bluuebunny/crossref_metadata_2025_split huggingface dataset:
The New Fluoroquinolones: A Critical Review
Authors: Zhanel George G , Walkty Andrew , Vercaigne Lavern , Karlowsky James A , Embil John , Gin Alfred S , Hoban Daryl J 
Published: March 2016

OBJECTIVE: This paper reviews the literature available on the new fluoroquinolones – clinafloxacin, gatifloxacin, grepafloxacin, levofloxacin, moxifloxacin, sparfloxacin and trovafloxacin – to compare these agents with each other and contrast them with ciprofloxacin, an older fluoroquinolone.DATA SELECTION: Published papers used were obtained by searching MEDLINE for articles published between 1994 and 1998, inclusive. References of published papers were also obtained and reviewed. Abstracts from scientific proceedings were reviewed.DATA EXTRACTION: Due to the limited data available on several of the agents, criteria for study inclusion in the in vitro, pharmacokinetics and in vivo sections were not restrictive.DATA SYNTHESIS: The new fluoroquinolones offer excellent Gram‐negative bacillary activity and improved Gram‐positive activity (eg, against Streptococcus pneumoniae and Staphylococcus aureus) over ciprofloxacin. Clinafloxacin, gatifloxacin, moxifloxacin, sparfloxacin and trovafloxacin display improved activity against anaerobes (eg, Bacteriodes fragilis). All of the new fluoroquinolones have a longer serum half‐life than ciprofloxacin (allowing for once daily dosing), and several are eliminated predominantly by nonrenal means. No clinical trials are available comparing the new fluoroquinolones with each other. Clinical trials comparing the new fluoroquinolones with standard therapy have demonstrated good efficacy in a variety of infections. Their adverse effect profile is similar to that of ciprofloxacin. Clinafloxacin and sparfloxacin cause a high incidence of phototoxicity (1.5% to 14% and 2% to 11.7%, respectively), grepafloxacin causes a high incidence of taste perversion (9% to 17%) and trovafloxacin causes a high incidence of dizziness (11%). They all interact with metal ion‐containing drugs (eg, antacids), and clinafloxacin and grepafloxacin interact with theophylline. The new fluoroquinolones are expensive; however, their use may result in savings in situations where, because of their potent and broad spectrum of activity, they can be used orally in place of intravenous antibiotics.CONCLUSIONS: The new fluoroquinolones offer advantages over ciprofloxacin in terms of improved in vitro activity and pharmacokinetics. Whether these advantages translate into improved clinical outcomes is presently unknown. The new fluoroquinolones have the potential to emerge as important therapeutic agents in the treatment of respiratory tract and genitourinary tract infections.
Bronchial Mucus Properties in Lung Cancer: Relationship with Site of Lesion
Authors: Zayas J Gustavo , Rubin Bruce K , York Ernest L , Lien Dale C , King Malcolm 
Published: March 2016

OBJECTIVE: To compare the biophysical properties of mucus from the left and right mainstem bronchi in patients undergoing diagnostic bronchoscopy because of a unilateral radiological abnormality. It was hypothesized that abnormalities in the properties of mucus would be greater on the side with the lesion and that this would be most obvious in patients with unilateral lung cancer.PATIENTS AND METHODS: Bilateral paired samples of bronchial mucus were taken from 38 nonatopic patients (aged 59.8±12.6 years) including 16 nonsmokers, 14 current smokers and eight exsmokers (more than one year). Twenty of the 38 patients had a radiologically defined unilateral abnormality. Eight of these 20, including one nonsmoker, had lung cancer. The viscoelastic properties of the collected mucus were determined by magnetic microrheometry, and the analysis was carried out without knowledge of the histological diagnosis or source.RESULTS: The rheological properties of mucus strongly suggested which was the abnormal side. Within the group of 20 patients with a unilateral radiological abnormality, mucus from the side of the lesion had a lower value of the loss tangent, tan δ100 (P=0.004), indicating greater mucus recoil. This is consistent with poor mucus cough clearability on the lesion side. All eight cancer patients fit this mucus rheological pattern with a lower value of tan δ100 on the affected side (P=0.007). Four of the five other patients with a similar mucus abnormality were categorized as high cancer risk by other criteria, while six of seven patients with mucus that did not have this abnormality were considered to be lower risk. Based on the mucus analysis done at the time of the bronchoscopy, two of the ‘noncancer’ patients initially designated as high risk had cancer detected after several months of follow‐up. Only two of the 18 patients without a defined unilateral lesion fit the mucus ‘cancer pattern’.CONCLUSIONS: These findings are consistent with the hypothesis that either abnormalities in mucus properties may represent a risk factor for the development of lung cancer or that bronchial mucus abnormalities may be associated with products secreted by the tumours that, in turn, may suppress mucus clearance.
Differential Yield of Pathogens from Stool Testing of Nosocomial versus Community‐Acquired Paediatric Diarrhea
Authors: Deorari Savita , McConnell Athena , Tan Kah-Kee , Jadavji Nadeem , Ma Doreen , Church Deirdre , Katzko Gary , Gall D Grant , Jadavji Taj , Davies H Dele 
Published: March 2016

