bluuebunny/crossref_metadata_2025_split huggingface dataset:
Molecular epidemiology of Candida albicans colonization and fungemia in very low birthweight infants
Authors: Robinson Joan L , Hartstein Alan I , Meuser Renate U , Morthland Virginia H , Dragoon Margaret E , Wenman Wanda M 
Published: March 2016

Objective: This study investigated the relationship between colonization and fungemia.Design: This was a prospective study involving surveillance cultures of the nares, base of umbilicus, point of entry of umbilical catheter and parenteral fluids. Blood cultures were done when sepsis was suspected. All Candida albicans isolates were typed using restriction enzyme analysis of DNA.Setting: Patients were from the neonatal intensive care unit of a tertiary care hospital.Population Studied: Twenty‐nine very low birthweight infants.Main Results: Eleven babies were colonized with C albicans and five of these babies developed fungemia, including five of seven who were colonized at the point of entry of the umbilical catheter. Three different strains of C albicans caused fungemia. In four of the five patients, initial catheter entry site isolates were identical to the subsequent blood isolates. Occasionally, infants were colonized with more than one strain of C albicans.Conclusions: Preceding colonization with C albicans and, in particular, colonization at the site of entry of umbilical vascular catheters are risk factors for subsequent development of C albicans fungemia. Fungemic and colonizing isolates are usually identical to one another by DNA typing.
Evaluation of Haemophilus influenzae Type B Conjugate Vaccine (Meningococcal Protein Conjugate) in Canadian Infants
Authors: Scheifele David W , Bjornson Gordean L , Meekison William G , Guasparini Roland , Mitchell Leslie A 
Published: March 2016

Objective: To assess adverse effects and immune responses with a three‐dose series of Haemophilus influenzae type b meningococcal protein conjugate (PedvaxHIB or Hib.OMP) vaccine, including any immunological response alterations from concurrent administration with routine vaccines for infants.Design: Randomized, controlled trial with treatment group crossover for dose 3.Setting: Two public health units near Vancouver.Participants: One hundred and ten healthy infants eight to 14 weeks old were enrolled; 105 completed the study (95%).Interventions: All participants received two doses of diphtheria‐pertussis‐tetanus (dpt) vaccine (at two and four months of age) and one dose of measles‐mumps‐rubella (mmr) vaccine at 12 months. In each instance, Hib.OMP was given either concurrently in another limb or after a delay of two weeks (after dpt) or four weeks (after mmr).Main Outcome Measures: Adverse effects, particularly fever and local erythema, were monitored by parents for 72 h after each dose of Hib.OMP vaccine. Five blood samples were taken at prescribed intervals to assess responses to each dose of Hib.OMP and to selected other vaccine antigens.Main Results: Follow‐up was obtained after all 322 doses of Hib.OMP. Local adverse effects were infrequent and mild: 13% had redness, 17% tenderness. Systemic effects in those given Hib.OMP alone included fever in 8%, irritability in 29%. Anti‐polyribose‐ribitol phosphate (prp) responses to Hib.OMP were not impaired by coadministration with dpt or mmr vaccines, nor were tetanus or diphtheria antitoxin levels or rubella or measles response rates affected. After two doses of Hib.OMP, 92% were seropositive and 64% had greater than 1.0 μg/mL of anti‐prp. After three doses, 100% were seropositive and 82% exceeded 1.0 μg/mL.Conclusion: Hib.OMP vaccine was well tolerated, immunogenic and compatible with vaccines routinely given to infants in Canada.
Captopril‐Associated Cough Is Not due to Increased Airway Responsiveness
Authors: Blackie SP , Hilliam C , Porter R , Rangno R , Paré PD 
Published: March 2016

BACKGROUND: Angiotensin‐converting enzyme (ACE) inhibitors
commonly cause cough. There is controversy as to
whether preexisting airway hyperresponsivencss predisposes
patients to ACE inhibitor‐induced cough and whether
ACE inhibitor therapy can cause airway hypcrresponsiveness.OBJECTIVES: To lest the predictive value of baseline airway
responsiveness fur the development of cough induced
by ACE inhibitors, and whether patients who developed
cough during ACE inhibitor therapy showed an increase in
airway responsiveness.METHODS: Baseline spiromctry and airway responsiveness
to methacholinc (expressed as the concentrat ion of
mcthacholine required to cause a 10% fall in forced expired
volume in 1 s [ FEV1 or PC10) were measured in 23 hypertensive
patients before and after 10 to l 2 weeks of treatment
with captopril at an initial daily dose of 50 mg.RESULTS: During caplopril therapy seven (30%) patients
developed new cough, which resolved after discontinuation
of captopril. The base line PC10 was the same in coughers
and noncoughers and did not predict the development of
cough. During caplopril therapy there was a nonsignificant
decrease in the geometric mean PC10 for all patients from
15 mg/mL (range 0.8 to 62) to 13 mg/ml (range 0.7 to 62)
(P=0.08). These changes were not different in cougher, and
noncoughers. FEV1, forced vital capacity and total lung
capacity did not change during the study.CONCLUSIONS: Cough caused by captopril is not predicted
by baseline airway responsiveness and is not associated
with increased airway res ponsiveness
Itraconazole: Precautions Regarding Drug Interactions and Bioavailability
Authors: Puttick Michael PE , Phillips Peter 
Published: March 2016

