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Weitzel T, Brown A, Libman M, Perret C, Huits R, Chen L, Leung D, Leder K, Connor BA, Menéndez MD, Asgeirsson H, Schwartz E, Salvador F, Malvy D, Saio M, Norman FF, Amatya B, Duvingnaud A, Vaughan S, Glynn M, Angelo KM. Intestinal protozoa in returning travellers: a GeoSentinel analysis from 2007 to 2019. J Travel Med 2024:taae010. [PMID: 38245913 DOI: 10.1093/jtm/taae010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND Prolonged diarrhoea is common among returning travellers and is often caused by intestinal protozoa. However, the epidemiology of travel-associated illness caused by protozoal pathogens is not well described. METHODS We analysed records of returning international travellers with illness caused by Giardia duodenalis, Cryptosporidium spp., Cyclospora cayetanensis, or Cystoisospora belli, reported to the GeoSentinel Network during January 2007-December 2019. We excluded records of travellers migrating, with an unascertainable exposure country, or from GeoSentinel sites that were not located in high-income countries. RESULTS There were 2517 cases, 82.3% giardiasis (n = 2072), 11.4% cryptosporidiosis (n = 287), 6.0% cyclosporiasis (n = 150), and 0.3% cystoisosporiasis (n = 8). Overall, most travellers were tourists (64.4%) on long trips (median durations: 18-30 days). Cryptosporidiosis more frequently affected people < 18 years (13.9%) and cyclosporiasis affected people ≥40 years (59.4%). Giardiasis was most frequently acquired in South-Central Asia (45.8%) and Sub-Saharan Africa (22.6%), cryptosporidiosis in Sub-Saharan Africa (24.7%) and South-Central Asia (19.5%), and cyclosporiasis in South East Asia (31.3%) and Central America (27.3%). and cystoisosporiasis in Sub-Saharan Africa (62.5%). Cyclosporiasis cases were reported from countries of uncertain endemicity (e.g. Cambodia) or in countries with no previous evidence of this parasite (e.g. French Guiana). The time from symptom onset to presentation at a GeoSentinel site was the longest among travellers with giardiasis (median: 30 days). Over 14% of travellers with cryptosporidiosis were hospitalized. CONCLUSIONS This analysis provides new insights into the epidemiology and clinical significance of 4 intestinal protozoa that can cause morbidity in international travellers. These data might help optimize pretravel advice and post-travel management of patients with travel-associated prolonged gastrointestinal illnesses. This analysis reinforces the importance of international travel-related surveillance to identify sentinel cases and areas where protozoal infections might be undetected or underreported.
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Affiliation(s)
- Thomas Weitzel
- Travel Medicine Program, Clínica Alemana, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
- Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Ashley Brown
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Michael Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, Montreal, Quebec, Canada
| | - Cecilia Perret
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Verona, Italy
| | - Lin Chen
- Division of Infectious Diseases, Mount Auburn Hospital, Cambridge, Massachusetts, United States of America
| | - Daniel Leung
- International Travel Clinic, University of Utah Hospital and Clinics, Salt Lake City, Utah, United States of America
| | - Karin Leder
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Bradley A Connor
- New York Center for Travel and Tropical Medicine, New York, United States of America
| | - Marta Diaz Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Madrid, Spain
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Eli Schwartz
- The Center of Geographical Medicine and Tropical Diseases, Sheba Medical Center, Tel HaShomer, Israel
- Ramat Gan & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Fernando Salvador
- Tropical Medicine Unit, Vall d'Hebron-Drassanes, Infectious Diseases Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Denis Malvy
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux, France
| | | | - Francesca F Norman
- National Referral Unit for Tropical Diseases, Infectious Diseases Department, Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Bhawana Amatya
- CIWEC Hospital and Travel Medicine Center, Kathmandu, Nepal
| | - Alexandre Duvingnaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, Bordeaux, France
| | - Stephen Vaughan
- Division of Infectious Diseases, University of Calgary, South Health Campus, Calgary, Alberta, Canada
| | - Marielle Glynn
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
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2
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Desai V, Vokey S, Vaughan S, Somayaji R. Necrotizing Soft-Tissue Infections: A Case-Based Review. Adv Skin Wound Care 2023; 36:571-577. [PMID: 37861662 DOI: 10.1097/asw.0000000000000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
GENERAL PURPOSE To review the assessment and management of necrotizing fasciitis. TARGET AUDIENCE This continuing-education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the etiologic pathogens for necrotizing fasciitis.2. Summarize assessment guidelines for patients who present with signs of necrotizing fasciitis.3. Explain recommended treatment protocols for patients who have necrotizing fasciitis.
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3
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Díaz-Menéndez M, Angelo KM, de Miguel Buckley R, Bottieau E, Huits R, Grobusch MP, Gobbi FG, Asgeirsson H, Duvignaud A, Norman FF, Javelle E, Epelboin L, Rothe C, Chappuis F, Martinez GE, Popescu C, Camprubí-Ferrer D, Molina I, Odolini S, Barkati S, Kuhn S, Vaughan S, McCarthy A, Lago M, Libman MD, Hamer DH. Dengue outbreak amongst travellers returning from Cuba-GeoSentinel surveillance network, January-September 2022. J Travel Med 2023; 30:taac139. [PMID: 36573483 PMCID: PMC10166199 DOI: 10.1093/jtm/taac139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/21/2022] [Accepted: 11/14/2022] [Indexed: 12/28/2022]
Abstract
Increasing numbers of travellers returning from Cuba with dengue virus infection were reported to the GeoSentinel Network from June to September 2022, reflecting an ongoing local outbreak. This report demonstrates the importance of travellers as sentinels of arboviral outbreaks and highlights the need for early identification of travel-related dengue.
