Epilepsy in the elderly: Unique challenges in an increasingly prevalent population.

Elderly individuals (aged at least 60 or 65 years) represent a rapidly growing segment of the population. The incidence and prevalence of epilepsy is higher in this age group than in any other. Diagnosing epilepsy in the elderly can be challenging because the causes and clinical manifestations of seizures often differ as compared with younger individuals.

Predictors of Clostridioides difficile Infection Among Asymptomatic, Colonized Patients: A Retrospective Cohort Study.

Background: Asymptomatic patients colonized with Clostridioides difficile are at risk of developing C. difficile infection (CDI), but the factors associated with disease onset are poorly understood. Our aims were to identify predictors of hospital-onset CDI (HO-CDI) among colonized patients and to explore the potential benefits of primary prophylaxis to prevent CDI.

Detection and Isolation of Clostridium difficile Asymptomatic Carriers During Clostridium difficile Infection Outbreaks: An Exploratory Study.

During 4 Clostridium difficile infection outbreaks, unit-wide screening of 114 patients led to detection and isolation of 15 (13%) C. difficile asymptomatic carriers. Carriage prevalence varied between outbreaks, from 0% to 29% (P = .

Impact of Isolating Clostridium difficile Carriers on the Burden of Isolation Precautions: A Time Series Analysis.

Background: The isolation of asymptomatic Clostridium difficile (CD) carriers may decrease the incidence of hospital-associated C. difficile infections (CDI), but its impact on isolation precaution needs is unknown.

Methods: A time series analysis was conducted to investigate the impact of isolating CD carriers on the burden of isolation precautions from 2008 to 2016 in a Canadian hospital.

Effect of Detecting and Isolating Clostridium difficile Carriers at Hospital Admission on the Incidence of C difficile Infections: A Quasi-Experimental Controlled Study.

Importance: Clostridium difficile infection (CDI) is a major cause of health care-associated infection worldwide, and new preventive strategies are urgently needed. Current control measures do not target asymptomatic carriers, despite evidence that they can contaminate the hospital environment and health care workers' hands and potentially transmit C difficile to other patients.

Objective: To investigate the effect of detecting and isolating C difficile asymptomatic carriers at hospital admission on the incidence of health care-associated CDI (HA-CDI).

The protein tyrosine phosphatase DEP-1/PTPRJ promotes breast cancer cell invasion and metastasis.

DEP-1/PTPRJ is a receptor-like protein tyrosine phosphatase mainly known for its antiproliferative and tumor-suppressive functions. Many identified substrates are growth factor receptors, and DEP-1 is deleted and/or mutated in human cancers including that of the breast. However, DEP-1 was also identified as a promoter of Src activation and proinvasive functions in the endothelium, suggesting it could perhaps mediate breast cancer invasiveness that is likewise driven by Src family kinases.

Rates of non-vertebral osteoporotic fractures in rheumatoid arthritis and postfracture osteoporosis care in a period of evolving clinical practice guidelines.

In 2002, guidelines for the management of osteoporosis were published by Osteoporosis Canada and widely disseminated. We aimed to assess if those guidelines had any impact on clinical practice and ultimately on fracture rates in rheumatoid arthritis (RA). This was an observational study using the Quebec healthcare databases.

Human metapneumovirus viral load is an important risk factor for disease severity in young children.

Background: The role of viral load in human metapneumovirus (HMPV) disease severity has not yet been clearly determined.

Objective: We evaluated the importance of viral load along with other factors in HMPV disease severity among children aged <3 years old.

Study Design: HMPV-positive cases were selected from a cohort of outpatients and hospitalized children with lower respiratory tract infections.

Emergence of an oseltamivir-resistant influenza A/H3N2 virus in an elderly patient receiving a suboptimal dose of antiviral prophylaxis.

We report the emergence of an influenza virus A/H3N2-E119V neuraminidase variant from an elderly patient with renal dysfunction who received a suboptimal dose of oseltamivir prophylaxis. In neuraminidase inhibition assays, the E119V variant showed a 413-fold increase in the 50% inhibitory oseltamivir concentration and grew at titers comparable to those of the wild type in vitro.

Rheumatoid arthritis pharmacotherapy and predictors of disease-modifying anti-rheumatic drug initiation in the early years of biologic use in Quebec, Canada.

Disease-modifying anti-rheumatic drugs (DMARDs) are the cornerstone of rheumatoid arthritis (RA) pharmacotherapy and should be initiated promptly after RA diagnosis. We examined trends in use of traditional and biologic DMARDs, and non-DMARD treatments, among overall RA patients, and factors associated with DMARD initiation in the newly diagnosed RA. RA subjects identified with the Quebec administrative databases were followed between January 1, 2002, and December 31, 2008.

Biologic disease-modifying anti-rheumatic drugs and the risk of non-vertebral osteoporotic fractures in patients with rheumatoid arthritis aged 50 years and over.

Unlabelled: Prevention of bone mineral density loss in rheumatoid arthritis (RA) has been associated with use of biologic disease-modifying anti-rheumatic drugs (DMARDs). However, in this study, we could not demonstrate a reduction in the risk of non-vertebral fractures. Additional research is required to clarify the impact of biologic DMARDs on fracture risk in RA.

Mortality and readmission rates after hospitalization for upper and lower gastrointestinal events in Quebec, Canada.

Goals: We determined yearly rates of upper and lower gastrointestinal (GI) hospitalizations in Quebec, Canada and compared the 1-year readmission and mortality risks among those discharged from lower versus upper GI hospitalizations.