Objective: To describe patients with fungal infections in whom drug interactions and bioavailability problems were associated with itraconazole treatment failure.Design: Retrospective chart review.Setting: Two tertiary care university‐affiliated teaching hospitals.Population Studied: Itraconazole‐treated patients between 1990 and 1992.Main Results: Four patients treated with itraconazole were identified in whom suboptimal serum itraconazole levels were associated with relapse of disseminated histoplasmosis, treatment failure of invasive aspergillosis or development of superficial mycoses. Low serum itraconazole levels were associated with concurrent therapy with rifampin or agents inhibiting gastric acid secretion, with administration of itraconazole capsule contents through a nasogastric tube or with the presence of aids.Conclusions: It is recommended that serum itraconazole levels be measured in patients with potentially life‐threatening mycoses if coexistent factors may interfere with itraconazole therapy.
Reproducibility of Protected Brush Catheter Specimen Cultures in Critically Ill Patients with Suspected Nosocomial Pneumonia
Authors: Fox George A , Leasa David J , Sibbald William J , McCormack David G 
Published: March 2016

OBJECTIVE: To determine the reproducibility of two protected brush catheter (PBC) specimens obtained during the same bronchoscopy in critically ill patients with suspected ventilator associated pneumonia.DESIGN: Prospective, observational study.SETTING: Two university‐affiliated multidisciplinary intensive care un its with a combined total of 50 beds.PATIENTS: A total of 75 (50 male. 25 female) patients with 84 episodes of suspected ventilator associated pneumonia were studied be tween January 1, 1991 and June 30, 1992. Age was 60.7±1.9 (mean ± SEM) years, and mean APACHE II score was 22.4±2.0. Twenty‐four patients were admitted from various medical services, 19 from surgical services including the operating room, 16 with central nervous system disease and 16 following multiple trauma. Twenty patients were transferred directly to the intensive care unit from peripheral hospitals.INTERVENTIONS: All patients had lower respiratory tract secretions obtained for culture by both aspiration through the endotracheal n1be (tracheal aspirates) and flexible bronchoscopy, with separate samples obtained by two PBCs (PBC‐A and PBC‐8).MAIN RESULTS: The overall proportion of agreement between the results of t he two PBC specimens was 0.928, with a calculated kappa statistic (κ) = 0.853 (P<0.01 versus κ=0.4, 95% CL 0.692, 1.014) indicating excellent agreement between the two specimens. Both PBC specimens had significant (ie, more than 103 colony‐forming units/mL) growth (positive/positive) in 33 cases, nonsignificant growth in 45 cases (negative/negative) and discordant results in six (positive/negative, n=3 or negative/positive, n=3 ). There was a significant relationship (P<0.05) between the concurrent use of antibiotics and a negative PBC result. However, after exclusion of patients on antibiotics, the overall proportion of agreement between the two PBCs was 0.94 with κ=0.875 (P<0.01 versus κ=0.4, 95% CL 0.721, 1.029), which also indicates excellent agreement between the two tests.CONCLUSIONS: Although discordant results were observed in 7.2% cases, the overall reproducibility of the PBC results appears to be high. The significant relationship between concurrent antibiotic use and a negative PBC result is of concern clinically since many patients arc being treated with antibiotics al the time of bronchoscopy. Therefore, when the diagnosis of nosocomial pneumonia in critically ill patients is established, the PBC result should be considered only in association with all the other clinical data, particularly in patients receiving concurrent antibiotics.
Intra‐ and Interlaboratory Reproducibility of an ELISA Serological Test for Lyme Disease
Authors: Tammemagi Martin C , Frank John W , LeBlanc Michael , Artsob Harvey 
Published: March 2016

