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PubMed2002

Treatment strategies for early presenting acetaminophen overdose: a survey of medical directors of poison centers in North America and Europe.

BACKGROUND: Acetaminophen is frequently used in self-poisoning in Western countries. Although treatment with N-acetylcysteine (NAC) reduces liver injury, no consensus exists on the preferred management of acetaminophen toxicity. OBJECTIVES: To describe the approach taken by toxicologists in North America and Europe toward the management of acetaminophen toxicity. METHODS: Medical directors of poison centers in the US, Canada, and Europe were surveyed by means of a questionnaire presenting two clinical scenarios of acetaminophen overdose: a healthy adolescent with no risk factors who had an acute ingestion of acetaminophen, and an adult with both acute ingestion and possible risk factors. For each case, several questions about the management of these patients were asked. RESULTS: Questionnaires were sent to medical directors of 76 poison centers in North America and 48 in Europe, with response rates of 62% and 44%, respectively. Forty percent of responders suggested using charcoal 4 hours after ingestion of a potential toxic dose of acetaminophen, and 90% recommended treatment with NAC when levels were above 150 microg/mL but below 200 microg/mL 4 hours after ingestion. Duration of treatment with oral NAC ranged from 24 to 96 hours; 38 responders suggested a duration of 72 hours. Of 49 centers recommending oral NAC, 18 (36.7%) said they might consider treatment for less than 72 hours. Eleven of 29 (37.9%) responders suggested treatment with intravenous NAC for more than 20 hours as their usual protocol or a protocol for specific circumstances. CONCLUSIONS: Our study showed large variability in the management of acetaminophen overdose. Variations in treatment protocols should be addressed in clinical trials to optimize the treatment for this common problem.

Acetaminophen↗
PubMed2000

Chaneya, a New Genus of Winged Fruit from the Tertiary of North America and Eastern Asia.

A new genus is recognized on the basis of wind-dispersed fruits from the Eocene of western North America and Miocene of eastern Asia. The fruits consist of an accrescent hypogynous calyx of five obovate sepals and one or more globose fruit bodies. Although the fossils were formerly placed in the extant genera Porana (Convolvulaceae) and Astronium (Anacardiaceae), our investigation of numerous specimens from several floras in the western United States (e.g., Florissant, Green River, Clarno) and Canada (Whipsaw Creek, British Columbia) and the Yilan and Shanwang floras of China reveals unique characters that indicate that the fossils are a distinct genus, which we name Chaneya. Unlike Porana and Astronium, the fossil calyces have stomata that are longitudinally aligned, and early stages of fruit development show a gynoecium of five apocarpous carpels, of which only one or two usually enlarge at maturity. Precise systematic placement of the fossil genus is uncertain, but similarities to the extant Picrasma of the Simaroubaceae are suggestive of possible affinities. Two species are recognized: Chaneya tenuis (Lesq.) comb. nov., from the Eocene of western North America and northeastern China, and Chaneya kokangensis (Endo) comb. nov., from the Miocene of eastern Asia.

Journal Article↗
PubMed1994

Comparison of serological and DNA HLA-DR typing results for transplantation in Western Europe, Eastern Europe, North America and South America.

In a previous study, DNA typing revealed that 25% of serological HLA-DR typings of kidney transplants were incorrect. In the current study, we analyzed whether this error rate had improved in recent years, and whether there were differences according to geographical region. From 1988 to 1991 the error rate of serological typing improved slightly in Western Europe from 19% to 16%, and in North America, from 21% to 16%. In Eastern Europe, the error rate decreased from 49% to 33% in 1991, whereas the rate remained high in South America at 60% in 1988 and 72% in 1991. The high error rates in South America and Eastern Europe reflected a lack of good quality serological typing reagents. The 16% typing errors in Western Europe and North America demonstrated the current limit of serological techniques for cadaver donor typing and underlined the need for prospective DNA typing.

DNA↗
PubMed2000

At the margins of human rights and psychiatric care in North America.