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Affiliation(s)
- Marta Díaz-Menéndez
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Pso de la Castellana, 261, 28046 Madrid, Spain
| | - Kristina M Angelo
- Division of Global Migration and Quarantine, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA 30329, USA
| | - Rosa de Miguel Buckley
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Pso de la Castellana, 261, 28046 Madrid, Spain
| | - Emmanuel Bottieau
- Department of Clinical Sciences, Institute of Tropical Medicine, 155 Nationalestraat, Antwerp 2000, Belgium
| | - Ralph Huits
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Martin P Grobusch
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Center, AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Federico Giovanni Gobbi
- Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, Via don A. Sempreboni, 5, 37024 Negrar, Verona, Italy
| | - Hilmir Asgeirsson
- Department of Infectious Diseases, Karolinska University Hospital, 14186 Stockholm, Sweden
- Division of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, 14186 Stockholm, Sweden
| | - Alexandre Duvignaud
- Department of Infectious Diseases and Tropical Medicine, Hôpital Pellegrin, CHU Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France
| | - Francesca F Norman
- Unidad de Medicina Tropical-Servicio de Enfermedades Infecciosas-Hospital Ramon y Cajal, C'tra de Calmenar Km. 9,1, Madrid 08001, Spain
| | - Emilie Javelle
- IHU-Méditerranée Infection, 19-21 Boulevard Jean Moulin, Marseille 13005, France
| | - Loïc Epelboin
- Centre Hospitalier Andree Rosemon, Av des flamboyants, Cayenne 97036, France
| | - Camilla Rothe
- Department of Infectious Diseases and Tropical Medicine, Ludwig-Maximilians-Universität München, Leopoldstrasse 5, 80802 Munich, Germany
| | - Francois Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 6 rue Gabrielle Perret Gentil, Geneva 1205, Switzerland
| | - Gabriela Equihua Martinez
- Institute of Tropical Medicine and International Health-Charité-Universitätsmedizin Berlin, Spandauer Damm 130, Berlin 10117, Germany
| | - Corneliu Popescu
- Carol Davila University of Medicine and Pharmacy, Dionisie Lupu St., 37, Sector 2, Bucharest 050474, Romania
- Dr Victor Babes Clinical Hospital and Infectious Diseases, Strada Gheorghe Adam 13, Timișoara 300310, Romania
| | - Daniel Camprubí-Ferrer
- ISGlobal, Hospital Clinic Universitat de Barcelona, Roselló, 132, 08036 Barcelona, Spain
| | - Israel Molina
- Hospital Universitari Vall d'Hebron, P° Vall d'Hebron 119, Barcelona 08035, Spain
| | - Silvia Odolini
- University Division of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia 25123, Italy
| | - Sapha Barkati
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1001 boul Decarie, Montreal, QC H4A 3J1, Canada
| | - Susan Kuhn
- Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Stephen Vaughan
- Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada
| | - Anne McCarthy
- The Ottawa Hospital Civic Campus, 501 Smyth Road, Ottawa, ON K1H 8L6, Canada
| | - Mar Lago
- Tropical Medicine Department, Hospital Universitario La Paz Carlos III, CIBERINFECT, Pso de la Castellana, 261, 28046 Madrid, Spain
| | - Michael D Libman
- J.D. MacLean Centre for Tropical Diseases, McGill University Health Centre, 1001 boul Decarie, Montreal, QC H4A 3J1, Canada
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health; Section of Infectious Diseases, Boston University School of Medicine; Center for Infectious Disease Policy and Research, Boston University; and National Emerging Infectious Disease Laboratory, Crosstown 308, 801 Massachusetts Avenue, Boston, MA 02118, USA
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Mah J, Lieu A, Bibby H, Vaughan S. A case of disseminated histoplasmosis mimicking miliary tuberculosis. J Travel Med 2022; 29:6633186. [PMID: 35796674 DOI: 10.1093/jtm/taac080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
A 50-year-old immunocompromised female presented with a 10-day history of fever and dyspnoea. She had recent VFR travel to Vietnam and had lived in Calgary, Alberta, for 20 years. Investigations revealed bicytopenia, elevated cholestatic enzymes and a miliary nodular pattern on chest imaging. She was diagnosed with a disseminated fungal infection.
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Affiliation(s)
- Jordan Mah
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada.,Division of Internal Medicine, Department of Medicine, University of Calgary, Calgary, AB T2N 2T9, Canada
| | - Anthony Lieu
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Helen Bibby
- Division of Microbiology, Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen Vaughan
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, AB, Canada
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5
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Stokes W, Chan WW, Thommasen A, Vaughan S. Chronic Cutaneous Lesion on the Left Lower Abdominal Wall. Clin Infect Dis 2022; 74:743-745. [PMID: 35230422 DOI: 10.1093/cid/ciab329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- William Stokes
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pathology and Laboratory Medicine, University of Alberta , Edmonton, Alberta, Canada
| | - Wilson W Chan
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Thommasen
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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6
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Robinson PD, Vaughan S, Missaghi B, Meatherall B, Pattullo A, Kuhn S, Conly J. A case series of infectious complications in medical tourists requiring hospital admission or outpatient home parenteral therapy. J Assoc Med Microbiol Infect Dis Can 2022; 7:64-74. [PMID: 36340853 PMCID: PMC9603019 DOI: 10.3138/jammi-2021-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/09/2021] [Accepted: 09/24/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Travelling for medical care is increasing, and this medical tourism (MT) may have complications, notably infectious diseases (ID). We sought to identify MT-related infections (MTRIs) in a large Canadian health region and estimate resulting costs. METHODS Retrospective and prospective capture of post-MT cases requiring hospital admission or outpatient parenteral antimicrobial therapy was completed by canvassing ID physicians practising in Calgary, Alberta, from January 2017 to July 2019. Cost estimates for management were made with the Canadian Institute for Health Information's (CIHI's) patient cost estimator database tool applied to estimated rates of Canadians engaging in MT from a 2017 Fraser Institute report. RESULTS We identified 12 cases of MT-related infectious syndromes. Eight had microbial etiologies identified. MTs were young (mean 40.3 [SD 12.2] y) and female (n = 11) and pursued surgical treatment (n = 11). Destination countries and surgical procedures varied but were largely cosmetic (n = 5) and orthopaedic (n = 3). Duration to organism identification (mean 5.3 wk) and treatment courses (mean 19 wk) appeared lengthy. CIHI cost estimates for management of relevant infectious complications of our cases ranged from $6,288 to $20,741, with total cost for cases with matching codes (n = 8) totalling $94,290. CONCLUSIONS In our series of MTRIs, etiologic organisms often found in Canadian-performed post-procedural infections were identified, and prolonged treatment durations were noted. Young women pursuing cosmetic surgery may be a population to target with public health measures to reduce the incidence of MTRIs and burden of disease.
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Affiliation(s)
- Paul D Robinson
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bayan Missaghi
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie Meatherall
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Andrew Pattullo
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - John Conly
- Department of Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Synder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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7
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Affiliation(s)
- Jordan Mah
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta.