OBJECTIVES: To evaluate the role of routine stool examination for all pathogens in paediatric nosocomial diarrhea (NAD) and community‐acquired diarrhea (CAD) over a two‐year period at Alberta Children’s Hospital and current practices in other Canadian hospitals. A secondary objective was to characterize features that may predict NAD or CAD etiology.STUDY DESIGN: Retrospective cohort study and telephone survey.SETTING: Alberta Children’s Hospital (retrospective review) and Canadian tertiary care paediatric centres (telephone survey).METHODS: The health and microbiological records of all children with an admission or discharge diagnosis of diarrhea were reviewed using a standardized data collection form. In addition, a telephone survey of laboratories serving all paediatric hospitals in Canada was conducted using a standard questionnaire to obtain information about practices for screening for pathogens related to NAD.RESULTS: Four hundred and thirty‐four CAD episodes and 89 NAD episodes were identified. Overall, rotavirus and Clostridium difficile were the most commonly identified pathogens. Bacterial culture was positive in 10.6% CAD episodes tested, with Escherichia coli O157:H7 identified as the most common non‐C difficile organism. In NAD, no bacteria were identified other than C difficile (toxin). Screening for ova and parasites had negligible yield. Viruses were more frequent in the winter months, while bacterial pathogens were more common in the summer and fall months. Over 50% of Canadian paediatric hospitals still routinely process NAD specimens similarly to CAD specimens.CONCLUSIONS: There is a need for the re‐evaluation of routine ova and parasite screening, and bacterial culture in nonoutbreak episodes of NAD in children.
Lung Volume Reduction for Emphysema and The Canadian Lung Volume Reduction (CLVR) Surgery Project
Authors: Miller John D , Malthaner Richard A , Goldsmith Charles H , Cox Gerard , Higgins David , Stubbing David , Kitching Allan , Newman Toni E , McDonald Ellen 
Published: March 2016

OBJECTIVE: To review the literature on the surgical treatment of emphysema and to present preliminary results from a pilot study of lung volume reduction (LVR) surgery.DESIGN: Case series of consecutive patients referred for LVR surgery. Outcomes were quality of life, pulmonary function and exercise capacity.SETTING: Two university‐affiliated hospitals in Ontario.POPULATION STUDIED: Patients between the ages of 40 and 75 years with emphysema who had severe airflow limitation, hyperinflation of the lungs and impaired quality of life.INTERVENTION: Bilateral reductions with multiple wedge resections of the lung using a linear stapling device with bovine pericardial buttressing were completed via a median sternotomy.MAIN RESULTS: Of 50 patients referred, 24 underwent LVR surgery. Mean age of the cohort was 63 years. Operative 30‐day or in hospital mortality was 8%. Two other patients (8%) died from respiratory failure after LVR within the first year. Postoperative complications included prolonged air leaks (six of 24), tracheobronchitis (five of 24), mechanical ventilation (four of 24) and pneumonia (three of 24). Mean length of stay was 18 days (median 12 days). At one year, there was a sustained decrease in total lung capacity from 133% to 123% predicted. There were improvements in forced expiratory volume in 1 s, from 22% of predicted preoperatively to 32% postoperatively, and in 6 min walk performance, from 345 to 381 m. Improvements were also noted in the quality of life assessments.CONCLUSIONS: Preliminary results suggest that LVR surgery is feasible and may improve the patient’s quality of life, pulmonary function and exercise capacity. A randomized clinical trial comparing LVR plus the best medical management with the best medical management alone is currently underway to determine the effectiveness of LVR.
Treatment of Neuropathic Pain: Focus on Antidepressants, Opioids and Gabapentin
Authors: Watson C Peter N , Watt-Watson Judith H 
Published: March 2016