Objectives: Lyme disease has been increasingly diagnosed throughout North America since the late 1970s. The clinical diagnosis and epidemiological monitoring of Lyme disease are aided by serological testing for the etiological agent, Borrelia burgdorferi. Numerous authorities have questioned the reproducibility of these serological tests. This study assessed the intra‐ and interlaboratory reproducibility of an elisa used to aid in the diagnosis of Lyme disease.Methods: Twenty‐seven sera from cases and noncases were tested by three laboratories. Two of the laboratories repeated the tests once. These testings were part of the 1991 quality control assessment of provincial laboratories carried out by the Laboratory Centre for Disease Control (lcdc), Ottawa.Results: The mean weighted kappa statistics were 0.87 for interlaboratory comparisons and 0.89 for intralaboratory comparisons.Conclusions: Overall, the elisa assessed in this study demonstrated good to excellent intra‐ and interlaboratory reproducibility in the lcdc 1991 quality control assessment when the data were assessed in the categorical scale using the weighted kappa statistic. Generalization of these findings to clinical laboratory settings must be done with caution.
Asthma Mortality in Canada, 1946 to 1990
Authors: Hogg Robert S , Schechter Martin T , Montaner Julio SG , Hogg James C 
Published: March 2016

OBJECTIVE: To assess the impact of asthma on Canadian mortality rates over a 45‐year period.DESIGN: A descriptive, population‐based study.SETTING: Canada.SUBJECTS: All persons who died from asthma in Canada from 1946 to 1990 as reported to Statistics Canada in Ottawa.MAIN OUTCOME MEASURES: Standardized mortality ratios, age‐specific patterns of death, potential years of life lost (PYLL) and life expectancy lost.RESULTS: A total of 12,010 male and 8486 female asthma deaths were recorded in Canada from 1946 to 1990. Mortality rates for both sexes declined from a high of between three to six deaths in 1951 to 1955 to approximately two deaths per 100,000 in 1986 to 1990, with the decline in rates being greater for males than females. Age‐specific mortality rates were highest al all ages in 1951 to 1955, except for 15 to 24 years when deaths rates for the 1981 to 1985 period were greater. PYLL exhibit the same pattern as mortality, peaking in 1951 to 1955 and subsequently declining with each period. Loss in life expectancy due to asthma was about one month (not significant) in all time periods.CONCLUSIONS: Asthma mortality rates have declined significantly over the study period. This decline appears to be linked with the convergence of sex‐specific rates and with changes in the patterning or age‐specific mortality. The impact of asthma on the life expectancy of Canadians is small.
Efficacy and Cost Benefit of Inhaled Corticosteroids in Patients Considered to Have Mild Asthma in Primary Care Practice
Authors: O′Byrne Paul , Cuddy Lauren , Taylor D Wayne , Birch Stephen , Morris Joanne , Syrotuik Jerry 
Published: March 2016

OBJECTIVE: Inhaled corticosteroids are infrequently used as asthma therapy in patients considered to have mild asthma in primary care practice. The purpose of this study was to determine whether the use of low doses of inhaled corticosteroids (budesonide), supplemented with bronchodilators as needed, provides clinical benefit and is cost beneficial compared with therapy with bronchodilators alone, in patients considered by their physicians in a primary care setting to have mild asthma, not requiring inhaled corticosteroids.DESIGN: Double‐blind, randomized controlled study comparing three parallel treatment groups receiving 400 mg or 800 mg inhaled budesonide/day or placebo.SETTING: Seven primary care practices across Canada.PATIENTS: Fifty‐seven adult asthmatics considered to have mild asthma not needing inhaled corticosteroids.OUTCOME MEASURES: Patients recorded morning and evening peak expiratory flow rates (PEFR) and daily asthma symptom scores. Economic data were collected regarding drug and service use and willingness to pay.RESULTS: Budesonide significantly reduced early morning and nocturnal symptoms and sputum production, and reduced the use of a bronchodilator compared with placebo. The budesonide groups also showed significant improvements in PEFR, before and after bronchodilator. No differences were found between the two dosages of budesonide; however, the study had insufficient power to detect differences between dosages, had they been present. There was a similar frequency of adverse events in all three treatment groups. The willingness‐to‐pay assessment found that both doses of budesonide were more cost beneficial than placebo.CONCLUSIONS: These results demonstrate that inhaled budesonide 400 mg/day provides better asthma control and is cost beneficial compared with bronchodilators alone in the management of patients with mild asthma who were not considered to need inhaled corticosteroids in primary care practice.
Chemotherapy of Drug‐Resistant Malaria
Authors: Kain Kevin C 
Published: March 2016