| | - Anthony Lieu
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
| | - Emma Holmes
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- Division of Infectious Diseases, Department of Medicine (Mah, Lieu, Vaughan); Department of Pathology and Laboratory Medicine (Holmes), University of Calgary, Calgary, Alta
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8
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Lieu A, Church D, Vaughan S. Bilateral Adrenal Histoplasmosis in an Immunocompetent Host. Am J Trop Med Hyg 2021; 105:1437-1438. [PMID: 34424862 PMCID: PMC8641327 DOI: 10.4269/ajtmh.21-0481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Anthony Lieu
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Infectious Diseases, University of Calgary, Calgary, Alta, Canada
| | - Deirdre Church
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Departments of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada
| | - Stephen Vaughan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.,Division of Infectious Diseases, University of Calgary, Calgary, Alta, Canada
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9
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Huddy JR, Freeman Z, Vaughan S, Tilney HS. Challenge of maintaining the initial benefits of a 'cold' elective surgical unit established during the first COVID-19 peak. Br J Surg 2021; 108:e194-e195. [PMID: 33619551 PMCID: PMC7989569 DOI: 10.1093/bjs/znab052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/24/2021] [Indexed: 11/17/2022]
Affiliation(s)
- J R Huddy
- Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK
| | - Z Freeman
- Department of General Surgery, Frimley Park Hospital, Camberley, UK
| | - S Vaughan
- Department of General Surgery, Frimley Park Hospital, Camberley, UK
| | - H S Tilney
- Department of Colorectal Surgery, Frimley Park Hospital, Camberley, UK
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10
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Houston S, Belga S, Buttenschoen K, Cooper R, Girgis S, Gottstein B, Low G, Massolo A, MacDonald C, Müller N, Preiksaitis J, Sarlieve P, Vaughan S, Kowalewska-Grochowska K. Epidemiological and Clinical Characteristics of Alveolar Echinococcosis: An Emerging Infectious Disease in Alberta, Canada. Am J Trop Med Hyg 2021; 104:1863-1869. [PMID: 33755579 PMCID: PMC8103444 DOI: 10.4269/ajtmh.20-1577] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/26/2021] [Indexed: 01/29/2023] Open
Abstract
Human alveolar echinococcosis (AE) is a zoonotic cestode infection which is usually fatal in the absence of treatment. Treatment involves major surgery or indefinite antiparasitic therapy. The incidence is rising in Europe and Asia, with an increased risk observed in immunocompromised individuals. Previously, AE acquisition in North America was extremely rare, except for one remote Alaskan Island. Recent studies have demonstrated a new European-like strain of Echinococcus multilocularis (Em) in wildlife and in human AE in western Canada. We report the experience of all AE patients diagnosed in Alberta. Each was diagnosed by histopathology, serology, and PCR-confirmed by a reference laboratory. Seventeen cases of human AE, aged 19-78 years, nine females, were diagnosed between 2013 and 2020: all definitely or probably acquired in Alberta. Six lived in urban areas, and 14 had kept dogs. In eight, the lesions were found incidentally on abdominal imaging performed for other indications. Six were immunocompromised to varying degrees. Six were first diagnosed at surgery. All have been recommended benzimidazole therapy. One died of surgical complications. Clinicians should be aware of this diagnostic possibility in patients presenting with focal nonmalignant hepatic mass lesions. Greater urbanization of coyotes, the predominant definitive host of Em in Alberta, and growing numbers of immune suppressed individuals in the human population may lead to increasing recognition of AE in North America.
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Affiliation(s)
- Stan Houston
- University of Alberta, Edmonton, Canada;,Address correspondence to Stan Houston, University of Alberta, 1-124 Clinical Sciences Bldg., 11350 83 Ave., Edmonton T6G 2G3, Canada. E-mail:
| | - Sara Belga
- University of Alberta, Edmonton, Canada;,University of British Columbia, Vancouver, Canada
| | | | | | | | | | - Gavin Low
- University of Alberta, Edmonton, Canada
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11
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Affiliation(s)
- Graeme Prosperi-Porta
- Cumming School of Medicine, Department of Medicine (Prosperi-Porta, Oleynick, Vaughan), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Vaughan), Foothills Medical Centre, Calgary, Alta.
| | - Christopher Oleynick
- Cumming School of Medicine, Department of Medicine (Prosperi-Porta, Oleynick, Vaughan), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Vaughan), Foothills Medical Centre, Calgary, Alta
| | - Stephen Vaughan
- Cumming School of Medicine, Department of Medicine (Prosperi-Porta, Oleynick, Vaughan), University of Calgary, Calgary, Alta.; Division of Infectious Diseases, Department of Medicine (Vaughan), Foothills Medical Centre, Calgary, Alta
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12
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Webb JA, Fabreau G, Spackman E, Vaughan S, McBrien K. The cost-effectiveness of schistosomiasis screening and treatment among recently resettled refugees to Canada: an economic evaluation. CMAJ Open 2021; 9:E125-E133. [PMID: 33622765 PMCID: PMC8034375 DOI: 10.9778/cmajo.20190057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Many refugees and asylum seekers from countries where schistosomiasis is endemic are infected with the Schistosoma parasite when they arrive in Canada. We assessed, from a systemic perspective, which of the following management strategies by health care providers is cost-effective: testing for schistosomiasis and treating if the individual is infected, treating presumptively or waiting for symptoms to emerge. METHODS We constructed a decision-tree model to examine the cost-effectiveness of 3 management strategies: watchful waiting, screening and treatment, and presumptive treatment. We obtained data for the model from the literature and other sources, to predict deaths and chronic complications caused by schistosomiasis, as well as costs and net monetary benefit. RESULTS Presumptive treatment was cost-saving if the prevalence of schistosomiasis in the target population was greater than 2.1%. In our baseline analysis, presumptive treatment was associated with an increase of 0.156 quality-adjusted life years and a cost saving of $405 per person, compared with watchful waiting. It was also more effective and less costly than screening and treatment. INTERPRETATION Among recently resettled refugees and asylum claimants in Canada, from countries where schistosomiasis is endemic, presumptive treatment was predicted to be less costly and more effective than watchful waiting or screening and treatment. Our results support a revision of the current Canadian recommendations.
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Affiliation(s)
- John A Webb
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Gabriel Fabreau
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Eldon Spackman
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
| | - Kerry McBrien
- South Zone Medical Affairs, Alberta Health Services (Webb); Department of Community Health Sciences (Fabreau, Spackman, McBrien), O'Brien Institute for Public Health (Fabreau, Spackman, McBrien), Department of Medicine (Fabreau, Vaughan), Division of Infectious Diseases (Vaughan) and Department of Family Medicine (McBrien), Cumming School of Medicine, University of Calgary, Calgary, Alta
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Abstract
GENERAL PURPOSE To provide information about infection with cutaneous larva migrans (CLM). TARGET AUDIENCE This continuing education activity is intended for physicians, physician assistants, NPs, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Distinguish the clinical features, diagnosis, and management of CLM.2. Explain the epidemiology of CLM. ABSTRACT Cutaneous larva migrans is a hookworm infection and one of the most common skin diseases of tourists in tropical countries. Most commonly, the infection is transmitted by contact with feces of dogs and cats containing hookworm eggs. This case-based review explores the epidemiology, diagnosis, clinical features, and management of cutaneous larva migrans infection.
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McLellan J, Gill MJ, Vaughan S, Meatherall B. Schistosoma and Strongyloides screening in migrants initiating HIV Care in Canada: a cross sectional study. BMC Infect Dis 2020; 20:76. [PMID: 31992216 PMCID: PMC6986152 DOI: 10.1186/s12879-020-4779-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following migration from Schistosoma and Strongyloides endemic to non-endemic regions, people remain at high risk for adverse sequelae from these chronic infections. HIV co-infected persons are particularly vulnerable to the serious and potentially fatal consequences of untreated helminth infection. While general screening guidelines exist for parasitic infection screening in immigrant populations, they remain silent on HIV positive populations. This study assessed the seroprevalence, epidemiology and laboratory characteristics of these two parasitic infections in a non-endemic setting in an immigrant/refugee HIV positive community. METHODS Between February 2015 and 2018 individuals born outside of Canada receiving care at the centralized HIV clinic serving southern Alberta, Canada were screened by serology and direct stool analysis for schistosomiasis and strongyloidiasis. Canadian born persons with travel-based exposure risk factors were also screened. Epidemiologic and laboratory values were analyzed using bivariate logistic regression. We assessed the screening utility of serology, direct stool analysis, eosinophilia and hematuria. RESULTS 253 HIV positive participants were screened. The prevalence of positive serology for Schistosoma and Strongyloides was 19.9 and 4.4%, respectively. Age between 40 and 50 years (OR 2.50, 95% CI 1.13-5.50), refugee status (3.55, 1.72-7.33), country of origin within Africa (6.15, 2.44-18.60), eosinophilia (3.56, 1.25-10.16) and CD4 count < 200 cells/mm3 (2.46, 1.02-5.92) were associated with positive Schistosoma serology. Eosinophilia (11.31, 2.03-58.94) was associated with positive Strongyloides serology. No Schistosoma or Strongyloides parasites were identified by direct stool microscopy. Eosinophilia had poor sensitivity for identification of positive serology. Hematuria was not associated with positive Schistosoma serology. CONCLUSION Positive Schistosoma and Strongyloides serology was common in this migrant HIV positive population receiving HIV care in Southern Alberta. This supports the value of routine parasitic screening as part of standard HIV care in non-endemic areas. Given the high morbidity and mortality in this relatively immunosuppressed population, especially for Strongyloides infection, screening should include both serologic and direct parasitological tests. Eosinophilia and hematuria should not be used for Schistosoma and Strongyloides serologic screening in HIV positive migrants in non-endemic settings.