BACKGROUND: The treatment of neuropathic pain continues to be difficult. Randomized, controlled trials (RCTs) provide some evidence to guide therapy. Most data relate to antidepressant therapy, although there is information on anticonvulsants and other treatments. Mistaken beliefs about many of these treatments are prevalent and need to be dispelled. Opioids are increasingly being used for the refractory patient. There has been recent enthusiasm for the anticonvulsant gabapentin for the treatment of these conditions.OBJECTIVE: To review the positive scientific data that are largely confined to RCTs in two neuropathic pain conditions that have proved to be good models for clinical investigation. These models are postherpetic neuralgia and painful diabetic neuropathy. Negative RCTs, weakly positive RCTs, other types of treatments and neuropathic conditions are also examined.METHODS: This review of the literature used MEDLINE, CINAHL and the Cochrane Database.RESULTS: There is extensive literature supporting the use of the older generation antidepressants, such as amitriptyline, in neuropathic pain. Newer RCTs support the use of gabapentin and opioids. Other therapies may be useful in individual cases on a trial and error basis but are largely unsupported by RCTs at this time. CONCLUSIONS: First‐line therapy for neuropathic pain may be either an older generation antidepressant, such as amitriptyline or nortriptyline, or the anticonvulsant gabapentin. A variety of trial and error approaches may be used, none of which has sound scientific approval. For refractory patients, chronic opioid therapy may be the only avenue of relief, and evidence is accumulating that this approach is safe if proper guidelines are observed. The possibility that some types of neuropathic pain may be prevented is exciting. Progress in the treatment of neuropathic pain has been slow but steady, and there continues to be a need to explore newer agents and approaches.
Surgical Management of Lung Gangrene
Authors: Krishnadasan Baiya , Sherbin Vandy L , Vallières Eric , Karmy-Jones Riyad 
Published: March 2016

OBJECTIVE:To review the outcomes of five cases of pulmonary resection for lung gangrene.DESIGN:A retrospective chart review.SETTING:A tertiary referral centre.POPULATION STUDIED:Five patients who underwent pulmonary resection for lung gangrene between April and December 1999.MAIN RESULTS:Pathological confirmation of lung gangrene was obtained in all cases. Three patients were ventilator dependent. All five patients had ongoing sepsis despite antibiotic therapy. Additional indications for resection included bronchopleural fistula (two patients), empyema (three patients) and hemoptysis (one patient). In two cases, there was evidence of bilateral, diffuse necrotizing pneumonia, while in three cases the process was localized to one side. Computed tomography revealed cavitation in four cases and the absence of blood supply to the affected lung in one case. Surgical resection included wedge resection (one patient), lobectomy (two patients), bilobectomy (one patient) and pneumonectomy (one patient). In all cases, the bronchial stump was reinforced with an intercostal flap. Postoperative empyema occurred in two cases, one treated by thoracoscopic decortication, the other by percutaneous drainage. There were no instances of stump leak and no deaths. One patient remains ventilator dependent.CONCLUSIONS:Resection for lung gangrene is possible even in the setting of diffuse parenchymal changes and ventilator dependency. A computed tomography scan of the chest is important to make the diagnosis of lung gangrene and to plan operative management. Reinforcement of the bronchial stump is critical.
Population‐Based Surveillance of HiB Invasive Infections in Children in British Columbia, Alberta and Ontario ‐‐ 1995 to 1997
Authors: Scheifele David , Bell Alison , Jadavji Taj , Vaudry Wendy , Waters John , Naus Monika , Sciberras Jill 
Published: March 2016

