University of Manitoba Researchers

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Open Access
1072. Red blood cell transfusion in acute cerebral injuries: a systematic review of preclinical animal studies
(2014-09-26) Laflamme, M; Boutin, A; Haghbayan, H; Shemilt, M; Lauzier, F; Moore, L; Zarychanski, R; Lacroix, J; Lamontagne, F; Fergusson, DA; Desjardins, P; Turgeon, AF
Open Access
10th anniversary of allergy, asthma & clinical immunology
(2014-10-22) Warrington, Richard J; Keith, Paul K
AbstractThis is an Editorial
Open Access
11B and 23 Na solid-state NMR and density functional theory studies of electric field gradients at boron sites in ulexite
(Royal Society of Chemistry, 2013-07-31) Zhou, Bing; Michaelis, Vladimir K.; Kroeker, Scott; Wren, John E. C.; Yao, Yefeng; Sherriff, Barbara L.; Pan, Yuanming
Nuclear magnetic resonance (NMR) parameters of 11B in borates and borosilicates, unlike those of many other nuclei such as 29Si and 27Al, vary only over limited ranges and have been thought to be insensitive to local structural environments. High-resolution NMR spectroscopy at high (14 T) and ultrahigh (21 T) fields yield precise 11B and 23Na NMR parameters for ulexite, which contains the pentaborate polyanion ([B5O6(OH)6]3−) as the fundamental building block (FBB). These NMR parameters are compared with ab initio theoretical calculations as implemented in WIEN2K, including optimization of the ulexite structure, determination of the electric field gradients (EFG) and consequently the nuclear quadrupole interaction (QI) parameters at the five distinct B sites, and calculations of the density of states (DOS). These calculations show that the magnitudes and signs of the EFG for [3]B and [4]B are determined by multiple factors, including the electron distributions in the B 2pz orbitals and their interactions with Ca-3p/O-2s orbitals. Most importantly, the calculated B 2pz orbitals at all B sites in ulexite are predominantly affected by the atoms within the fundamental building block, resulting in the insensitivity of the 11B QI parameters to the weak interunit interactions among FBB. Calculations with the water molecules removed from the ulexite structure provide further support for the strong intraunit interactions in FBB as a cause for the poor sensitivity of 11B NMR parameters to local structural environments, including hydrogen bonding, in borates.
Open Access
17 β-Estradiol mineralization in human waste products and soil in the presence and the absence of antimicrobials
(Taylor Francis, 2016-06) Amarakoon, Inoka; Farenhorst, Annemieke; Rose, Karin; Ascef, B.
Natural steroidal estrogens such as 17 β-estradiol (E2), as well as antimicrobials such as doxycycline and norfloxacin, are excreted by humans and hence detected in sewage sludge and biosolid. The disposal of human waste products on agricultural land results in estrogens and antibiotics being detected as mixtures in soils. The objective of this study was to examine microbial respiration and E2 mineralization in sewage sludge, biosolid and soil in the presence and absence of doxycycline and norfloxacin. The antimicrobials were applied to the media either alone or in combination at total rates of 4 and 40 mg kg-1, with the 4 mg kg-1 rate being an environmentally relevant concentration. The calculated time that half of the applied E2 was mineralized ranged from 294 to 418 d in sewage sludge, from 721 to 869 d in soil and from 2,258 to 14,146 d in biosolid. E2 mineralization followed first-order and the presence of antimicrobials had no significant effect on mineralization half-lives, except for some antimicrobial applications to the human waste products. At 189 d, total E2 mineralization was significantly greater in sewage sludge (38 ±0.7%) > soil (23 ±0.7%) > biosolid (3 ±0.7%), while total respiration was significantly greater in biosolid (1,258 mg CO2) > sewage sludge (253 mg CO2) ≥ soil (131 mg CO2). Strong sorption of E2 to the organic fraction in biosolid may have resulted in reduced E2 mineralization despite the high microbial activity in this media. Total E2 mineralization at 189 d was not significantly influenced by the presence of doxycycline and/or norfloxacin in the media. Antimicrobial additions also did not significantly influence total respiration in media, except that total CO2 respiration at 189 d was significantly greater for biosolid with 40 mg kg-1 doxycycline added, relative to biosolid without antimicrobials. We conclude that it is unlikely for doxycycline and norfloxacin, or their mixtures, to have a significant effect on E2 mineralization in human waste products and soil. However, the potential for E2 to be persistent in biosolids, with and without the presence of antimicrobials, is posing a challenge for biosolid disposal to agricultural lands.