The roots and expanse of the rights of psychiatric patients in North America are broad and diverse. This paper focuses on four rights that are pushing at the contemporary margins of patients' rights. First, the right to treatment, a moral position casting about for legal grounding. Second, the rights of psychiatrically hospitalized patients, articulated in statutes, court decisions, organizational standards and patients' bills of right. Third, patient participation in treatment planning, a process involving both rights and responsibilities. Fourth, the right to involuntary outpatient treatment, a process sometimes viewed as a deprivation of and other times as an expansion of rights for patients. These rights are addressed in the context of the question, are we going in the proper direction?

Commitment of Persons with Psychiatric Disorders↗
PubMed1997

Acanthocephala of the bald eagle (Haliaeetus leucocephalus) in North America.

Examination of bald eagles (Haliaeetus leucocephalus) collected from several locations in North America contributed new information concerning the acanthocephalan fauna of this host. Representatives of Arythmorhynchus brevis, representing a new host record, were collected from eagles in Florida, New Hampshire, and Wisconsin. Plagiorhynchus sp. was collected from an eagle in Florida. Corynosoma strumosum was collected from an eagle in Alaska. Andracantha phalacrocoracis, representing a new host record, was collected from an eagle in Alaska. Southwellina hispida, representing a new host record, was collected from eagles in Maine and Virginia. The occurrence of gravid or mature females of A. brevis, Plagiorhynchus sp., and S. hispida suggests that the bald eagle may serve as a competent definitive host for these species.

Acanthocephala↗
PubMed2003

West Nile virus: an emerging virus in North America.

West Nile virus is an emerging virus that first appeared in North America during the summer of 1999 in New York City. There were seven deaths associated with this event. Surveillance reports indicate that the virus had been spreading south and west and in 2002, had been reported in 42 states and the District of Columbia. As of September 2002, there were 2121 total human cases reported, induding 104 deaths. The fatality rate for the West Nile virus is very low and the majority of individuals will have no clinical symptoms; however, individuals at most risk for more serious form of the disease are the elderly, the immunocompromised, and young individuals. The virus is spread by certain mosquito species and certain populations of birds serve as the reservoir hosts. Because person-to-person transmission does not occur, humans are therefore considered dead-end hosts. Confirmation of cases West Nile virus infections in humans are determined based on clinical and laboratory findings.

Animals↗
PubMed2006

Forgoing life sustaining treatments: differences and similarities between North America and Europe.

BACKGROUND: As evidence exist that severe neurological damage or prolonged death after inappropriate CPR could occur, restraints and indications for CPR were perceived as necessary. The objective of this review is to examine policies and attitudes towards end-of-life decisions in Europe and North America and to outline differences and similarities. METHODS: A bibliographic database search from 1990 to 2006 was performed using the following terms: do-not-resuscitate orders, end-of-life decisions, withholding/withdrawal of life-sustaining treatments, medical futility and advanced directives. Eighty-eight articles, out of 305 examined, were analyzed and their data systematically reported and compared where possible. They consisted of studies, questionnaires and surveys answering the following questions: percentage of deaths of critical patients preceded by do-not-resuscitate orders, factors affecting the decision for do-not-resuscitate orders, people involved in this decision (patient, surrogates and medical staff) and how it was performed. RESULTS: There is an evident gap between the North American use of standard and formal procedures compared with Europe. Second, they diverge in the role acknowledged to surrogates in the decisional process, as in Europe, restraints and reserves to accept surrogates as decision makers seem still strong and a paternalistic approach at the end-of-life is still present. CONCLUSION: Incidentally, despite the predictable differences between Europe and North America, concerns do exist about the actual extent of autonomy wished by patients and surrogates. It is important to highlight these findings, as the paternalistic attitude, too often negatively depicted, could be, according to the best medical practice, justified and more welcomed in some instances.

Cardiopulmonary Resuscitation↗
PubMed1997

Routine skin cleansing with povidone-iodine is not a common cause of transient neonatal hypothyroidism in North America: a prospective controlled study.

