction with participants to consenting and questions and not during the actual pain task) eliminates the influence of examiner characteristics on subjective pain reports and whether using different cold pain apparatus (cooler versus machine) influences reports.METHODS:The present experiment manipulated the gender of the experimenter (male, female and transgender) and the type of cold pressor task (CPT) apparatus (ice cooler versus refrigerated bath circulator). Participants conducted the CPT at one of two pain levels (5°C or 16°C) without an experimenter present.RESULTS:Men and women showed lower pain sensitivity when they were processed by biological male personnel than by biological female personnel before the CPT. Women who interacted with a transgendered researcher likewise reported higher pain sensitivity than women processed by biological male or female researchers. The type of CPT apparatus, despite operating at equivalent temperatures, also influenced subjective pain reports.DISCUSSION: The findings show that even minimal interactions with laboratory personnel who differ in gender, and differences in laboratory materials impact the reliable measurement of pain.CONCLUSION: More standardized protocols for measuring pain across varying research and clinical settings should be developed.
Serum Voriconazole Level Variability in Patients with Hematological Malignancies Receiving Voriconazole Therapy
Authors: Saini Lalit , Seki Jack T , Kumar Deepali , Atenafu Eshetu G , Cole David EC , Wong Betty YL , Božović Andrea , Brandwein Joseph M 
Published: March 2016

INTRODUCTION: Voriconazole plasma concentrations have been correlated with oral dosing in healthy subjects, but have been poorly characterized in ill patients with hematological malignancies receiving intensive chemotherapy.METHODS: The relationship between orally administered voriconazole, plasma concentrations and liver toxicity was examined in a cohort of 69 primarily acute leukemia patients undergoing intensive chemotherapy.RESULTS: Oral administration of voriconazole was associated with significant interpatient variability, with voriconazole steady‐state concentrations ranging from 0 μg/mL to 16.6 μg/mL. Approximately 20% of patients achieved steady‐state concentrations <1 μg/mL. When adjusted for weight, patients receiving higher voriconazole doses tended toward higher plasma concentrations; however, there was no significant relationship between the plasma concentration and genotype, age, sex or use of concomitant proton pump inhibitors. Voriconazole concentrations were correlated with higher serum alkaline phosphatase levels at day 6 to 8, and with higher bilirubin and aspartate aminotransferase levels at day 14 to 16, but not with other liver enzyme levels.CONCLUSION: In ill patients with acute leukemia and related disorders undergoing treatment with oral voriconazole, there is a poor correlation between the voriconazole dose and plasma concentrations, and many patients achieve levels that are considered to be subtherapeutic. The findings support the routine use of therapeutic drug monitoring in these patients.
Use of a Level 3 Portable Monitor for The Diagnosis and Management of Sleep-Disordered Breathing in an Inpatient Tertiary Care Setting
Authors: Povitz Marcus , Kimoff R John 
Published: March 2016

BACKGROUND: Sleep-disordered breathing (SDB) may impact the course of medical illness among hospitalized patients. Access to testing during hospitalization to assess this may be limited by wait times for laboratory polysomnography. Level 3 portable monitoring (PM) may provide an alternative.OBJECTIVE: To assess the rate of technically adequate studies, diagnostic information obtained and impact on patient management of inpatient PM studies performed for SDB.METHODS: A retrospective review of 114 PM (Embletta, Natus Inc, Canada) records from the past two years was performed. Studies were ordered by pulmonologists, initiated by respiratory therapists and performed unattended on inpatient units. Admitting diagnoses, indication for sleep study, diagnostic information obtained from recordings and change in clinical management subsequent to PM were determined from medical charts.RESULTS: Of 114 studies reviewed, 99 (87%) met predetermined criteria for adequate signal quality and duration. Five studies could not be interpreted due to inadequate data, yielding an overall success rate of 83% (94 of 114). Of 86 studies performed for diagnosis, clinical and PM data supported a new diagnosis of SDB in 55 patients, of which 23 (42%) were started on positive pressure therapy. Thirteen PM studies were performed during SDB treatment. All were technically adequate and six of 13 demonstrated new or persistent SDB. Results from PM testing informed clinical management during hospitalization in 70 (61%) cases.CONCLUSION: Unattended level 3 PM studies are technically feasible in hospitalized patients and may provide information that influences clinical management.
The Utility of a Portable Sleep Monitor to Diagnose Sleep‐Disordered Breathing in a Pediatric Population
Authors: Massicotte Colin , Al-Saleh Suhail , Witmans Manisha , Narang Indra 
Published: March 2016