OBJECTIVE: To assess vaccine effectiveness through enhanced disease surveillance following the change in childhood immunization programs in 1995, when all provinces and territories chose to use polyribosyl ribitol phosphate‐tetanus protein (PRP‐T) Haemophilus influenzae type b (Hib) conjugate vaccine, generally in combination with diphtheria‐pertussis‐tetanus inactivated polio vaccine (DPT‐IPV) (as PENTA vaccine) because the protective efficacy of this regimen had not been directly measured.DESIGN: Prospective, active, laboratory‐based Hib case surveillance was implemented in British Columbia and Alberta, and enhanced, stimulated laboratory surveillance in Ontario during 1995 to 1997, centred on invasive infections in children. Case details and immunization histories were uniformly collected and centrally collated.MAIN RESULTS: Thirty‐eight Hib cases were detected, but only 12 cases arose among PENTA‐eligible children, an attack rate of 0.85 cases/100,000 child‐years of observation. Annual case totals declined from 20 in 1995 to seven in 1997, when only one to three cases were encountered in each province and the incidence rate in children under age five years was 0.6/100,000. Only four cases occurred after primary immunization with PENTA, a failure rate of 0.28 cases/100,000 child‐years of observation. Three cases among PENTA‐eligible children reflected parental refusal of infant vaccinations, accounting for 25% of cases in eligible children.CONCLUSIONS: PRP‐T conjugate vaccine was highly effective when given in combination with DPT‐IPV vaccine. Provincial programs that used this regimen resulted in the near elimination of invasive Hib disease in children, but unimmunized children remain at risk.
Asthma Management in the Emergency Department
Authors: Reid John , Marciniuk Darcy D , Cockcroft Donald W 
Published: March 2016

OBJECTIVES: To evaluate various aspects of the management of adult patients who present to the emergency department with acute exacerbations of asthma and who are discharged from the emergency department without hospital admission. Further, to compare the results with accepted management guidelines for the emergency department treatment of asthma.DESIGN: A retrospective chart collection and review until each site contributed 50 patients to the survey.SETTING: Three tertiary care hospitals in the Saskatoon Health District, Saskatoon, Saskatchewan. The study period was from July 1, 1997 to November 18, 1997.POPULATION: Patients aged 17 years or older, who were discharged from the emergency department with the diagnosis of asthma.METHODS: Data were collected on 130 patients from 147 emergency department visits.RESULTS: A number of important physical examination findings were frequently not documented. In contrast to management guidelines, peak expiratory flow rates (44%) and spirometry (1%) were not commonly used in patient assessments. Only 59% of patients received treatment in the emergency departments with inhaled or systemic corticosteroids. Furthermore, specific follow‐up plans were infrequently documented in the emergency department charts (37%).CONCLUSIONS: Adherence with published Canadian guidelines for the emergency department management of acute asthma exacerbations was suboptimal. Corticosteroid use in the emergency department was significantly less than recommended. Increased emphasis on education and implementation of accepted asthma management guidelines is necessary.
Low Prevalence of VRE Gastrointestinal Colonization of Hospitalized Patients in Manitoba Tertiary Care and Community Hospitals
Authors: Zhanel George G , Harding Godfrey KM , Rosser Stuart , Hoban Daryl J , Karlowsky James A , Alfa Michelle , Kabani Amin , Embil John , Gin Alfred , Williams Trevor , Nicolle Lindsay E 
Published: March 2016

