Pregnancy Among HIV-Serodiscordant Couples: Case Report of Vertical Transmission and Retrospective Case Series.

Background: HIV transmission during pregnancy and breastfeeding among serodiscordant heterosexual couples represents an ongoing barrier to the elimination of vertical transmission of HIV-1 infection in Canada.

Objective: To report a case of vertical HIV transmission during breastfeeding and examine the prevalence of risk factors for HIV transmission in the pregnancy and postpartum periods among serodiscordant couples where the male partner is HIV positive and female partner HIV negative.

Methods: Case report and retrospective chart review of HIV-serodiscordant pregnant couples over an eight-year period in Edmonton, Canada.

Poor Physical Function as a Marker of Sarcopenia in Adults with Class II/III Obesity.

Background: Adults with class II/III obesity [body mass index (in kg/m) ≥35] may present with a phenotype characterized by low lean mass and excess fat mass, a condition known as sarcopenic obesity (SO). Little is known about the prevalence and relevance of SO in these individuals, primarily due to a lack of relevant diagnostic criteria.

Objective: Here, we explored the definition of SO based on physical function as an outcome of interest in adults with class II/III obesity and applied this definition to compare clinical characteristics between SO and non-SO patients.

Patterns of utilization of complementary and alternative medicine in 2 pediatric gastroenterology clinics.

Objectives: The aim of the present study was to assess the prevalence and patterns of complementary and alternative medicine (CAM) use among pediatric patients with gastrointestinal (GI) disorders at academic clinics in Canada.

Methods: The survey was carried out at 2 hospital-based gastroenterology clinics: the Stollery Children's Hospital in Edmonton and the Children's Hospital of Eastern Ontario (CHEO) in Ottawa.

Results: CAM use at the Stollery was 83% compared with 36% at CHEO (P < 0.

CAM and Pediatric Oncology: Where Are All the Best Cases?

Background. Use of complementary and alternative medicine (CAM) by children with cancer is high; however, pediatric best cases are rare. Objectives.

Complementary and alternative medicine use by pediatric specialty outpatients.

Objective: Complementary and alternative medicine (CAM) use is high among children and youth with chronic illnesses. The objective of this study was to assess the prevalence and patterns of CAM use in 10 subspecialty clinics in Canada and to compare CAM use between 2 geographically diverse locations.

Methods: This survey was carried out at 1 Children's Hospital in western Canada (Edmonton) and 1 Children's Hospital in central Canada (Ottawa).

Left ventricular dysfunction in the haemodialysis population.

Cardiovascular disease in the haemodialysis population continues to contribute to mortality and morbidity. Disorders of left ventricular geometry and function are highly prevalent and lead to increased mortality in this highly vulnerable population. Left ventricular dysfunction (LVDys), often as a result of hypertension, ischaemic cardiac disease or dilated cardiomyopathy, has not been uniformly defined in the literature making diagnosis and therapy problematic.

Urge incontinence and impaired detrusor contractility in the elderly.

Among the elderly, both urge incontinence and elevated residual urine are common. When they occur together, they present a challenging clinical problem, called detrusor hyperactivity with impaired contractile function (DHIC). Impaired detrusor contractility has two aspects: elevated post-void residual urine volume and reduced detrusor contraction strength.

Chronic nausea in advanced cancer patients: a retrospective assessment of a metoclopramide-based antiemetic regimen.

The purpose of this retrospective study is to assess the frequency and intensity of chronic nausea in patients admitted to the Palliative Care Unit and the results of a metoclopramide-based treatment regimen. We reviewed the medical records of 100 consecutive patients admitted to the Palliative Care Unit at the Edmonton General Hospital until death during 1992-1993. All patients had terminal cancer and normal cognitive function.

Volume of hydration in terminal cancer patients.

In this retrospective study we reviewed the volume and modality of hydration of consecutive series of terminal cancer patients in two different settings. In a palliative care unit 203/290 admitted patients received subcutaneous hydration for 12 +/- 8 days at a daily volume of 1015 +/- 135 ml/day. At the cancer center, 30 consecutive similar patients received intravenous hydration for 11.

Decreased opioid doses used on a palliative care unit.

We have previously published data on our use of opioids in the last week of life. A change in our pattern of opioid use, i.e.

Symptomatic hypocalcemia after intravenous pamidronate.

A 65-year-old woman admitted for palliative care of metastatic renal/bladder carcinoma developed symptomatic hypocalcemia nine days following a single dose of pamidronate. This may have implications for management of patients following discharge from hospital.

Urge incontinence in elderly people: factors predicting the severity of urine loss before and after pharmacological treatment.

Geriatric patients with urge incontinence lose different amounts of urine and respond differently to treatment. Identification of factors predicting the amount of urine loss before or after treatment might help to select therapy. We have sought such factors in 41 elderly patients (23 women and 18 men), mean age 79 years with established urge incontinence that was urodynamically proven to be associated with detrusor hyperreflexia, who were treated with oxybutynin chloride.