Open Access
17β-Estradiol mineralization under field and laboratory incubations
(2017) Farenhorst, Annemieke; Amarakoon, Inoka; Andronak, Lindsey
Mineralization studies of natural steroid hormones (e.g., 17β-estradiol, E2) are performed in environmental incubators, usually under a constant temperature such as 20°C. In this paper, we present a microcosm protocol that quantified the mineralization of E2 in soils under field temperatures. The nine agricultural soils tested had a wide range of soil organic carbon (1.1 to 5.2%) and clay (9 to 57%) contents. The calculated time over which half of the applied E2 was mineralized (E2-½) ranged from 299 to 910 d, and total E2 mineralization at 48 d (E2-TOT48) ranged from 4 to 13%. In subsequent laboratory incubations, the same soils were incubated under a constant temperature of 20°C, as well as under cyclic temperatures of 14.5°C (14 h) and 11.5°C (10h), which was within the temperature extremes observed in the field microcosms. E2-½ ranged from 157 to 686 d at 20°C and from 103 to 608 d at the cyclic temperatures, with the E2-TOT48 ranging from 6 to 21% at 20°C and from 7 to 30% under cyclic temperatures. Despite the overall 6.75 °C lower mean temperatures under the cyclic versus constant temperatures, E2 mineralization was stimulated by the temperature cycles in three soils. Regardless of the incubation, the same loamy sand soil always showed larger E2 mineralization than the other eight soils and this loamy sand soil also had the smallest E2 sorption. Current modeling approaches do not take into consideration the effects of temperature fluctuations in the field because the input parameters used to describe degradation are derived from laboratory incubations at a constant temperature. Across the eight soils, E2-½ was on average 1.7 times larger and E2-TOT48 was on average 0.8 times smaller under field temperatures than under a constant 20°C. Hence, we conclude that incubations at 20°C give a reasonable representation of E2 mineralization occurring under field conditions to be expected in a typical Prairie summer season.
Restricted
The 2003 R.M. Hardy lecture: Soil parameters for numerical analysis in clay
(2006-02-01T11:58:14Z) Graham, J
Engineers in geotechnical practice work on increasingly complex problems with increasingly powerful numerical tools. Effective solutions to design problems need good information about the site and parameters (or functions) that describe how the soil will behave under the proposed loadings. These loadings can include heating, drying or wetting, time effects, and chemical changes as well as the more common structural loads. This paper outlines issues that need to be considered when laboratory tests are used to produce soil properties for use in numerical analyses. The focus is on soft to moderately stiff saturated clays. Similar considerations for in situ tests, stiff clays, and sands are not considered.