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Affiliation(s)
- Jessica McLellan
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada.
| | - M John Gill
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Meatherall
- Department of Medicine, The University of Calgary, Calgary, Alberta, Canada
- Division of Infectious Disease, The University of Calgary, Calgary, Alberta, Canada
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Diaz Pallares C, Griener T, Vaughan S. Ureaplasma urealyticum disseminated multifocal abscesses in an immunocompromised adult patient: a case report. BMC Infect Dis 2020; 20:47. [PMID: 31941460 PMCID: PMC6964043 DOI: 10.1186/s12879-020-4771-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/07/2020] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND Ureaplasma urealyticum is a fastidious bacteria which lacks a cell wall. Extragenital infections are rare in immunocompetent adults. There are few literature reports of perinephric abscess. We present a case of non-resolving multifocal "culture-negative" abscesses in a hypogammaglobulinemic adult female due to U. urealyticum. CASE PRESENTATION 66-year-old female with a one-week history of fever, malaise and new right hip and leg pain. Past medical history was notable for chronic pancytopenia secondary to in remission B cell follicular lymphoma, ESRD on intermittent hemodialysis with bilateral nephrostomy tubes and Crohn's. CT abdomen/pelvis revealed a small left perinephric hematoma and proximal right femur fluid collection. Persistent right thigh pain led to additional ultrasound with anterior thigh collection and CT revealed an irregular rim-enhancing fluid collection in the left posterior pararenal space. Antimicrobial therapy included ertapenem and vancomycin followed by meropenem, trimethoprim-sulfamethoxazole, daptomycin and metronidazole in setting of persistent culture-negative results and clinical deterioration. Following detection of U. urealyticum by 16S rDNA PCR in both left pararenal and right trochanteric bursa abscesses doxycycline was started. Despite this, the patient died four days later. CONCLUSIONS Disseminated infection by U. urealyticum has been documented in immunocompromised adult patients with few reports of perinephric abscess. We propose that ascending genitourinary route led to perinephric abscess. The multiple disseminated fluid collections make it highly suspicious for hematogenous spread given the lack of radiographic enhancement to suggest contiguous spread. Diagnosis and treatment of U. urealyticum-disseminated infection is extremely challenging as culture is laborious and not routinely performed. Furthermore, the lack of cell wall renders beta-lactams and vancomycin ineffective and therefore requirement for "atypical" coverage. Early diagnosis and treatment are key to prevent further complications and death.
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Affiliation(s)
- Carolina Diaz Pallares
- University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Thomas Griener
- University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Stephen Vaughan
- University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Marasinghe DH, Cheaveau J, Meatherall B, Kuhn S, Vaughan S, Zimmer R, Pillai DR. Risk of malaria associated with travel to malaria-endemic areas to visit friends and relatives: a population-based case-control study. CMAJ Open 2020; 8:E60-E68. [PMID: 31992561 PMCID: PMC6996033 DOI: 10.9778/cmajo.20190070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Reports relying on population-based data and using epidemiologic methodologies such as case-control study designs for malaria in travellers and multivariable regression analysis of risk factors are rare. The aim of this study was to investigate the epidemiologic characteristics of travellers who tested positive for malaria after visiting friends and relatives in malaria-endemic areas to determine the risk of malaria associated with such travel. METHODS Using routinely collected data from a population-based laboratory database, we conducted a case-control study of symptomatic people returning from travel to malaria-endemic areas who presented for malaria testing in Calgary from 2013 to 2017. We used a multivariable logistic regression to analyze the association between the presence of malaria and other risk factors. RESULTS There were 251 confirmed malaria cases during the study period, of which 219 were matched to 1129 returning travellers without malaria. Based on the multivariable regression, the odds of a traveller who visited friends and relatives in malariaendemic areas being diagnosed with malaria was 2.82 (95% confidence interval [CI] 1.42-5.92) times greater than that of other travellers to these regions. Adults (odds ratio [OR] 3.62, 95% CI 1.66-8.84), males (OR 2.70, 95% CI 1.56-4.80), travellers to Africa (OR 11.52, 95% CI 6.33-22.05) and those who did not seek pretravel advice (OR 0.38, 95% CI 0.20-0.70) were more likely to be diagnosed with malaria. Although those travelling to visit friends and relatives tended to stay longer in endemic areas than other travellers, visit duration was not associated with an increased likelihood of malaria in the model. The annual incidence of malaria was highest (13.34 per 100 000) in metropolitan wards associated with lower socioeconomic status and immigrant communities. INTERPRETATION Travellers who visited friends and relatives in malaria-endemic areas were less likely than other travellers to these regions to seek pretravel advice, take prophylaxis and have a visit duration less than 2 weeks; travelling to Africa and being male increased the odds of being diagnosed with malaria, independent of other factors. These data suggest that targeted strategies to provide pretravel care to travellers who visit friends and relatives in malaria-endemic areas may aid in reducing the burden of malaria in this population.
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Affiliation(s)
- Dewdunee H Marasinghe
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - James Cheaveau
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Bonnie Meatherall
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Susan Kuhn
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Stephen Vaughan
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Rudolf Zimmer
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta
| | - Dylan R Pillai
- Department of Epidemiology, Biostatistics and Occupational Health (Marasinghe), McGill University, Montréal, Que.; Departments of Microbiology, Immunology and Infectious Diseases (Cheaveau, Pillai), Medicine (Meatherall, Vaughan, Pillai), Pediatrics (Kuhn), Community Health Sciences (Zimmer, Pillai) and Pathology and Laboratory Medicine (Pillai), University of Calgary, Calgary, Alta.