Background: The burden of serious upper and lower GI events is substantial.

Study: Demographic, medical, pharmaceutical, and hospital records were used in a retrospective cohort study to assess risks of mortality and hospital readmission for upper and lower GI events among patients 50 years and older during 1998 to 2006.

Gastrointestinal Mucormycosis following a Streptococcus pyogenes Toxic Shock Syndrome in a Previously Healthy Patient: A Case Report.

Mucormycosis is an uncommon opportunistic infection and the gastrointestinal form is the rarest. Rhizopus sp. is the most frequent pathogen and infection occurs almost exclusively in immunocompromised patients.

Increasing risk of infectious complications after transrectal ultrasound-guided prostate biopsies: time to reassess antimicrobial prophylaxis?

Background: An increasing risk of infectious complications following transrectal ultrasound-guided prostate needle biopsy (PNB) has been observed recently in some centers.

Objective: To delineate the risk factors associated with post-PNB bacteremia and/or urinary tract infection (UTI) and determine why this risk has risen over time.

Design, Setting, And Participants: A case-control study in a Canadian tertiary-care center.

Concordance with guideline recommendations: previous and more recent nonsteroidal anti-inflammatory drug prescriptions in Quebec, Canada.

Background: Clinical practice guidelines for appropriate nonsteroidal anti-inflammatory drug (NSAID) utilisation focus on preventing NSAID-related gastrointestinal (GI), cardiovascular (CV), congestive heart failure (CHF) and renal adverse events. We compared concordance of NSAID prescriptions with clinical practice guideline recommendations in Quebec, pre and post rofecoxib withdrawal from market.

Methods: Data were obtained from the Quebec Health Insurance Agency (RAMQ).

Use of nonsteroidal antiinflammatory drugs: is there a change in patient risk profile after withdrawal of rofecoxib?

Objective: Use of traditional nonsteroidal antiinflammatory drugs (tNSAID) increased after rofecoxib withdrawal. tNSAID use is associated with increased gastrointestinal (GI) toxicity and cardiovascular (CV) risk similar to celecoxib. The objective of our study was to describe changes in celecoxib and tNSAID use regarding GI and CV risk and congestive heart failure (CHF) and renal risk that occurred in Quebec, Canada, between April 2005-March 2007 (the post-period) compared to April 2002-March 2004 (the pre-period).

Proven infection-related sepsis induces a differential stress response early after ICU admission.

Introduction: Neuropeptides arginine-vasopressin (AVP), apelin (APL), and stromal-derived factor-1α (SDF-1α) are involved in the dysfunction of the corticotropic axis observed in septic ICU patients. Study aims were: (i) to portray a distinctive stress-related neuro-corticotropic systemic profile of early sepsis, (ii) to propose a combination data score, for aiding ICU physicians in diagnosing sepsis on admission.

Methods: This prospective one-center observational study was carried out in a medical intensive care unit (MICU), tertiary teaching hospital.

Comparison of the metabolic and economic consequences of long-term treatment of schizophrenia using ziprasidone, olanzapine, quetiapine and risperidone in Canada: a cost-effectiveness analysis.

Rationale, Aims And Objectives: Second-generation antipsychotic agents have varying propensities to cause weight gain, elevated lipid levels and associated long-term complications. This study evaluates the cost-effectiveness of four second-generation antipsychotic agents used in Canada for the treatment of schizophrenia (ziprasidone, olanzapine, quetiapine, risperidone) with a focus on their long-term metabolic consequences.

Method: Using data from the Clinical Antipsychotic Trials of Intervention Effectiveness Study, a semi-Markov model was developed to predict the incidence and associated costs of type 2 diabetes, cardiovascular complications (e.

Cost-utility of celecoxib use in different treatment strategies for osteoarthritis and rheumatoid arthritis from the Quebec healthcare system perspective.

Objective: To assess the cost-utility of celecoxib in three treatment strategies for arthritis in Quebec, considering both upper gastrointestinal (GI) and cardiovascular (CV) events.

Methods: A Markov analytic framework was used to model patients with osteoarthritis and rheumatoid arthritis at low/average and high risk of GI and CV toxicity over 5 years with monthly cycles. Treatment strategies were modelled in line with Canadian clinical practice.

Cost of corneal transplantation for the Quebec health care system.

Objective: Although corneal graft is a common, long-standing procedure, little is known about its economic impact. The purpose of this study was to estimate resource use and costs associated with corneal transplantation according to a public third-party perspective.

Design: Retrospective study using claim data from the Régie de l'assurance maladie du Québec (RAMQ).

Mercury sorption on a thiocarbamoyl derivative of chitosan.

The grafting of thiourea on chitosan backbone allows synthesizing a thiocarbamoyl derivative that was very efficient for mercury sorption in acidic solutions. Though the sorption capacity is not increased compared to raw chitosan in near neutral solutions, this modification allowed maintaining high sorption capacity (close to 2.3 mmol Hg g(-1)) at pH 2.

Influence of chitosan characteristics on the coagulation and the flocculation of bentonite suspensions.

Ten chitosan preparations with different molecular weights (MW) and degrees of deacetylation (DD) were tested for coagulation of 5 g L(-1) bentonite suspensions at pH 5 and 7 in demineralized water (DW) and in tap water (TW). Coagulation was better in TW than in DW for every condition and lower doses of chitosan were required at pH 5 than at pH 7. More than 95% of residual turbidity (after sedimentation in the absence of chitosan) was removed using less than 0.