bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predeominace of Herpes Simplex Virus Type 1 from Patients with Genital Herpes in Nova Scotia
Authors: Forward Kevin R , Lee Spencer HS 
Published: March 2016

The epidemiology of genital herpes is changing with evidence to suggest an increasing incidence of herpes simplex virus type 1 (HSV‐1) infections. The results of 6529 HSV genital cultures taken between April 1998 and December 2001 were reviewed. Overall, HSV‐1 was recovered more often than HSV‐2; 1213 versus 1045. This trend was particularly striking in young women 30 years of age or less, in whom 70.8% of isolates were HSV‐1. In men of the same age range, 45% of isolates were HSV‐1. The proportion of women with HSV‐1 declined from 73.7% in those younger than 31 years of age to 4.5% in those older than 60 years of age.These observations have important implications. The decline in the relative proportion of HSV‐1 isolates from young adults may be the result of changing sexual practices, changing susceptibility or increased exposure to HSV‐1 during vaginal intercourse. In this setting HSV‐2 vaccines may be less likely to produce the desired reduction in the overall prevalence of genital herpes infections.
Invasive Streptococcus pneumoniae Infection Causing Hemolytic Uremic Syndrome in Children: Two Recent Cases
Authors: Vanderkooi Otto G , Kellner James D , Wade Andrew W , Jadavji Tajdin , Midgley Julian P , Louie Thomas , Tyrrell Gregory J 
Published: March 2016

INTRODUCTION: Streptococcus pneumoniae is an uncommon cause of hemolytic uremic syndrome (HUS) with a unique pathophysiology that differs from Shiga toxin‐related HUS.METHODS: Case descriptions for each patient are provided. Each strain of S pneumoniae was subjected to a pulsed‐field gel electrophoresis (PFGE) analysis, Shiga toxin assay and polymerase chain reaction to detect Shiga toxin genes. A review of the current literature was conducted.CASE PRESENTATIONS: Two patients with S pneumoniae‐related HUS that presented to the Alberta Children′s Hospital, Calgary, Alberta, within four weeks of each other in 2001 are described. Both presented with pneumonia and empyema with associated HUS. Both patients required dialysis, one patient for 10 days and the other for 18 days. Neither patient demonstrated evidence of Shiga toxin‐related disease. S pneumoniae isolated from blood or pleural fluid was penicillin susceptible. One isolate was serotype 3 and the other was serotype 14. The two strains had different PFGE patterns. Both patients recovered well with no persistent renal dysfunction.CONCLUSIONS: S pneumoniae continues to be an uncommon but important cause of HUS. Most cases can be confirmed or at least considered probable without performing a renal biopsy.
Does Participation in a Pain Course Based on the International Association for the Study of Pain’s Curricula Guidelines Change Student Knowledge about Pain?
Authors: Strong Jenny , Meredith Pamela , Darnell Ross , Chong Marlene , Roche Patricia 
Published: March 2016

BACKGROUND: The People in Pain course was set up as a joint initiative of the Departments of Occupational Therapy and Physiotherapy within the School of Health and Rehabilitation Sciences at The University of Queensland. It was instigated in response to the publication of Pain Curricula for Occupational Therapy and Physiotherapy by the International Association for the Study of Pain (IASP) in 1994 (1). The first year it was offered, the ′People in Pain′ course comprised 14 h of lecture content. It was then expanded to encompass 28 h of lectures and seminar involvement.OBJECTIVES: To evaluate the impact of participation in a university pain course that meets the IASP pain curricula guidelines to increase health professional students′ knowledge about pain.METHODS: Students who participated in the People in Pain course over the first three years were invited to complete the Revised Pain Knowledge and Attitudes Questionnaire (R‐PKAQ) pre‐ and postcourse. Data obtained from 22 students in the short course formed a pilot project, and data from 22 students in the longer version of the course were used in the present study.RESULTS: Examination of the correlation matrix indicated substantial correlations between all R‐PKAQ subscales except physiological basis of pain and pharmacological management of pain. In both the pilot project during the first year of the course and the expanded course in the following two years, significant improvement was found in the students′ knowledge on five of the six subscales of the R‐PKAQ: physiological basis of pain, psychological factors of pain perception, assessment and measurement of pain, cognitive‐behavioural methods of pain relief, and pharmacological management of pain. Improvements in the developmental aspects of pain perception subscale failed to reach significance.CONCLUSIONS: An integrated pain course developed according to the pain curriculum guidelines developed by the IASP resulted in increased student knowledge regardless of the length of the program attended.
Pulmonary Function and Circulating Adhesion Molecules in Patients with Diabetes Mellitus
Authors: Boulbou Mary S , Gourgoulianis Konstantinos I , Petinaki Efthymia A , Klisiaris Vasilios K , Maniatis Antonios N , Molyvdas Paschalis A 
Published: March 2016