A high incidence of transient neonatal hypothyroidism has been observed in premature infants after routine skin cleansing with iodine. Because these reports have been predominantly from Europe, a borderline, iodine-deficient area, we wished to determine whether this was also true in North America, an iodine-sufficient area. A prospective, controlled study was performed in premature babies < or = 36 weeks gestation admitted to a neonatal intensive care nursery. Thyroxine (T4) and thyrotropin (TSH) were measured at day 1, days 4 to 6, and 10 to 12 after skin preparation with iodine or with a noniodine-containing antiseptic solution (chlorhexidine) that served as control. If repeat cleansing was required, this sequence was repeated. Urinary iodine was quantitated on days 1 to 3 to estimate iodine exposure. There was no difference in the mean T4 concentration at any of the time points evaluated nor in the incidence of transient hypothyroidism between the iodine-exposed (2/17) and control babies (0/14) despite urinary iodine excretion up to 88 times the control value. Unexpectedly 5 iodine-exposed but 0 control babies developed severe hypothyroxinemia (T4 < 40 nmol/L), compatible with the sick euthyroid syndrome; one of them died. We conclude that, unlike in Europe, transient hypothyroidism is not a common sequela of routine skin cleansing with iodine in premature newborn infants in North America. This difference in incidence may be due to prior iodine status. Whether excessive iodine absorption in premature infants is associated with thyroid-independent toxic effects remains to be clarified.

Anti-Infective Agents, Local↗
PubMed2002

Tick-borne relapsing fever in North America.

Relapsing fever is characterized by recurring episodes of fever and nonspecific symptoms (e.g., headache, myalgia, arthralgia, shaking chills, and abdominal complaints). The illness is caused by an infection from the Borrelia species (spirochetes) that may be acquired through the bite of an infected tick (Ornithodoros species) or contact with the hemolymph of an infected human body louse (Pediculus humanus). In North America, most cases have been acquired in the western United States, southern British Columbia, and few cases have been reported from Mexico. Most cases have been acquired from exposure to rustic tick-infested cabins and caves. This article reviews relapsing fever, especially tick-borne relapsing fever in North America.

Anti-Bacterial Agents↗
PubMed2003

Mutations in the fumarate hydratase gene cause hereditary leiomyomatosis and renal cell cancer in families in North America.

Hereditary leiomyomatosis and renal cell cancer (HLRCC) is an autosomal dominant disorder characterized by smooth-muscle tumors of the skin and uterus and/or renal cancer. Although the identification of germline mutations in the fumarate hydratase (FH) gene in European families supports it as the susceptibility gene for HLRCC, its role in families in North America has not been studied. We screened for germline mutations in FH in 35 families with cutaneous leiomyomas. Sequence analysis revealed mutations in FH in 31 families (89%). Twenty different mutations in FH were identified, of which 18 were novel. Of these 20 mutations, 2 were insertions, 5 were small deletions that caused frameshifts leading to premature truncation of the protein, and 13 were missense mutations. Eleven unrelated families shared a common mutation: R190H. Eighty-one individuals (47 women and 34 men) had cutaneous leiomyomas. Ninety-eight percent (46/47) of women with cutaneous leiomyomas also had uterine leiomyomas. Eighty-nine percent (41/46) of women with cutaneous and uterine leiomyomas had a total hysterectomy, 44% at age < or =30 years. We identified 13 individuals in 5 families with unilateral and solitary renal tumors. Seven individuals from four families had papillary type II renal cell carcinoma, and another individual from one of these families had collecting duct carcinoma of the kidney. The present study shows that mutations in FH are associated with HLRCC in North America. HLRCC is associated with clinically significant uterine fibroids and aggressive renal tumors. The present study also expands the histologic spectrum of renal tumors and FH mutations associated with HLRCC.

Carcinoma, Renal Cell↗
PubMedDate not supplied

Prevalence of the breed-related glaucomas in pure-bred dogs in North America.