OBJECTIVE: To review the impact of drug‐resistant malaria on current management of plasmodial infections.DATA SOURCES: A MEDLINE search of the English‐language medical literature from 1985 to 1995; bibliographies of selected papers; international malaria advisory experts.DATA SYNTHESIS: Combinations of artemisinin derivatives and mefloquine or atovaquone plus proguanil appear to be the most active drug regimens against multidrug‐resistant falciparum malaria from Southeast Asia. The optimal therapy for chloroquine‐resistant Plasmodium vivax is unknown, but recent data indicate that halofantrine or chloroquine plus high doses of primaquine are efficacious.CONCLUSIONS: The incidence of drug‐resistant malaria continues to increase at a rate that exceeds new drug development. Ultimately the control of malaria will require more creative approaches than just the development of additional inhibitory drugs. These might include the identification of biochemical pathways unique to the parasite (such as drug efflux and heme polymerization), making it possible to design new classes of antimalarial agents that are selectively toxic to the parasite; methods to block parasite development in the mosquito vector; and multistage vaccines against asexual and sexual stages to block both the pathophysiology and the transmission of disease.
Seroprevalence of Toxoplasma Antibody in a Toronto Population
Authors: Ford-Jones EL , Kitai I , Corey M , Notenboom R , Hollander N , Kelly E , Akoury H , Ryan G , Kyle I , Gold R 
Published: March 2016

OBJECTIVE: To determine the prevalence of infection with toxoplasmosis by country of birth and age in a sample of convenience.DESIGN: Banked sera and the computerized data base of demographic and other factors from an earlier epidemiological study were retrieved.SETTING: Thirty‐eight infant‐toddler day care centres in Toronto.POPULATION: Day care providers from whom informed consent was obtained and banked sera were available.MAIN RESULTS: Of the 124 providers whose serum was tested, 16 (12.9%) were seropositive. Of those providers born in Canada, 8.2% were seropositive, while of those born outside of Canada, 19.6% were positive (P=0.067, OR 2.68, 95% CI 0.91, 7.94). While there was no significant association of seropositivity with age, the association of seropositivity with country of birth was different in the providers under 30 years of age. Among those born in Canada, 4.6% were seropositive, while among those born outside of Canada 23.1% were seropositive.CONCLUSIONS: The data supplement the limited existing data on toxoplasmosis infection in Canada. Among Canadians, those born outside of Canada were more likely to be seropositive than those born in Canada, suggesting that there may be a differential risk of congenital infection for infants whose parents were born outside of Canada.
Comparison of Community‐Acquired Pneumonia Requiring Admission to Hospital in HIV‐and Non‐HIV‐Infected Patients
Authors: Touchie Claire , Marrie Thomas J 
Published: March 2016

OBJECTIVE: To compare community‐acquired pneumonia (CAP) in hospitalized human immunodeficiency virus (HIV)‐infected patients with that in hospitalized non‐HIV‐infected patients by assessing presenting characteristics, etiology and outcomes.DESIGN: Retrospective chart review.SETTING: A tertiary care centre in Halifax, Nova Scotia.POPULATION STUDIED: Thirty‐two HIV‐infected patients requiring hospitalization for treatment of CAP were identified from September 1991 to October 1993 and compared with 33 age‐matched non‐HIV‐infected patients who presented with pneumonia during the same period.MAIN RESULTS: The two populations were comparable in age, sex and race. Fifty per cent of the HIV‐infected and 20.8% of the non‐HIV‐infected patients had had a previous episode of pneumonia. Pneumocystis carinii pneumonia (PCP) accounted for 16 of the 32 episodes of CAP in the HIV‐infected patients, while none of the non‐HIV‐infected patients had PCP. Pneumonia secondary to Streptococcus pneumoniae was more common in the non‐HIV‐infected patients (five versus one, P=0.02). Vital signs and initial PO2 did not differ between the two groups. White blood cell count was lower at admission for the HIV population (5.7×109/L versus 12.7×109/L, P=0.003). The HIV patients were more likely to undergo bronchoscopy (27.7% versus 0%, P<0.001). The length of stay in hospital, transfer to the intensive care unit and necessity for intubation were the same for both groups. The in‐hospital mortality for HIV‐infected patients was eight of 32 (25%) while for the non‐HIV‐infected patients it was none of 33 (P=0.002).CONCLUSIONS: Patients with HIV infection who present with CAP are more likely to have PCP, to have had a past episode of pneumonia and to die while in hospital than age‐ and sex‐matched non‐HIV‐infected patients with CAP.
Superiority of Spacer/Mask Topical Anesthetic Compared with Conventional Spray and Gargle Method for Fibreoptic Bronchoscopy
Authors: Balkissoon RC , Clelland L , Whitehead L , Newhouse MT 
Published: March 2016