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Diaz Pallares C, Bourassa-Blanchette S, Fonseca K, Vaughan S. Leprosy: Challenges in diagnosis. J Assoc Med Microbiol Infect Dis Can 2019; 4:187-189. [PMID: 36340646 PMCID: PMC9603024 DOI: 10.3138/jammi.2019.05.24.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 05/24/2019] [Indexed: 06/16/2023]
Abstract
Leprosy (Hansen's disease) is caused by Mycobacterium leprae. It affects the skin and peripheral nerves. Incidence and prevalence are underestimated due to challenges in diagnosis and unfamiliarity with the disease in Canada. Untreated disease can lead to permanent nerve damage with subsequent loss of function. We present a case of Hansen's disease with delay in diagnosis and treatment. A 31-year-old female recent immigrant from the Philippines presented with a 2-year history of a palpable erythematous rash on her face and arms. She had a diagnosis of cryoglobulinemic vasculitis associated with her chronic hepatitis B. A course of topical corticosteroids did not alleviate symptoms. The rash had a waxing and waning pattern that was felt to mirror her antiviral therapy. Although hepatitis B cryoglobulinemia has been reported in the remote literature, further studies have failed to illustrate that it is a significant cause of cryoglobulinemia. Retrospective analysis of the case identified that anchoring to the initial diagnosis was the reason for delay in diagnosis and treatment.
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Affiliation(s)
- Carolina Diaz Pallares
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Samuel Bourassa-Blanchette
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Fonseca
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Stephen Vaughan
- Division of Infectious Diseases, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Massolo A, Klein C, Kowalewska-Grochowska K, Belga S, MacDonald C, Vaughan S, Girgis S, Giunchi D, Bramer SA, Santa MA, Grant DM, Mori K, Duignan P, Slater O, Gottstein B, Müller N, Houston S. European Echinococcus multilocularis Identified in Patients in Canada. N Engl J Med 2019; 381:384-385. [PMID: 31340100 DOI: 10.1056/nejmc1814975] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | | | | | - Sara Belga
- University of Alberta, Edmonton, AB, Canada
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Vaughan S, Arvai K, Jouldjian S, Mitchell M, Salloum A, Chowdhuri S, Shamim-Uzzaman A, Henzel M, Sankari A, Martin J, Badr M. 1043 Pulmonary Function and Sleep Quality in Patients with Spinal Cord Injury and Disease. Sleep 2018. [DOI: 10.1093/sleep/zsy061.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - K Arvai
- John D. Dingell VAMC, Detroit, MI
| | - S Jouldjian
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - M Mitchell
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | | | | | | | - M Henzel
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH
| | | | - J Martin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - M Badr
- John D. Dingell VAMC, Detroit, MI
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Charette J, Mohamed R, Andrews CN, Vaughan S, Larios O, Jayakumar S. A207 SCLEROSING CHOLANGITIS SECONDARY TO DISSEMINATED VARICELLA ZOSTER VIRUS: A CASE REPORT. J Can Assoc Gastroenterol 2018. [DOI: 10.1093/jcag/gwy008.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Charette
- University of Calgary, Calgary, AB, Canada
| | - R Mohamed
- University of Calgary, Calgary, AB, Canada
| | - C N Andrews
- Gastroenterology, University of Calgary, Calgary, AB, Canada
| | - S Vaughan
- University of Calgary, Calgary, AB, Canada
| | - O Larios
- University of Calgary, Calgary, AB, Canada
| | - S Jayakumar
- Medicine, University of Calgary, Calgary, AB, Canada
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Robinson S, Campsall P, Parfitt E, Conly J, Dalton B, Stokes W, Kushner B, Vaughan S, Missaghi B, Chaubey V, Gregson D, Zuege D. Impact of an Innovative Smartphone “App” on Intensive Care Unit (ICU) Antimicrobial Utilization Across a Large Metropolitan Health Region in Canada: An Interrupted Time Series Analysis. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Stephen Robinson
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Paul Campsall
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
- University of British Columbia, Kamloops, British Columbia, Canada
| | - Elizabeth Parfitt
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
- University of British Columbia, Kamloops, British Columbia, Canada
| | - John Conly
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Bruce Dalton
- Pharmacy, Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - William Stokes
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Barry Kushner
- Pharmacy, Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Stephen Vaughan
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | - Bayan Missaghi
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
| | | | - Daniel Gregson
- University of Calgary, Calgary, Alberta, Canada
- Snyder Institute for Chronic Diseases, Calgary, Alberta, Canada
- Calgary Laboratory Services, Calgary, Alberta, Canada
| | - Dan Zuege
- University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary Zone, Calgary, Alberta, Canada
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Lam JC, Robinson SR, Schell A, Vaughan S. Pulmonary neuroendocrine carcinoma mimicking neurocysticercosis: a case report. J Med Case Rep 2016; 10:144. [PMID: 27250121 PMCID: PMC4890325 DOI: 10.1186/s13256-016-0910-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/25/2016] [Indexed: 11/10/2022] Open
Abstract
Background Neurocysticercosis occurs when the eggs of the pork tapeworm (Taenia solium) migrate and hatch into larvae within the central nervous system. Neurocysticercosis is the most common cause of seizures in the developing world and is characterized on brain imaging by cysts in different stages of evolution. In Canada, cases of neurocysticercosis are rare and most of these patients acquire the disease outside of Canada. We report the case of a patient with multiple intracranial lesions whose history and diagnostic imaging were consistent with neurocysticercosis. Pathological investigations ultimately demonstrated that her brain lesions were secondary to malignancy. Brain metastases are considered to be the most common cause of intracranial cystic lesions. Case presentation We present the case of a 60-year-old Canadian-born Caucasian woman with a subacute history of ataxia, lower extremity hyper-reflexia, and otalgia who resided near a pig farm for most of her childhood. Computed tomography and magnetic resonance imaging showed that she had multiple heterogeneous intracranial cysts, suggestive of neurocysticercosis. Despite a heavy burden of disease, serological tests for cysticercosis were negative. This result and a lack of the central scolices on neuroimaging that are pathognomonic of neurocysticercosis prompted whole-body computed tomography imaging to identify another etiology. The whole-body computed tomography revealed right hilar lymphadenopathy associated with soft tissue nodules in her chest wall and abdomen. A biopsy of an anterior chest wall nodule demonstrated high-grade poorly differentiated carcinoma with necrosis, which stained strongly positive for thyroid transcription factor-1 and synaptophysin on immunohistochemistry. A diagnosis of stage 4 metastatic small cell neuroendocrine carcinoma was made and our patient was referred for oncological palliative treatment. Conclusions This case illustrates the importance of the diagnostic approach to intracranial lesions. Our patient’s diagnosis of neuroendocrine carcinoma was delayed because of her nontraditional presentation. Despite extensive metastatic burden, the lack of perilesional edema and the identification of lesions appearing to be in various stages of development led to a pursuit of neurocysticercosis as the diagnosis. The absence of constitutional symptoms should not discount the possibility of malignancy from the differential diagnosis.