BACKGROUND: Lung function in diabetes has been reported in several studies with contradictory results. Diabetes mellitus increases expression of adhesion molecules through hyperglycemia. These molecules play an important role in the pathophysiological dysfunction of the vasculature.OBJECTIVE: To explore the possible relationship between lung function and circulating levels of adhesion molecules in diabetes.METHODS: Sixteen type 1 diabetic patients, 33 type 2 diabetic patients and 22 healthy subjects matched for age and sex were studied. Spirometry measurements were performed and pulmonary diffusion capacity for carbon monoxide (DLco) was measured in sitting and supine positions by the single-breath method corrected by alveolar volume (VA). Glycosylated hemoglobin, retinopathy and nephropathy were included as parameters of metabolic control and diabetic complications. Circulating levels of soluble E-selectin and vascular cell adhesion molecule-1 (VCAM-1) were determined in all subjects.RESULTS: Diabetic subjects showed lower variation in DLco and DLco/VA by changing posture from sitting to supine position (P=0.043 and P<0.001, respectively), and showed reduced total lung capacity (P<0.001) and forced expiratory volume in 1 s/forced vital capacity (P=0.009) compared with healthy control subjects. Serum concentrations of E-selectin were elevated in diabetic patients (P<0.001). There was no difference in serum VCAM-1 concentrations between diabetic and control subjects. On stepwise regression analysis, E-selectin concentrations were the most important contributing factor to the variation in DLco/VA.CONCLUSIONS: Diabetic patients show lower pulmonary volumes and variation in DLco by changing posture from sitting to supine position, and they also show increased levels of E-selectin. A possible explanation is impaired pulmonary microvasculature, because adhesion molecules seem to be sensitive markers of endothelial activation and damage seen in diabetes.
Adjustable Maintenance Dosing with Budesonide/Formoterol Reduces Asthma Exacerbations Compared with Traditional Fixed Dosing: A Five‐Month Multicentre Canadian Study
Authors: FitzGerlad J Mark , Sears Malcolm R , Boulet Louis-Philippe , Becker Allan B , McIvor Andrew R , Ernst Pierre , Smiljanic-Georgijev Natasha M , Lee Joanna SM 
Published: March 2016

BACKGROUND: Adjustable maintenance dosing with budesonide/formoterol in a single inhaler (Symbicort, AstraZeneca, Lund, Sweden) may provide a convenient means of maintaining asthma control with the minimum effective medication level.Objectives: To compare adjustable and fixed maintenance dosing regimens of budesonide/formoterol in asthma.METHODS: This was an open‐label, randomized, parallel‐group, multicentre, Canadian study of asthma patients (aged 12 years or older, postbronchodilator forced expiratory volume in 1 s 70% or greater of predicted normal). Following a one‐month run‐in on budesonide/formoterol (100/6 µg or 200/6 µg metered doses, two inhalations twice daily), 995 patients were randomly assigned either to continue on this fixed dosing regimen or to receive budesonide/formoterol adjustable dosing (step down to one inhalation twice daily if symptoms were controlled or temporarily step up to four inhalations twice daily for seven or 14 days if asthma worsened). The primary efficacy variable was the occurrence of exacerbations (requiring oral or inhaled corticosteroids, emergency department treatment, serious adverse events or added maintenance therapy because of asthma).RESULTS: With adjustable dosing, significantly fewer patients experienced exacerbations compared with fixed dosing (4.0% versus 8.9%, P=0.002; number needed to treat=21 [95% CI 13 to 59]). Patients required 36% fewer overall doses of budesonide/formoterol (2.5 versus 3.9 inhalations/day, P<0.001), and total costs per patient were lower (difference over five months CDN$‐141 [95% CI ‐$162 to ‐$116]). Asthma symptom severity (modified National Heart, Lung, and Blood Institute stage) was maintained or improved in 97% or greater of patients in both groups (pre‐run‐in to end of treatment). Both treatments were well tolerated.CONCLUSIONS: Budesonide/formoterol adjustable maintenance dosing provided more effective asthma control than fixed dosing, with a lower overall drug dose and reduced total cost.
Nelfinavir and Non‐Nucleoside Reverse Transcriptase Inhibitor‐Based Salvage Regimes in Heavily Hiv Pretreated Patients
Authors: Baril Jean-Guy , Lefebvre Eric A , Lalonde Richard G , Shafran Stephen D , Conway Brian 
Published: March 2016