Open Access
2010 International consensus algorithm for the diagnosis, therapy and management of hereditary angioedema
(2010-07-28) Bowen, Tom; Cicardi, Marco; Farkas, Henriette; Bork, Konrad; Longhurst, Hilary J; Zuraw, Bruce; Aygoeren-Pursun, Emel; Craig, Timothy; Binkley, Karen; Hebert, Jacques; Ritchie, Bruce; Bouillet, Laurence; Betschel, Stephen; Cogar, Della; Dean, John; Devaraj, Ramachand; Hamed, Azza; Kamra, Palinder; Keith, Paul K; Lacuesta, Gina; Leith, Eric; Lyons, Harriet; Mace, Sean; Mako, Barbara; Neurath, Doris; Poon, Man-Chiu; Rivard, Georges-Etienne; Schellenberg, Robert; Rowan, Dereth; Rowe, Anne; Stark, Donald; Sur, Smeeksha; Tsai, Ellie; Warrington, Richard; Waserman, Susan; Ameratunga, Rohan; Bernstein, Jonathan; Bjorkander, Janne; Brosz, Kristylea; Brosz, John; Bygum, Anette; Caballero, Teresa; Frank, Mike; Fust, George; Harmat, George; Kanani, Amin; Kreuz, Wolfhart; Levi, Marcel; Li, Henry; Martinez-Saguer, Inmaculada; Moldovan, Dumitru; Nagy, Istvan; Nielsen, Erik W; Nordenfelt, Patrik; Reshef, Avner; Rusicke, Eva; Smith-Foltz, Sarah; Spath, Peter; Varga, Lilian; Xiang, Zhi Y
Abstract Background We published the Canadian 2003 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema (HAE; C1 inhibitor [C1-INH] deficiency) and updated this as Hereditary angioedema: a current state-of-the-art review: Canadian Hungarian 2007 International Consensus Algorithm for the Diagnosis, Therapy, and Management of Hereditary Angioedema. Objective To update the International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema (circa 2010). Methods The Canadian Hereditary Angioedema Network (CHAEN)/Réseau Canadien d'angioédème héréditaire (RCAH) http://www.haecanada.com and cosponsors University of Calgary and the Canadian Society of Allergy and Clinical Immunology (with an unrestricted educational grant from CSL Behring) held our third Conference May 15th to 16th, 2010 in Toronto Canada to update our consensus approach. The Consensus document was reviewed at the meeting and then circulated for review. Results This manuscript is the 2010 International Consensus Algorithm for the Diagnosis, Therapy and Management of Hereditary Angioedema that resulted from that conference. Conclusions Consensus approach is only an interim guide to a complex disorder such as HAE and should be replaced as soon as possible with large phase III and IV clinical trials, meta analyses, and using data base registry validation of approaches including quality of life and cost benefit analyses, followed by large head-to-head clinical trials and then evidence-based guidelines and standards for HAE disease management.
Open Access
2078- Immunotherapy – 2078: Allergen-specific oral immunotherapy for peanut allergy: a Cochrane systematic review
(2013-04-23) Nurmatov, Ulugbek; Venderbosch, Iris; Devereux, Graham; Simons, F Estelle R; Sheikh, Aziz
Open Access
2078- Immunotherapy – 2078. Allergen-specific oral immunotherapy for peanut allergy: a Cochrane systematic review
(2013-04-23) Nurmatov, Ulugbek; Venderbosch, Iris; Devereux, Graham; Simons, F E R; Sheikh, Aziz
Open Access
2SLGBTQIA+ Nurses: A Historical Narrative Literature Review
(2023-11-13) Brandt, Adam; Scruby, Lynn
Background: Nurses are the largest group of health care providers in Canada, and researchers hypothesize that a large subcategory of nurses is nurses who identify as 2SLGBTQIA+. Literature shows that patients want and feel safer when their health care providers share similar identities with them. The roots of the nursing profession are steeped in social justice and advocacy, so why has the nursing profession remained silent on the experiences of this large group of nurses? What are the experiences of 2SLGBTQIA+ nurses throughout history? Methods: A historical qualitative narrative review method was utilized to summarize and synthesize the body of literature available on nurses identifying as 2SLGBTQIA+. Results: Early literature between 1980-1999 describes the pressures many nurses faced to keep their identities hidden, and despite many of the founders of modern nursing hypothesized as being queer, the profession has knowingly hidden their identities. From 2000-2009, the literature continued to discuss the invisibility of queer nurses while starting to explore the discrimination these nurses faced and the nuances of disclosing their identities in the workplace. 2010-2019, the literature evolved to suggest breaking the historical silence on 2SLGBTQIA+ issues and creating policy change to protect equity-deserving nurses. From 2020 to the present, the literature has begun to utilize Minority Stress Theory to describe the effects discrimination has on 2SLGBTQIA+ nurses, along with their improving experiences and affirmation in the profession. Conclusion: Promoting increased diversity within the nursing profession and policy changes protecting 2SLGBTQIA+ nurses is paramount and may improve equity-deserving patients' health outcomes.