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Affiliation(s)
- John C Lam
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada.
| | - Stephen R Robinson
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Andrew Schell
- Department of Pathology and Laboratory Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada
| | - Stephen Vaughan
- Department of Medicine, The University of Calgary, Calgary, AB, T2N 2T9, Canada.,Department of Infectious Disease, The University of Calgary, Calgary, AB, T2N 2T9, Canada.,Foothills Medical Center, The University of Calgary, 1403 29 Street NW, Calgary, AB, T2N 2T9, Canada
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Edelson R, Gelbord JM, Horne K, McHardy IM, Peterson BM, Arévalo P, Breeveld AA, Rosa GD, Evans PA, Goad MR, Kriss GA, Brandt WN, Gehrels N, Grupe D, Kennea JA, Kochanek CS, Nousek JA, Papadakis I, Siegel M, Starkey D, Uttley P, Vaughan S, Young S, Barth AJ, Bentz MC, Brewer BJ, Crenshaw DM, Dalla Bontà E, Cáceres ADL, Denney KD, Dietrich M, Ely J, Fausnaugh MM, Grier CJ, Hall PB, Kaastra J, Kelly BC, Korista KT, Lira P, Mathur S, Netzer H, Pancoast A, Pei L, Pogge RW, Schimoia JS, Treu T, Vestergaard M, Villforth C, Yan H, Zu Y. SPACE TELESCOPE AND OPTICAL REVERBERATION MAPPING PROJECT. II.SWIFTANDHSTREVERBERATION MAPPING OF THE ACCRETION DISK OF NGC 5548. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/806/1/129] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Rosa GD, Peterson BM, Ely J, Kriss GA, Crenshaw DM, Horne K, Korista KT, Netzer H, Pogge RW, Arévalo P, Barth AJ, Bentz MC, Brandt WN, Breeveld AA, Brewer BJ, Dalla Bontà E, Lorenzo-Cáceres AD, Denney KD, Dietrich M, Edelson R, Evans PA, Fausnaugh MM, Gehrels N, Gelbord JM, Goad MR, Grier CJ, Grupe D, Hall PB, Kaastra J, Kelly BC, Kennea JA, Kochanek CS, Lira P, Mathur S, McHardy IM, Nousek JA, Pancoast A, Papadakis I, Pei L, Schimoia JS, Siegel M, Starkey D, Treu T, Uttley P, Vaughan S, Vestergaard M, Villforth C, Yan H, Young S, Zu Y. SPACE TELESCOPE AND OPTICAL REVERBERATION MAPPING PROJECT. I. ULTRAVIOLET OBSERVATIONS OF THE SEYFERT 1 GALAXY NGC 5548 WITH THE COSMIC ORIGINS SPECTROGRAPH ONHUBBLE SPACE TELESCOPE. ACTA ACUST UNITED AC 2015. [DOI: 10.1088/0004-637x/806/1/128] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Bosanquet DC, Vaughan S, Stephenson BM. Late mesh sepsis: how late is late? Hernia 2015; 19:1035-6. [PMID: 25731949 DOI: 10.1007/s10029-015-1364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 02/20/2015] [Indexed: 11/29/2022]
Affiliation(s)
- D C Bosanquet
- Departments of General Surgery, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, South Wales, UK.
| | - S Vaughan
- Departments of General Surgery, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, South Wales, UK
| | - B M Stephenson
- Departments of General Surgery, Royal Gwent Hospital, Cardiff Road, Newport, NP20 2UB, South Wales, UK
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Edelson R, Vaughan S, Malkan M, Kelly BC, Smith KL, Boyd PT, Mushotzky R. DISCOVERY OF A ∼5 DAY CHARACTERISTIC TIMESCALE IN THEKEPLERPOWER SPECTRUM OF Zw 229–15. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/0004-637x/795/1/2] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Ihedioha U, Vaughan S, Mastermann J, Singh B, Chaudhri S. Patient education videos for elective colorectal surgery: results of a randomized controlled trial. Colorectal Dis 2013; 15:1436-41. [PMID: 23841586 DOI: 10.1111/codi.12348] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/06/2013] [Indexed: 12/15/2022]
Abstract
AIM Recent advances in surgery have focused on peri-operative care and interventions to improve outcome following surgery. Psychological preparation has a positive impact on recovery and incorporates a range of strategies with dissemination of information as one of the key elements. Information can be given verbally, through printed information or through use of a video. Traditionally, reliance has been on the use of written material as an adjunct to patient education in clinic. The current study is a randomized trial on the use of video education in patients undergoing elective colorectal resection within an enhanced recovery programme. METHOD Sixty-five eligible patients undergoing elective colorectal surgery were identified and 61 were randomized between August 2010 and August 2011 to either video and information leaflets or information leaflets alone. A fast track protocol was established for all the patients. Clinicians in charge of postoperative recovery were blinded. Standard discharge criteria were employed for all patients. RESULTS Of 61 patients randomized, one dropped out and outcomes on 60 were analysed. There was no difference in baseline characteristics between the groups (age, P = 0.964; body mass index, P = 0.829). Twenty-eight (91%) patients in the video group had left sided resections while two (6%) had right sided resections. Nineteen (66%) in the non-video group had left sided resections while nine (31%) had right sided resections. One (3%) patient in the non-video group and one (3%) in the video group had a total colectomy. Fourteen (45%) patients in the video group and 12 (41%) in the non-video group had surgery completed laparoscopically. There was no difference in the primary (median hospital stay 5 vs 5 days; P = 0.239) or the secondary outcome measures (pain score on movement, P = 0.338; pain score at rest, P = 0.989; nausea score, P = 0.74; epidural use, P = 0.984; paracetamol use, P = 0.44; voltarol use, P = 0.506) between the groups. CONCLUSION Use of video education in the psychological preparation of patients undergoing elective colorectal surgery does not improve short-term outcomes.
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Affiliation(s)
- U Ihedioha
- Department of Surgery, University Hospitals of Leicester, Leicester, UK
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Barry S, Towers K, Vaughan S. Screening ciliopathy genes in the model organism Trypanosoma brucei. Cilia 2012. [PMCID: PMC3555850 DOI: 10.1186/2046-2530-1-s1-p81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S Barry
- Oxford Brookes University, UK
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Towers K, Hughes LC, Vaughan S. Three dimensional organisation of basal bodies in Trypanosoma brucei. Cilia 2012. [PMCID: PMC3555948 DOI: 10.1186/2046-2530-1-s1-p54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Ridge S, Heuer C, Cogger N, Heck A, Moor S, Baker I, Vaughan S. Herd management practices and the transmission of Johne's disease within infected dairy herds in Victoria, Australia. Prev Vet Med 2010; 95:186-97. [DOI: 10.1016/j.prevetmed.2010.05.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 04/01/2010] [Accepted: 05/01/2010] [Indexed: 10/19/2022]
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McKie A, Vaughan S, Okon I, Zanini E, Al-Jayoosi F, Agarwal R, Lam E, Gabra H. 421 The OPCML tumour suppressor functions as a repressor-adaptor, negatively regulating receptor tyrosine kinases in ovarian cancer. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)71222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Stranieri A, Vaughan S. Coalescing medical systems: a challenge for health informatics in a global world. Stud Health Technol Inform 2010; 161:159-168. [PMID: 21191169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
As globalisation advances, patients in many nations increasingly access diverse medical systems including Western medicine, Traditional Chinese Medicine, Homeopathy and Ayervedic medicine. The trend toward co-existence of medical systems presents challenges for health informatics including the need to develop standards that can encompass the diversity required, the need to develop software applications that effectively inter-operate across diverse systems and the need to support patients when evaluating competing systems. This article advances the notion that the challenges can most effectively be met with the development of informatics approaches that do not assume the superiority of one medical system over another. Argument visualization to support patient decision making in selecting an appropriate medical system is presented as an application that exemplifies this stance.