OBJECTIVE: To assess the efficacy of nelfinavir mesylate (NFV) in combination with delavirdine mesylate(DLV) or efavirenz (EFV) and other antiretroviral agents following virological failure on other protease inhibitor (PI)‐based regimens.DESIGN: Multicentre, retrospective chart review.METHODS: One hundred‐one patients who were naive to both NFV and non‐nucleoside reverse transcriptase inhibitors (NNRTIs) and who initiated NFV plus DLV or EFV‐based salvage regimens were reviewed. Response to treatmentwas defined as a reduction in HIV ribonucleic acid (RNA) levels to unquantifiable levels (less than 50 copies/mL, less than 400 copies/mL, less than 500 copies/mL) on at least one occasion after the initiation of salvage therapy. Baseline correlates of response, including prior duration of HIV infection, prior number of regimens, viral load and CD4 cell counts were also evaluated.RESULTS: Patients had a mean duration of HIV infection of 10 years, a mean duration of prior therapy of four years, a median of four prior nucleoside reverse transcriptase inhibitors and a median of two prior PIs. At the time of review the mean duration of salvage therapy was 63.4 weeks. Virological suppression was achieved in 59 (58.4%) patients within a mean of eight weeks and maintained for a mean of 44.9 weeks (themean follow‐up was78 weeks). Of the non‐responders, 16 (38%) achieved a less than 1 log10 decrease in HIV RNA levels. Although there was no association between baseline correlates, response rate (75.7%) was significantly higher in patients with HIV RNA levels of 50,000 copies/mL or lower and CD4 counts greater than 200 cells/mm3.CONCLUSION: NFV/NNRTI‐based highly active antiretroviral therapy regimens are an effective therapy in many patients who have experienced virological breakthroughs on at least one prior PI‐based regimen.
Assessment of Two Alternative Sample Transport and Fixation Methods in the Microbiological Diagnosis of Bacterial Vaginosis
Authors: Eason Erica , Toye Baldwin , Wells George A , Senterman Mary 
Published: March 2016

BACKGROUND: The standard method for specimen collection and transport for microbiological diagnosis of bacterial vaginosis is an air‐dried smear of vaginal secretions, promptly heat‐ or alcohol‐fixed, Gram‐stained and scored by Nugent′s criteria.OBJECTIVE: Two alternative methods are evaluated: sending a swab in transport medium to be smeared and Gram‐stained in the laboratory two days later; and sending a smear of vaginal secretions sprayed with cytological fixative to the laboratory for Gram staining seven days later.PATIENTS AND METHODS: One hundred fifty‐two women aged 18 years and older who attended a hospital colposcopy clinic or a community healthy sexuality clinic were studied. This was a prospective study: three vaginal swabs were taken from each patient and handled as described above. Each slide was blindly and independently interpreted by two microbiology technologists. The sensitivity, specificity and coefficient of agreement of the transported swab and cytologically fixed methods were compared with the air‐dried smear method.RESULTS: Smears from swabs in transport medium and cytologically fixed smears both had 90% sensitivity and 97% specificity for bacterial vaginosis compared with diagnosis from air‐dried smears. Cohen′s kappa was 0.88 (95% CI 0.79 to 0.97) for each method. Inter‐rater reliability assessed over all slides (all sampling techniques) was excellent (kappa 0.94).CONCLUSIONS: For the diagnosis of bacterial vaginosis, both alternative techniques provide results equivalent to air‐dried direct smears. A vaginal smear sprayed with cytological fixative provides immediate fixation of material to the slide, permits delays in swab transport and avoids the requirement for transport at a controlled temperature imposed by swabs.
Antimicrobials in Acute Exacerbations of Chronic Obstructive Pulmonary Disease ‐ An Analysis of the Time to Next Exacerbation Before and After Implementation of Standing Orders
Authors: Goddard Rob D , McNeil Shelly A , Slayter Kathryn L , McIvor R Andrew 
Published: March 2016