Open Access
3D nuclear organization and genomic instability in cancer
(2013-04-04) Mai, Sabine
Open Access
50,000 years of Japanese prehistory : a transcript of the symposium of November 1, 1978, University of Manitoba
(2012-04-11) Monks, Gregory G.; Kobayoshi, Tatsuo; Pearson, Richard; Ikawa-Smith, Fumiko; Koike, Hiroko; Matsushima, Yoshiake
This volume contains two presentations. The first is a transcript of a seminar on Japanese prehistory, which was given in conjunction with (and to provide context for) the exhibit, "50,000 Years of Japanese Prehistory" at the Manitoba Museum of Man and Nature. It has been edited heavily (by G.G. Monks) in places to ensure clarity, eliminate redundancy and improve grammar. The second presentation is a paper on seasonality estimation using bivalve mollusc shells.
Open Access
7 versus 14 days of antibiotic treatment for critically ill patients with bloodstream infection: a pilot randomized clinical trial
(2018-02-17) Daneman, Nick; Rishu, Asgar H; Pinto, Ruxandra; Aslanian, Pierre; Bagshaw, Sean M; Carignan, Alex; Charbonney, Emmanuel; Coburn, Bryan; Cook, Deborah J; Detsky, Michael E; Dodek, Peter; Hall, Richard; Kumar, Anand; Lamontagne, Francois; Lauzier, Francois; Marshall, John C; Martin, Claudio M; McIntyre, Lauralyn; Muscedere, John; Reynolds, Steven; Sligl, Wendy; Stelfox, Henry T; Wilcox, M. E; Fowler, Robert A
Abstract Background Shorter-duration antibiotic treatment is sufficient for a range of bacterial infections, but has not been adequately studied for bloodstream infections. Our systematic review, survey, and observational study indicated equipoise for a trial of 7 versus 14 days of antibiotic treatment for bloodstream infections; a pilot randomized clinical trial (RCT) was a necessary next step to assess feasibility of a larger trial. Methods We conducted an open, pilot RCT of antibiotic treatment duration among critically ill patients with bloodstream infection across 11 intensive care units (ICUs). Antibiotic selection, dosing and route were at the discretion of the treating team; patients were randomized 1:1 to intervention arms consisting of two fixed durations of treatment – 7 versus 14 days. We recruited adults with a positive blood culture yielding pathogenic bacteria identified while in ICU. We excluded patients with severe immunosuppression, foci of infection with an established requirement for prolonged treatment, single cultures with potential contaminants, or cultures yielding Staphylococcus aureus or fungi. The primary feasibility outcomes were recruitment rate and adherence to treatment duration protocol. Secondary outcomes included 90-day, ICU and hospital mortality, relapse of bacteremia, lengths of stay, mechanical ventilation and vasopressor duration, antibiotic-free days, Clostridium difficile, antibiotic adverse events, and secondary infection with antimicrobial-resistant organisms. Results We successfully achieved our target sample size (n = 115) and average recruitment rate of 1 (interquartile range (IQR) 0.3–1.5) patient/ICU/month. Adherence to treatment duration was achieved in 89/115 (77%) patients. Adherence differed by underlying source of infection: 26/31 (84%) lung; 18/29 (62%) intra-abdominal; 20/26 (77%) urinary tract; 8/9 (89%) vascular-catheter; 4/4 (100%) skin/soft tissue; 2/4 (50%) other; and 11/12 (92%) unknown sources. Patients experienced a median (IQR) 14 (8–17) antibiotic-free days (of the 28 days after blood culture collection). Antimicrobial-related adverse events included hepatitis in 1 (1%) patient, Clostridium difficile infection in 4 (4%), and secondary infection with highly resistant microorganisms in 10 (9%). Ascertainment was complete for all study outcomes in ICU, in hospital and at 90 days. Conclusion It is feasible to conduct a RCT to determine whether 7 versus 14 days of antibiotic treatment is associated with comparable 90-day survival. Trial registration ClinicalTrials.gov , identifier: NCT02261506 . Registered on 26 September 2014.