BACKGROUND: Central and/or obstructive sleep‐disordered breathing (SDB) in children represents a spectrum of abnormal breathing during sleep. SDB is diagnosed using the gold standard, overnight polysomnography (PSG). The limited availability and access to PSG prevents its widespread use, resulting in significant delays in diagnosis and treatment of SDB. As such, portable sleep monitors are urgently needed.OBJECTIVE: To evaluate the utility of a commercially available portable sleep study monitor (PSS‐AL) (ApneaLink, ResMed, USA) to diagnose SDB in children.METHODS: Children referred to a pediatric sleep facility were simultaneously monitored using the PSS‐AL monitor and overnight PSG. The apnea‐hypopnea index (AHI) was calculated using the manual and autoscoring function of the PSS‐AL, and PSG. Sensitivity and specificity were compared with the manually scored PSS‐AL and PSG. Pearson correlations and Bland‐Altman plots were constructed.RESULTS: Thirty‐five children (13 female) completed the study. The median age was 11.0 years and the median body mass index z‐score was 0.67 (range −2.3 to 3.8). SDB was diagnosed in 17 of 35 (49%) subjects using PSG. The AHI obtained by manually scored PSS‐AL strongly correlated with the AHI obtained using PSG (r=0.89; P<0.001). Using the manually scored PSS‐AL, a cut‐off of AHI of >5 events/h had a sensitivity of 94% and a specificity of 61% to detect any SDB diagnosed by PSG.CONCLUSIONS: Although PSG is still recommended for the diagnosis of SDB, the ApneaLink sleep monitor has a role for triaging children referred for evaluation of SDB, but has limited ability to determine the nature of the SDB.
Regional Differences in Outcomes of Nonvariceal upper Gastrointestinal Bleeding in Saskatchewan
Authors: O’Byrne Michael , Smith-Windsor Erin L , Kenyon Chris R , Bhasin Sanchit , Jones Jennifer L 
Published: March 2016

BACKGROUND: Nonvariceal upper gastrointestinal bleeding (NVUGIB) is associated with significant mortality.OBJECTIVE: To examine several factors that may impact the mortality and 30-day rebleed rates of patients presenting with NVUGIB.METHODS: A retrospective study of the charts of patients admitted to hospital in either the Saskatoon Health Region (SHR) or Regina Qu’Appelle Health Region (RQHR) (Saskatchewan) in 2008 and 2009 was performed. Mortality and 30-day rebleed end points were stratified according to age, sex, day of admission, patient status, health region, specialty of the endoscopist and time to endoscopy. Logistic regression modelling was performed, controlling for the Charlson comorbidity index, age and sex as covariates.RESULTS: The overall mortality rate observed was 12.2% (n=44), while the overall 30-day rebleed rate was 20.3% (n=80). Inpatient status at the time of the rebleeding event was associated with a significantly increased risk of both mortality and rebleed, while having endoscopy performed in the RQHR versus SHR was associated with a significantly decreased risk of rebleed. A larger proportion of endoscopies were performed both within 24 h and by a gastroenterologist in the RQHR.CONCLUSION: Saskatchewan has relatively high rates of mortality and 30-day rebleeding among patients with NVUGIB compared with published rates. The improved outcomes observed in the RQHR, when compared with the SHR, may be related to the employ of a formal call-back endoscopy team for the treatment of NVUGIB.