OBJECTIVE: To compare the mean time to next exacerbation in patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) before and after the implementation of standing orders.SETTING: Tertiary care hospital, Halifax, Nova Scotia, Canada.POPULATION STUDIED: The records of 150 patients were analyzed, 76 were in the preimplementation group, 74 in the postimplementation group.INTERVENTION: The management and outcomes of patients admitted with an acute exacerbation of COPD before and after the implementation of standing orders were compared.DESIGN: A retrospective chart review.MAIN RESULTS: There was no difference in the mean time to next exacerbation between treatment groups (preimplementation group: 310 days, postimplementation group: 289 days, P=0.53). Antibiotics were used in 90% of the cases (preimplementation group: 87%, postimplementation group: 93%). The postimplementation group had a 20% increase in the use of first‐line agents over the preimplementation group. Overall, first‐line agents represented only 37% of the antibiotic courses.CONCLUSIONS: The implementation of standing orders encouraged the use of first‐line agents but did not influence subsequent symptom resolution, length of hospital stay, or the infection‐free interval in patients with acute exacerbations of COPD.
Computed Tomography and Bronchoscopy in Endobronchial Tuberculosis
Authors: Yanardag Halil , Tetikkurt Cüneyt , Tetikkurt Seza , Demirci Sabriye , Karayel Tuncer 
Published: March 2016

BACKGROUND: The therapeutic response to endobronchial tuberculosis is usually evaluated by bronchoscopy. Currently, there are no published studies investigating the use of computed tomography for the evaluation of therapeutic response in endobronchial tuberculosis.OBJECTIVE: A retrospective study was performed to evaluate the bronchoscopic and computed tomographic features of endobronchial tuberculosis before and after treatment. The aim of this study was to investigate the usefulness of computed tomography for the assessment of treatment.METHODS: The clinical, pathological and bronchoscopic features of endobronchial tuberculosis were evaluated in 55 patients. The age range of the patients was 21 to 52 years. Computed tomography and bronchoscopy were performed before and after treatment.RESULTS: Diagnosis of tuberculosis was confirmed by culture and histopathological examination. Bronchoscopic examination revealed 89 endobronchial lesions of various types in 55 patients. The exudative type was the most common. Follow‐up bronchoscopy revealed that exudative‐, ulcerative‐ and granular‐type lesions healed completely. Computed tomography performed after treatment correlated well with the follow‐up bronchoscopic findings.CONCLUSION: The results suggest that follow‐up computed tomography is useful for the evaluation of therapeutic response and complications associated with endobronchial tuberculosis, and may replace bronchoscopy.
Coxiella burnetii Seroprevalence of Shepherds and Their Flocks in the Lower Saint‐Lawrence River Region of Quebec, Canada
Authors: Dolcé Patrick , Bélanger Marie-Joële , Tumanowicz Krzysztof , Gauthier Claude P , Jutras Philippe , Massé Richard , Montpetit Claude , Bernatchez Harold , McColl Dorothy , Artsob Harvey 
Published: March 2016