OBJECTIVE: To compare the safety and efficacy of a new spacer‐oral nasal mask device with those of the standard needle nozzle spray method for the delivery of aerosolized lidocaine to the upper airway for pre‐bronchoscopic anaesthesia in a tertiary care hospital.DESIGN: Single‐blind randomized control trial.SETTING: University affiliated tertiary care hospital, ambulatory care bronchoscopy unit.SUBJECTS: Thirty consecutive consenting patients referred for fibreoptic bronchoscopy for various indications.INTERVENTION: Thirty randomized subjects received 150 mg of topical 1% aerosolized lidocaine via standard long needle nosed applicator (group A) or via a new oral/ nasal mask with spacer device (group B). Bronchoscopists, blinded as to the preprocedure topical anaesthetic method used, gave additional topical lidocaine at their discretion.MEASUREMENTS: The study nurse recorded the total dose of lidocaine (mg), timing of the procedure (s), cough frequency expressed as coughs per minute (c/min), vital signs, time for return of gag reflex and patients′ subjective comments.RESULTS: Fifteen patients were randomized to each group. The lidocaine dose required for insertion through the vocal cords (mean ± SD) was 282.6±66.3 mg in group A and 203.3±70.6 mg in group B (PÃ0.005). Total lidocaine dose required for the procedure was 330.6±70.2 mg in group A and 256.6±75 mg in group B (PÃ0.01). The mean time for passage of the bronchoscope from mouth entry to through the vocal cords was 82.7±54.5 s in group A and 110.5±64.4 s in group B (P>0.1). The mean total time for the procedure was 699.7±377.5 s in group A and 697.2±409.1 s in group B (not significant). The mean cough frequency was 8.2±6.1 c/min in group A and 7.0±5.7 c/min in group B (not significant). There were no statistically significant differences in heart rate, in return of gag reflex time or in complication rate between the two groups.CONCLUSIONS: A statistically significant reduction in the dose of lidocaine is required to achieve equivalent topical anaesthetic for bronchoscopy with a new mask and spacer device compared with a more conventional method. Since no other variables related to the procedure showed a significant difference, the new method appears to be superior to the previous method.
Possible Nonopioid‐Mediated Analgesia Produced by Methotrimeprazine in Rats
Authors: Fuchs Perry N , Kerr Bradley , Melzack Ronald 
Published: March 2016

BACKGROUND: Several reports in the 1960s demonstrated that methotrimeprazine (MTMZ), a phenothiazine derivative, is effective for treating acute and chronic pain. Although MTMZ has received little attention in recent decades, the fact that it derives from a class of drugs usually associated with cognitive and emotional processes, rather than the traditional analgesics, makes it interesting as a potential source of information about the mechanisms of analgesia.OBJECTIVE: To explore the analgesic properties of MTMZ in a dose‐related design in the formalin test, and to examine whether the lowest dose of MTMZ that produces analgesia will activate endogenous opioid systems.METHODS: The analgesic properties of three doses of MTMZ, compared with a saline control, were explored in male Sprague‐Dawley rats using the formalin test. Sedative effects were studied by using the line‐crossing test concomitantly with the formalin test.RESULTS: MTMZ had no effect during the first phase of formalin responding. During the second phase of the formalin test, MTMZ doses of 5.0 and 10.0 mg/kg produced a significant decrease in formalin responses. Sedative effects were observed at all doses, even though the dose of 2.5 mg/kg did not significantly decrease formalin responses compared with controls. Statistical analyses revealed no significant correlation between the degree of sedation and the degree of analgesia at any dose of MTMZ. The nonspecific opioid antagonist naloxone did not alter the analgesic effect of 5.0 mg/kg MTMZ, indicating that the mechanism of action is independent of endogenous opioid systems.CONCLUSION: MTMZ decreased responses in the formalin pain test in rats. Although the drug′s sedative effects were apparent in the line crossing test, they were not significantly correlated with pain responses. These results suggest that the decrease in formalin responses might be due, in part at least, to the analgesic properties of MTMZ. The fact that MTMZ belongs to a class of drugs that is relatively unexplored in relation to pain and analgesia indicates a potential source for the development of new pharmacological agents for treating persistent pain. Furthermore, the nonopioid mechanism of action suggests that this agent may be useful when opioid medications are contraindicated.