Open Access
A (H1N1) pdm09 HA D222 variants associated with severity and mortality in patients during a second wave in Mexico
(2013-01-31) Vazquez-Perez, Joel A; Isa, Pavel; Kobasa, Darwyn; Ormsby, Christopher E; Ramirez-Gonzalez, Jose E; Romero-Rodriguez, Damaris P; Ranadheera, Charlene; Li, Yan; Bastien, Nathalie; Embury-Hyatt, Carissa; Gonzalez-Duran, Elizabeth; Barrera-Badillo, Gisela; Ablanedo-Terrazas, Yuria; Sevilla-Reyes, Edgar E; Escalera-Zamudio, Marina; Cobian-Guemes, Ana G; Lopez, Irma; Ortiz-Alcantara, Joanna; Alpuche-Aranda, Celia; Perez-Padilla, Jose R; Reyes-Teran, Gustavo
Abstract Background Pandemic type A (H1N1) influenza arose in early 2009, probably in Mexico and the United States, and reappeared in North America in September for seven more months. An amino acid substitution in the hemagglutinin (HA), D222G, has been reported in a significant proportion of patients with a severe and fatal outcome. We studied the prevalence of HA222 substitutions in patients in Mexico during the second wave and its association with clinical outcome and pathogenicity in a mouse model. Methods The nucleotide sequences of hemagglutinin (HA) from viruses collected from 77 patients were determined including 50 severe and fatal cases and 27 ambulatory cases. Deep sequencing was done on 5 samples from severe or fatal cases in order to determine the quasispecies proportion. Weight loss and mortality due to infection with cultured influenza viruses were analyzed in a mouse model. Results Viruses from 14 out of 50 hospitalized patients (28%) had a non aspartic acid residue at the HA 222 position (nD222), while all 27 ambulatory patients had D222 (p = 0.0014). G222 was detected as sole species or in coexistence with N222 and D222 in 12 patients with severe disease including 8 who died. N222 in coexistence with D222 was detected in 1 patient who died and co-occurrence of A222 and V222, together with D222, was detected in another patient who died. The patients with a nD222 residue had higher mortality (71.4%), compared to the group with only D222 (22.2%, p = 0.0008). Four of the 14 viruses from hospitalized patients were cultured and intranasally infected into mice. Two viruses with G222 were lethal while a third virus, with G222, caused only mild illness in mice similar to the fourth virus that contained D222. Conclusions We confirm the elevated incidence of HA222 (H1N1)pdm09 variants in severe disease and mortality. Both clinical and mouse infection data support the idea that nD222 mutations contribute to increased severity of disease but additional determinants in disease outcome may be present.
Open Access
A bioavailable form of curcumin suppresses cationic host defence peptides cathelicidin and calprotectin in a murine model of collagen-induced arthritis
(BMC, 2023-09-04) Hemshekhar, Mahadevappa; Lloyd, Dylan; El-Gabalawy, Hani; Mookherjee, Neeloffer
Curcumin, a component of the South-Asian spice turmeric, elicits anti-inflammatory functions. We have previously demonstrated that a highly bioavailable formulation of cucurmin, Cureit/Acumin™ (CUR), can suppress disease onset and severity, in a collagen-induced arthritis (CIA) mouse model. In a previous study, we have also shown that the abundance of antimicrobial host defence peptides, specifically cathelicidin (CRAMP) and calprotectin (S100A8 and S100A9), is significantly increased in the joint tissues of CIA mice. Elevated levels of cathelicidin and calprotectin have been associated with the pathogenesis of rheumatoid arthritis. Therefore, in this study, we examined the effect CUR administration on the abundance of cathelicidin and calprotectin in the joints, in a CIA mouse model. Here, we demonstrate that daily oral administration of CUR significantly reduces the elevated levels of CRAMP and calprotectin to baseline in the joints of CIA mice. We also show a linear correlation between the abundance of these peptides in the joints with serum inflammatory cytokines TNFα, IFNγ, and MCP-1. Overall, our results suggest that oral administration of a bioavailable CUR can suppress cathelicidin and calprotectin in the joints and regulate both local (joints) and systemic (serum) inflammation, in inflammatory arthritis.