Capsules and suppositories of methadone for patients on high-dose opioids for cancer pain: clinical and economic considerations.

The dose ratio, analgesic efficacy, toxicity and cost of methadone for cancer pain were evaluated in a retrospective review of 50 consecutive patients treated on a Palliative Care Unit. Patients were switched from hydromorphone 267.7 +/- 178.

The frequency of alcoholism among patients with pain due to terminal cancer.

The purpose of this retrospective study was to determine the prevalence of alcoholism among terminally ill cancer patients when assessed by multidisciplinary interviews and by the CAGE Questionnaire. We reviewed the charts of 100 consecutive patients assessed by a multidisciplinary team for the presence of alcoholism during 1989, and 100 consecutive patients assessed by the CAGE Questionnaire during 1992. Alcoholism was diagnosed in 28/100 patients during 1989 (28%) and 18/66 patients during 1992 (27%).

Is this opioid analgesic tolerance?

Tolerance to the analgesic effect of opioids is a poorly understood phenomenon. While generally accepted to be an uncommon problem, it clearly can present major management difficulties in some patients. This case report illustrates different aspects of tolerance, describes a management approach using different opioids, and provides a focus for discussion of some current developments in understanding and managing this problem.

Comparison of two different concentrations of hyaluronidase in patients receiving one-hour infusions of hypodermoclysis.

The purpose of this randomized, double-blind study was to compare 300 units of hyaluronidase per one-half liter to 150 units per one-half liter in patients receiving brief infusions for subcutaneous hydration. Twenty-five evaluable patients were randomized to receive a local injection of 300 units of hyaluronidase or 150 units of hyaluronidase immediately before two 1-hr infusions of two-thirds dextrose 5% and one-third normal saline solution (500 cc volume). The following day a crossover took place, and patients received the alternate treatment before each of the two 1-hr infusions.

Custom-made capsules and suppositories of methadone for patients on high-dose opioids for cancer pain.

In a prospective, open study, 37 advanced cancer patients in poor pain control receiving high doses of subcutaneous hydromorphone (mean daily dose: 276 +/- 163 mg) were switched to methadone by use of custom-made capsules (21 patients) or suppositories (16 patients). The change in opioid took place over 6.5 +/- 3.

Management of malignant ureteral obstruction in the palliative care setting.

Acute renal failure due to bilateral ureteral obstruction is a common problem in palliative care. We report on two patients with advanced rectosigmold carcinoma in which bilateral malignant ureteral obstruction was managed by pharmacological and endourologic methods, respectively. The first patient showed excellent response to high-dose corticosteroids.

Respiratory depression in a patient receiving oral methadone for cancer pain.

Methadone is a synthetic opioid with excellent oral bioavailability, variable, but long duration of action and extremely low cost. Our group has found that methadone is well tolerated in patients with difficult pain syndromes who are receiving high dose opioids. However, because of high interpersonal variation in bioavailability and the long duration of action of this drug, treatments should be highly personalized.

A prospective multicenter assessment of the Edmonton staging system for cancer pain.

Two hundred and seventy-seven patients were admitted to this prospective multicenter study in order to assess the accuracy of a staging system for cancer pain. The staging system (SS) was completed by a trained physician during the initial consultation. This system included the assessment of pain mechanism (PM, neuropathic versus nonneuropathic), pain characteristic (PC, continuous versus incidental), previous opioid dose (OD), cognitive function (CF), psychological distress (PD), tolerance (T), past history of alcohol or drugs (A).

Steady-state pharmacokinetic evaluation of a novel, controlled-release morphine suppository and subcutaneous morphine in cancer pain.

Although the oral route is the preferred method for morphine administration for cancer pain, many patients will require an alternate route of administration at some point during their illness. The authors studied the steady-state pharmacokinetics of morphine after administration of a novel, controlled-release suppository (MS-CRS) and subcutaneous morphine in a randomized, double-blind, two-way crossover evaluation in 10 patients with cancer pain. When administered at a 2.

Changing pattern of agitated impaired mental status in patients with advanced cancer: association with cognitive monitoring, hydration, and opioid rotation.

In late 1990, it became standard practice at the palliative care unit of the Edmonton General Hospital to regularly administer the Mini-Mental State Questionnaire (MMSQ) and to undertake opioid rotation and hydration upon detection of cognitive failure. We retrospectively reviewed the charts of 117 and 162 patients admitted in 1988-1989 and 1991-1992, respectively, to assess the impact of these maneuvers on the prevalence of agitated impaired mental status (IMS). All patients underwent regular cognitive assessment in 1991-1992 versus none in 1988-1989.

Opioid availability in Latin America: the Declaration of Florianópolis.

This declaration was formulated by consensus of the various government agencies and other organizations involved. It is hoped that it will be widely circulated.