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Affiliation(s)
- Andrew Stranieri
- Health Informatics Laboratory, Centre for Informatics and Applied Optimisation, University of Ballarat, Mt Helen, Victoria, Australia.
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Abstract
Advance care planning (ACP) as a process of discussing and recording wishes for future care and treatment is increasingly being promoted and discussed in the UK, reflecting recent changes in legislation. This study describes current ACP practice in care homes for older people drawing on data from a questionnaire survey (n = 213) of, and interviews (n = 15) with, care home managers. Whilst consultation about general care is taking place in the majority of homes surveyed using both formal and informal processes, the number of residents that have completed any ACP processes varies. Managers face intrinsic and extrinsic challenges related to the ascertaining of, and the implementing of wishes as they address ACP in the care home context. Until these wider contextual factors are addressed it will be difficult for staff in care homes to effectively undertake and implement ACP in care homes.
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Affiliation(s)
- K Froggatt
- Lancaster University, Division of Health Research, Lancaster, UK.
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Barthelmy SD, Chincarini G, Burrows DN, Gehrels N, Covino S, Moretti A, Romano P, O'Brien PT, Sarazin CL, Kouveliotou C, Goad M, Vaughan S, Tagliaferri G, Zhang B, Antonelli LA, Campana S, Cummings JR, D'Avanzo P, Davies MB, Giommi P, Grupe D, Kaneko Y, Kennea JA, King A, Kobayashi S, Melandri A, Meszaros P, Nousek JA, Patel S, Sakamoto T, Wijers RAMJ. An origin for short gamma-ray bursts unassociated with current star formation. Nature 2005; 438:994-6. [PMID: 16355219 DOI: 10.1038/nature04392] [Citation(s) in RCA: 262] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2005] [Accepted: 10/31/2005] [Indexed: 11/09/2022]
Abstract
Two short (< 2 s) gamma-ray bursts (GRBs) have recently been localized and fading afterglow counterparts detected. The combination of these two results left unclear the nature of the host galaxies of the bursts, because one was a star-forming dwarf, while the other was probably an elliptical galaxy. Here we report the X-ray localization of a short burst (GRB 050724) with unusual gamma-ray and X-ray properties. The X-ray afterglow lies off the centre of an elliptical galaxy at a redshift of z = 0.258 (ref. 5), coincident with the position determined by ground-based optical and radio observations. The low level of star formation typical for elliptical galaxies makes it unlikely that the burst originated in a supernova explosion. A supernova origin was also ruled out for GRB 050709 (refs 3, 31), even though that burst took place in a galaxy with current star formation. The isotropic energy for the short bursts is 2-3 orders of magnitude lower than that for the long bursts. Our results therefore suggest that an alternative source of bursts--the coalescence of binary systems of neutron stars or a neutron star-black hole pair--are the progenitors of short bursts.
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Affiliation(s)
- S D Barthelmy
- NASA/Goddard Space Flight Center Greenbelt, Maryland 20771, USA.
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Lachlan M, Licence K, Oates K, Vaughan S, Hill R. Practical lessons from the management of an outbreak of small round structured virus (Norwalk-like virus) gastroenteritis. Commun Dis Public Health 2002; 5:43-7. [PMID: 12070977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
An outbreak of viral gastroenteritis caused illness in 92 people during October 2000. All the cases had an association with one hotel and 80% of cases identified had attended one of two buffet meals on 18th October 2000. Cohort analysis did not implicate any particular foodstuff in this outbreak. All bacteriological tests on food samples were negative. Small round structured virus (SRSV)/Norwalk-like virus (NLV) particles were seen by electron microscopy in 6 out of 27 stool samples submitted for analysis. This paper describes the outbreak and in particular the lessons learned from the management and control of it. These include practical points with regard to the outbreak control team, liaison with the microbiology laboratory, handling data, agreeing a case definition, and occupational health issues. All can be applied elsewhere by those responsible for managing outbreaks at a local level.
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Abstract
Although most eukaryotic cells can express multiple isotypes of αβ-tubulin, the significance of this diversity has not always been apparent. Recent data indicate that particular αβ-tubulin isotypes, both genome encoded and those derived by post-translational modification, can directly influence microtubule structure and function — thus validating ideas originally proposed in the multitubulin hypothesis over 25 years ago.It has also become increasingly evident over the past year that some (but intriguingly not all) eukaryotes encode several other tubulin proteins, and to date five further members of the tubulin superfamily, γ, δ, ϵ, 𝛇 and η, have been identified. Although the role of γ-tubulin in the nucleation of microtubule assembly is now well established, far less is known about the functions of δ-, ϵ-, 𝛇- and η-tubulin. Recent work has expanded our knowledge of the functions and localisation of these newer members of the tubulin superfamily, and the emerging data suggesting a restricted evolutionary distribution of these `new' tubulin proteins, conforms to established knowledge of microtubule cell biology. On the basis of current evidence, we predict that δ-, ϵ-, 𝛇- and η-tubulin all have functions associated with the centriole or basal body of eukaryotic cells and organisms.
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Affiliation(s)
- P G McKean
- School of Biological Sciences, University of Manchester, UK
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Abstract
OBJECTIVE To address both clinical and ethical concerns in psychiatric research, the study assessed the subjective experience of being a participant in a feasibility study of outcome in long-term psychodynamic psychotherapy and psychoanalysis. METHOD A questionnaire assessing positive and negative reactions to three typical research methodologies (self-report questionnaires, structured diagnostic interviews, and tape-recording of sessions) was administered to 23 patient-therapist pairs. RESULTS Patients reported that questionnaires and interviews were slightly to moderately helpful in promoting self-realization and facilitating therapy, and not at all to slightly intrusive and disruptive. Adjustment to audiotaping of sessions was rapid (within two sessions). Therapists significantly overestimated the negative effects and underestimated the positive benefit patients reported from participating in research. CONCLUSIONS Traditional objections to research in dynamic psychotherapy on the grounds that patients experience research procedures as significantly intrusive and disruptive appear to be unfounded.
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Affiliation(s)
- R Marshall
- Anxiety Disorders Clinic, New York State Psychiatric Institute, New York, NY 10032, USA.
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Flakoll PJ, Zheng M, Vaughan S, Borel MJ. Determination of stable isotopic enrichment and concentration of glycerol in plasma via gas chromatography-mass spectrometry for the estimation of lipolysis in vivo. J Chromatogr B Biomed Sci Appl 2000; 744:47-54. [PMID: 10985565 DOI: 10.1016/s0378-4347(00)00209-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Measuring glycerol's rate of appearance into the plasma compartment provides an excellent estimation of whole-body lipolysis. The glycerol rate of appearance can be calculated by estimating the plasma dilution of continuously infused stable or radioactive isotopes of glycerol. Previously, determination of glycerol stable isotopic enrichment has required either chemical ionization gas chromatography-mass spectrometry (GC-MS) or electron impact ionization GC-MS in which a fragment containing only a portion of the glycerol molecule was measured. The present method uses tert.-butyldimethylsilyl (tBDMS) derivatization and electron impact ionization to measure a fragment including the entire glycerol molecule. The method determines concentration and enrichment of plasma glycerol in a simple, precise, and cost-efficient manner, providing a basis from which lipid homeostasis can be assessed.