OBJECTIVE: To determine the prevalence of vancomycin‐resistant enterococci (VRE) bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing.DESIGN: Two tertiary care and five community hospitals in Winnipeg and three rural Manitoba community hospitals participated in this study. From January 1 to December 31, 1997 stool specimens, one per patient, submitted to hospital microbiology laboratories for C difficile toxin and/or culture testing were screened for VRE on colistin‐nalidixic acid‐vancomycin (6 g/mL) (CNAV) agar plates. The study was divided into six, eight‐week intervals. Stool specimens received in the first two weeks of each eight week interval were screened for VRE.MAIN RESULTS A total of 1408 stool specimens were submitted over the 48‐week study period. Sixty‐seven (4.8%) patients with VRE colonization of their lower gastrointestinal tract were identified. Three of the 67 (4.5%) VRE isolates were Enterococcus faecium, with the remaining 64 (95.5%) were Enterococcus gallinarum. The three vancomycin‐resistant E faecium (VREF) (from two different Winnipeg hospitals) demonstrated the vanA genotype, and were resistant to vancomycin, teicoplanin and ampicillin. All three VREF isolates also demonstrated high level resistance to both gentamicin and streptomycin but were susceptible to quinuprisitin/dalfopristin and LY333328.CONCLUSION: VRE colonization in hospitalized patients in Manitoba is infrequent and most commonly due to E gallinarum. The prevalence of VREF colonization in the patients studied was 0.2% (three of 1408).
How Novel Methods Can Help Discover More Information about Foodborne Pathogens
Authors: Griffiths Mansel W 
Published: March 2016

Considerable emphasis is being placed on quantitative risk assessment modelling as a basis for regulation of trade in food products. However, for models to be accurate, information about the behaviour of potential pathogens in foods needs to be available. The question is how to obtain this knowledge in a simple and cost effective way. One technique that has great potential is the use of reporter bacteria which have been genetically modified to express a phenotype that can be easily monitored, such as light production in luminescent organisms. Bacteria carrying these (lux) genes can easily be detected using simple luminometers or more sophisticated low light imaging equipment.By monitoring light output from these bacteria over time, it can easily be determined if the organism is growing (resulting in an increase in light emission), is dead (causing a decrease in light production) or is injured (light output remains constant). The use of imaging systems allows the response of bioluminescent bacteria to be studied directly on the food, making the technique even more useful. Applications of bioluminescence are discussed below and include use as reporters of gene expression; biocide efficacy and antibiotic susceptibility; sub‐lethal injury; adhesion and biofilm formation; the microbial ecology of foods; pathogenesis; and as biosensors.
Revisiting ′Respiratory Function in Emphysema in Relation to Prognosis′
Authors: Bates David V 
Published: March 2016

BACKGROUND: The 1956 paper by DV Bates, JMS Knott and RV Christie, "Respiratory function in emphysema in relation to prognosis" Quart J Med 1956;97:137‐157 is largely reprinted with a commentary by the first author, Dr David Bates. Although the pathology of emphysema was well recognized at the time, the clinical diagnosis and assessment of its severity were known to be imprecise; physiological measurements assessing and following the clinical course had not been established. The study aimed to follow systematically a group of patients, selected by clinical criteria using standardized clinical and physiological techniques, over four years and correlate physiological and clinical changes in relation to prognosis and eventually to postmortem findings. Fifty‐nine patients were recruited to an emphysema clinic at St Bartholomew′s Hospital, London, England. Inclusion criteria were dyspnea without other causes and no cor pulmonale present. Patients′ symptoms were assessed by a standardized questionnaire, and measurements were taken of lung volumes, maximal ventilatory volume, carbon monoxide diffusing capacity at rest, exercise and oxygen saturation by oximetry. During the four years of the study, 17 patients died (actuarial expected ‐ four) and 13 presented with signs of pulmonary heart failure. All postmortem examinations (n=9) showed advanced emphysema. A seasonal variation in dyspnea was established (the period included the infamous 1952 London smog). Four patients improved, and the remainder were unchanged or deteriorated. Close relationships were shown between dyspnea and function results, particularly for the diffusing capacity of lungs for carbon monoxide (DLCO. A comparison among a group of patients with chronic bronchitis without dyspnea showed that the DLCO discriminated between them. A loss of the normal increase in DLCO during exercise was shown in emphysema.IMPORTANCE: The study showed the value of standardized clinical and physiological techniques in following chronic obstructive pulmonary disease patients, and of separating the effects of airflow obstruction from impaired gas exchange function. Impaired gas exchange was shown to be important in influencing prognosis.