Open Access
A bioavailable form of curcumin, in combination with vitamin-D- and omega-3-enriched diet, modifies disease onset and outcomes in a murine model of collagen-induced arthritis
(2021-01-25) Hemshekhar, Mahadevappa; Anaparti, Vidyanand; El-Gabalawy, Hani; Mookherjee, Neeloffer
Abstract Objective Curcumin (CUR), vitamin D3 (D3), and omega-3-fatty acids (O3FA) individually modulate inflammation and pain in arthritis. Although these supplements are widely used, their combinatorial effects have not been defined. In this study, we examined the effects of a D3 and O3FA (VO)-enriched diet in conjunction with a highly bioavailable form of CUR (Cureit/Acumin™) in a collagen-induced arthritis (CIA) murine model. Methods Male DBA/1J mice were acclimatized to VO-enriched diet and challenged with bovine collagen II (CII). Bioavailable CUR was administered daily by oral gavage from the onset of CII challenge. Disease severity was determined by monitoring joint thickness and standardized clinical score. Cellular infiltration and cartilage degradation in the joints were assessed by histology, serum cytokines profiled by Meso Scale Discovery multiplex assay, and joint matrix metalloproteinases examined by western blots. Results CUR by itself significantly decreased disease severity by ~ 60%. Administration of CUR in CIA mice taking a VO-enriched diet decreased disease severity by > 80% and maximally delayed disease onset and progression. Some of the disease-modifying effects was mediated by CUR alone, e.g., suppression of serum anti-collagen antibodies and decrease of cellular infiltration and MMP abundance in the joints of CIA mice. Although CUR alone suppressed inflammatory cytokines in serum of CIA mice, the combination of CUR and VO diet significantly enhanced the suppression (> 2-fold compared to CUR) of TNF, IFN-γ, and MCP-1, all known to be associated with RA pathogenesis. Conclusion This study provides proof-of-concept that the combination of bioavailable CUR, vitamin D3, and O3FA substantially delays the development and severity of CIA. These findings provide a rationale for systematically evaluating these widely available supplements in individuals at risk for developing future RA.
Open Access
A birth cohort study to investigate the association between prenatal phthalate and bisphenol A exposures and fetal markers of metabolic dysfunction
(2014-10-22) Ashley-Martin, Jillian; Dodds, Linda; Arbuckle, Tye E; Ettinger, Adrienne S; Shapiro, Gabriel D; Fisher, Mandy; Morisset, Anne-Sophie; Taback, Shayne; Bouchard, Maryse F; Monnier, Patricia; Dallaire, Renee; Fraser, William D
Abstract Background Obesity and type-2 diabetes are on the rise and in utero exposure to environmental contaminants is a suspected contributing factor. Our objective was to examine associations between prenatal exposure to potential endocrine disrupting chemicals and markers of fetal metabolic dysfunction. Methods The Maternal-Infant Research on Environmental Chemicals Study (MIREC) recruited 2001 women during the first trimester of pregnancy from 10 Canadian sites. First trimester maternal urine was measured for 11 phthalate metabolites and bisphenol A (BPA). Leptin and adioponectin measured in 1,363 available umbilical cord blood samples served as markers of metabolic function. Restricted cubic spline curves were used to assess the relationship between continuous measures of phthalate and BPA levels and cord blood adipokines. Polytomous logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for the association between phthalates and BPA and both high (≥90th percentile) and low (≤10th percentile) fetal adiponectin and leptin, adjusting for confounding factors. Analyses were conducted for all subjects, overall, and separately by fetal sex. Results Leptin was significantly higher in female than male infants. We observed an inverse, non-linear relationship between BPA and adiponectin among males in the restricted cubic spline and linear regression analysis. Mono-(3-carboxypropyl) (MCPP) was associated with increased odds of high leptin among males in the polytomous logistic regression models (4th quartile OR = 3.5 95% CI: 1.1-11.6). Conclusion Our findings contribute to the growing body of evidence examining the influence of early life exposure on metabolic regulation and function. Associations between maternal exposure to chemicals and markers of metabolic function appear to be potentially sex specific. However, further investigation is required to determine whether in utero and childhood exposure to BPA and phthalates are associated with metabolic dysfunctions later in life.