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Affiliation(s)
- P J Flakoll
- Department of Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Abstract
UNLABELLED Occlusal splints (Michigan splints, night/bite guards or bite-raising appliances) can be an effective, inexpensive and reversible treatment for a wide range of dental problems. OBJECTIVE The aim of this study was to analyse retrospectively the provision of occlusal splint ('Michigan' type) in general dental practice, following a prescription by a restorative dental consultant. METHOD One hundred patients were recruited from consultant clinics in a department of conservative dentistry during 1995 and 1996. All patients were prescribed a maxillary, full-coverage, heat-cured, acrylic-resin splint (Michigan splint) as part of a treatment plan. An explanatory letter and questionnaire were sent to all patients and to their referring general dental practitioner in 1997 and 1998. RESULTS A response rate of 79% was achieved in obtaining completed questionnaires from both patients and general dental practitioners. Of respondents 43% (34/79) received an occlusal splint of some form. A small proportion of the respondents (16.5% [13/79]) received a Michigan splint as prescribed. Irrespective of the type of appliance provided, most patients (82% [28/34]) found them helpful. Of those who did not receive an occlusal splint, 38% (17/45) of patients felt financial implications deterred them from obtaining an appliance. Other common reasons for non-provision included: patients felt that symptoms had improved (18% [8/45]) and patients did not agree with treatment (18% [8/45]). The general dental practitioners had similar opinions to their patients. DISCUSSION These findings raise some serious doubts on the efficacy of consultant clinic advice in the prescription of occlusal splints in general dental practice. The financial and educational issues raised by this study will need to be addressed to improve service provision. CONCLUSION The results of this study indicate that 16.5% of patient respondents prescribed a Michigan splint at a consultant clinic received such an appliance in general dental practice.
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Affiliation(s)
- K Patel
- Eastman Dental Institute and Hospital, London
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Greenawald MH, Vaughan S. What is the long-term prognosis for patients with Lyme disease? J Fam Pract 2000; 49:397-465. [PMID: 10836768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- M H Greenawald
- Carilion Family Practice Residency Program, Roanoke, Virginia, USA.
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Abstract
STATEMENT OF PROBLEM Severe tooth wear localized to the anterior maxillary or mandibular teeth with loss of interocclusal space is difficult to manage. PURPOSE This study evaluated the outcome of composite restorations placed at an increased vertical dimension of occlusion in such patients. METHODS AND MATERIAL Sixteen patients were restored with 104 restorations in 2 groups. In group A, Durafill composite and Scotchbond Multipurpose dentine adhesive system were used to place direct anterior restorations (N = 52). In group B, Herculite XRV composite and Optibond dentine bonding agent was used (N = 52). The restorations were placed at an increased vertical dimension of occlusion creating a posterior disclusion of 1 to 4 mm. RESULTS Clinical follow-up showed that the posterior occlusion remained satisfactorily restored after a mean duration of 4.6 months (range 1 to 11 months). Mean follow-up of 30 months has shown a combined success rate of 89.4% for both groups with 93 of the restorations remaining in service. Maintenance in group A was high with 33 failures, but low in group B with 6 failures. Patient satisfaction was reported as good. CONCLUSION Direct composite restorations may be a treatment option for localized anterior tooth wear.
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Affiliation(s)
- K W Hemmings
- Eastman Dental Hospital and Institute for Oral Healthcare Sciences, London, United Kingdom.
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Chao MW, Byram D, Bell R, Bond R, Vaughan S, McLennan R, Lim-Joon M, Wada M, Joseph D. Postoperative adjuvant radiotherapy and 5-fluorouracil chemotherapy for rectal carcinoma. Australas Radiol 1998; 42:47-51. [PMID: 9509605 DOI: 10.1111/j.1440-1673.1998.tb00564.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Postoperative combined modality therapy with radiotherapy and 5-fluorouracil (5FU) chemotherapy is an effective adjuvant approach that reduces locoregional and distant metastatic disease in patients with high-risk rectal carcinoma. However, this approach results in a treatment regimen of at least 6 months' duration. The present prospective study investigates the integration of radiotherapy and 5FU chemotherapy in a protocol designed to minimize toxicity and reduce the overall treatment time. A total of 40 patients with TNM stage II or III disease received postoperative radiotherapy at four fractions per week with weekly 5FU bolus injections delivered on the fifth non-radiotherapy day. Patients also received systemic chemotherapy with leucovorin both before and after pelvic irradiation, with the total treatment duration extending for only 18 weeks. Patients were able to complete radiotherapy in 90% of cases, while the delivery of full-dose chemotherapy was achievable in the vast majority. The incidence of haematologic and gastrointestinal toxicities requiring the cessation of treatment was acceptable. With a median follow-up of 20.9 months among surviving patients, the estimated progression-free and overall survival at 2 years were 71% and 79%, respectively.
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Affiliation(s)
- M W Chao
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
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Degrazio FL, Hlobik T, Vaughan S. Silicone absorption of elastomeric closures--an accelerated study. PDA J Pharm Sci Technol 1998; 52:19-22. [PMID: 9542410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
There is a trend in the parenteral industry to move from the use of elastomeric closures which are washed, siliconized, dried and sterilized in-house at the pharmaceutical manufacturers' site to pre-prepared closures purchased from the closure supplier. This preparation can consist of washing to reduce particle-load and bioburden, siliconization, placement in ready-to-sterilize bags and may eventually extend to sterilization by steam autoclave or gamma irradiation. Since silicone oil lubrication is critical to the processability/machinability of closures, research was designed to investigate this phenomenon in closures prepared using the Westar RS (Ready-to-Sterilize) process. This paper presents the data gathered in a study of the characteristic of silicone absorption into elastomeric closures under accelerated conditions. Variables such as silicone viscosity, rubber formulation, effect of sterilization and others are considered.
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Hood A, Veen C, Vaughan S, Edwards MP, Simmons I, Misson G. The quantitative evaluation of total internal reflection in keratoconus. Ophthalmic Physiol Opt 1997. [DOI: 10.1046/j.1475-1313.1997.97873437.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
This research study, which, because of its small numbers should be regarded as more of a pilot study, investigated the effect that therapeutic touch may have on measurable physical signs of the subjects involved. It also looked at any change this complementary therapy may have made in health perception immediately following the experiment and 1 week later. The design is modelled on that of Quinn (1984), eminent researcher in the field of energy exchange. Therapeutic touch is a misnomer because physical touch is not necessary--it is the energy field that is touched.
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Vaughan S. The NHS--safe in their hands? Br Dent J 1993; 175:6. [PMID: 8334055 DOI: 10.1038/sj.bdj.4808217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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