OBECTIVE: To determine the seroprevalence of Coxiella burnetii among the shepherds and their sheep in the lower Saint‐Lawrence River region (LSLRR) of Quebec, Canada.DESIGN: A prospective human‐animal comparative study was conducted with 81 shepherds from 46 farms and a control group matched for sex and age. All participants answered a standardized questionnaire to evaluate their risk factors for Q fever, including a specific section on the work practices of the shepherds. All human subjects had a blood sample taken for serology to phase I and phase II antigens of C burnetii performed by indirect immunofluorescence assay. At each participating farm, seven to nine sheep had blood samples taken for C burnetii serology to be assessed by the complement fixation test.RESULTS: The seroprevalence to C burnetii was higher in the group of shepherds (28.4%) than the control group (1.2%) (P<0.005). Among the group of shepherds, spending more than 5 h/week in the sheep barn (P=0.06) and buying and/or trading sheep within the past six months (P=0.004) were associated with positive C burnetii serology. A total of 137 of 334 sheep (41%) were seropositive for C burnetii. These positive sheep were distributed in 41 of the 46 flocks (89%). No correlation could be demonstrated between a serology for C burnetii in the herds and the shepherds.CONCLUSION: Q fever is highly prevalent in the LSLRR of Quebec, affecting 89% of the flocks and 28% of the shepherds. Shepherds in this region are at increased risk for C burnetii infection in comparison to the general population.
Predictors of a Positive Duplex Scan in Patients with a Clinical Presentation Compatible with Deep Vein Thrombosis or Cellulitis
Authors: Rabuka Curtis E , Azoulay Laurent Y , Kahn Susan R 
Published: March 2016

BACKGROUND: Deep vein thrombosis (DVT) and cellulitis are common conditions whose symptoms lead patients to seek medical attention in the emergency department (ED). Distinguishing between these two conditions quickly and accurately is important.OBJECTIVES: To determine the yield of duplex scanning among ED patients whose clinical presentation is compatible with DVT or cellulitis. In addition, to determine whether baseline clinical variables are predictive of the final diagnosis among ED patients with an initial clinical impression of ′DVT versus cellulitis′ who underwent duplex scanning.METHODS: In this historical cohort study, patients with a final diagnosis of DVT (positive duplex) were compared on several baseline variables with patients with a final diagnosis of cellulitis (negative duplex and antibiotics prescribed) .RESULTS: One hundred‐nine of 542 ED patients referred for a duplex scan were initially diagnosed as ′DVT versus cellulitis′, 17% of whom had DVT confirmed by a positive duplex scan. Comparing patients with DVT versus those with cellulitis, 0% versus 15.3% had rigors (P=0.06); 0% versus 8.3% had distinct margins of erythema (P<0.01); 5.3% versus 22.2% were currently on antibiotics (P=0.09); and 50% versus 21.3% had an elevated white blood cell count (P=0.04).CONCLUSION: There are differences in a number of baseline characteristics of ′DVT versus cellulitis′ patients who went on to have either positive or negative duplex scans, some of which were statistically significant despite the limited sample size. These findings should be confirmed prospectively in a larger study sample since they may have the potential to aid in the clinical differentiation between DVT and cellulitis.
Treatment of Chronic Intractable Neuropathetic Pain with Dronabinol: Case Report of Two Adolescents
Authors: Rudich Zvia , Stinson Jennifer , Jeavons Michael , Brown Stephen C 
Published: March 2016

OBJECTIVE: To evaluate the effectiveness of dronabinol for the treatment of neuropathic pain refractory to previous treatment.METHODS: We studied the response (reduction of pain intensity and functional improvement) to dronabinol (5 mg/day to 25 mg/day) in two adolescents with neuropathic pain and depression refractory to previous treatments over two and five years, respectively.RESULTS: Reduction in pain intensity (45%) was achieved in patient 2 and was unchanged in patient 1. Functional improvement was markedly increased in terms of academic performance, mood and sleep in both patients over four to five months, without major adverse effects. While these improvements dissipated over time, the patients were more reconnected with rehabilitation and focused less on the intrusiveness of their pain problem in their every day lives.CONCLUSIONS: Dronabinol appeared to be effective in improving pain affect and psychosocial functioning in the treatment of refractory neuropathic pain and may be considered as an adjuvant medication in the rehabilitation process. Well‐controlled placebo studies are required for further evaluation.