Open Access
A Case of Acquired Rifampin Resistance in Mycobacterium bovis Bacillus Calmette-Guérin-Induced Cystitis: Necessity for Treatment Guidelines
(2006-1-1) Wolfe, Joyce N; Blackwood-Antonation, Kym S; Sharma, Meenu K; Cook, Victoria J
A case of presumed bacillus Calmette-Guérin (BCG) cystitis in an elderly female patient following direct intravesical BCG instillation treatment for papillary transitional cell carcinoma is reported. The organism cultured from urine samples was eventually identified as a rifampin-resistant Mycobacterium bovis BCG isolate. Because the patient had received rifampin monotherapy during the course of treatment for presumed BCG disease, the clinical picture favoured acquired rifampin resistance. Sequencing of the target gene for rifampin (rpoB) confirmed a known mutation responsible for conferring high levels of resistance to both rifampin and rifabutin (Ser531Tyr). To the authors' knowledge, this is the first reported case of M bovis BCG disease in a non-HIV patient where the organism had acquired drug resistance to rifampin, and the second reported case of M bovis BCG that had acquired drug resistance. The present case demonstrates the necessity to re-evaluate appropriate guidelines for the effective treatment of BCG disease.
Open Access
A Case of Group A Streptococcal Meningitis in an Adult
(1993-1-1) Pattullo, Andrew LS; Bow, Eric J
Group A streptococci are an important cause of soft tissue infections but have rarely been reported as the cause of pyogenic meningitis since the advent of antibiotics. A case of group A streptococcal meningitis in an adult is presented along with a review of similar cases reported in the literature. This case serves to illustrate the virulent nature of this pathogen in infections of the meninges, the potential for associated complications, and the need for rapid diagnosis and appropriate treatment. The source of infection in this and many other cases in the literature is the upper respiratory tract. The case presented responded well to antibiotics but resulted in permanent auditory-vestibular dysfunction.
Open Access
A Case-Control Study of the Role of Cold Symptoms and other Historical Triggering Factors in Asthma Exacerbations
(2000-1-1) Tarlo, Susan M; Broder, Irvin; Corey, Paul; Chan-Yeung, Moira; Ferguson, Alexander; Becker, Allan; Warren, Peter; Simons, F Estelle R; Sherlock, Christopher; Okada, Marilyn; Manfreda, Jure
BACKGROUND: Asthma exacerbations can be provoked by many triggers such as allergens, respiratory irritants and viral infections. The relative importance of these has not been prospectively documented in a case-control study.OBJECTIVE: To assess the relative importance of colds and other nonclimatic historical triggers of asthma exacerbations.METHODS: One hundred and nineteen adults and children with asthma in two Canadian cities participated in a one-year study of the role of exacerbating factors in asthma. Among these, 36 pairs (21 adult, 15 children) completed the case-control study. Patients were considered cases if they developed an acute asthma exacerbation and notified the centre within 24 h to allow the completion of a questionnaire and viral studies (cultures of nasopharyngeal swabs and serology). Control people with asthma were matched for sex, age and area of residence, had no exacerbation during the preceding four weeks and participated within 48 h of the case patients.RESULTS: Case patients versus control patients had a mean age of 22 years versus 20 years, 50% versus 55% were male, and 92% versus 86% had at least one positive aeroallergen skin test. Cases were more likely to have taken regular inhaled steroids (63% versus 33%, Pud_less_than0.002). Cases were more likely to report the following within the previous week: fever (Pud_less_than0.001), sore throat (Pud_less_than0.001), increase in nasal symptoms (Pud_less_than0.01), increased dust exposure (Pud_less_than0.05), exposure to others with a cold (Pud_less_than0.001) and, over the previous year, increased passive smoke exposure (Pud_less_than0.05). Viral cultures and paired serology were negative.CONCLUSIONS: Symptomatic colds were the most common trigger of asthma exacerbations in the winter and spring, while a transient increase in dust exposure was also identified as a significant trigger. The association with chronic, passive smoke exposure and the use of inhaled costicosteroid medications likely reflected less stable pre-study asthma in those with exacerbations.