OBJECTIVE: To determine the prevalence of the breed-related glaucomas in pure-bred dogs presented to the veterinary medical teaching hospitals in North America that participate in the Veterinary Medical Data Base (VMDB). MATERIALS AND METHODS: In this retrospective study, age of first diagnosis, breed, and gender data for all breeds of dogs were collected from the VMDB with the clinical diagnosis of primary glaucoma (glaucoma-NOS) at 5-10 year intervals from 1964 to 2002. The prevalence for each breed (affected dogs compared to all dogs of each breed), any changes over the 38 years, and any gender differences for these glaucomas were determined. RESULTS: The prevalence of the primary breed-related glaucomas has gradually increased from 0.29% (1964-1973); 0.46% (1974-1983); 0.76% (1984-1993); to 0.89% (1994-2002). Breeds that consistently featured among the highest 10 for glaucoma prevalence from four different periods (1964 to 2002) included American Cocker Spaniel, Basset Hound, Wire Fox Terrier, and Boston Terrier. During the last observation period (1994-2002), 22 different breeds had 1% or higher prevalence of the glaucomas. The highest prevalence of glaucomas in 1994-2002 by breed included: American Cocker Spaniel (5.52%); Basset Hound (5.44%); Chow Chow (4.70%); Shar-Pei (4.40%); Boston Terrier (2.88%); Wire Fox Terrier (2.28%); Norwegian ElkHound (1.98%); Siberian Husky (1.88%); Cairn Terrier (1.82%); and Miniature Poodle (1.68%). A predominance of females with glaucoma occurred in the American Cocker Spaniel, Basset Hound, Cairn Terrier, Chow Chow, English Cocker Spaniel, Samoyed, and perhaps the Siberian Husky, and a predominance of males in the Australian Cattle dog and St Bernard. Age affected the time for first presentation of the glaucomas in the pure-bred dog. In the majority of breeds the glaucomas were presented for initial diagnosis in dogs between 4 and 10 years of age. CONCLUSION: Breed-related glaucomas in pure-bred dogs are frequently presented to the veterinary medical teaching hospitals in North America. The prevalence of the breed-related glaucomas in the dog appears similar to humans, and in some breeds exceeds that in humans. In many breeds the high prevalence of the glaucomas suggests a genetic basis.

Animals↗
PubMed1979

Variation of melanoma incidence with latitude in North America and Europe.

The relationship between melanoma incidence and latitude was investigated in North American and Europe, using the data collected by 43 population-based cancer registries. In North America melanoma incidence increased with decreasing latitude, supporting the role of UV light in the induction of melanoma. Within England the data from the National Cancer Registration scheme also showed that trend of decreased frequency of melanoma with decreasing latitude. In contrast, across Europe the trend was in the opposite direction, of increasing melanoma incidence with increasing latitude. It is suggested that across Europe there is a range of skin colour from dark in the south to light in the north, which gives rise to a range of susceptibility to the induction of melanoma by UV. The effect of this susceptibility must be large enough to overwhelm the opposing effect of decreased UV intensity at higher latitudes, and this emphasizes the dangers of excessive solar exposure to fair-skinned individuals. The populations of England may be a sufficiently random mix of skin colour, owing to repeated invasions, for the effect of UV intensity to be observed.

Epidemiologic Methods↗
PubMed2002

Carbohydrates and colorectal cancer risk among Chinese in North America.

Previous studies have analyzed total carbohydrate as a dietary risk factor for colorectal cancer (CRC) but obtained conflicting results, perhaps attributable in part to the embedded potential confounder, fiber. The aim of this study was to analyze the nonfiber ("effective") carbohydrate component (eCarb) separately and to test the hypothesis that effective carbohydrate consumption is directly related to CRC risk. The data (473 cases and 1192 controls) were from a large, multicenter, case-control study of Chinese residing in North America. Multivariate logistic regression was used to perform a secondary analysis controlling for age; sex; consumption of fat, fiber, calcium, and total kilocalories; body mass (Quetelet's) index; family history; education; and years in North America. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to estimate risk among subgroups by sex and cancer site. A statistically significant positive association was observed between eCarb consumption and risk of CRC in both men (OR, 1.7 comparing highest with lowest tertile of eCarb consumption; 95% CI, 1.1-2.7) and women (OR, 2.7; 95% CI, 1.5-4.8). As expected, the ORs for total carbohydrate were somewhat lower than those for effective carbohydrate, but the differences were not large. A sex difference in risk by colorectal subsite was observed, with risk concentrated in the right colon for women (OR, 6.5; 95% CI, 2.4-18.4) and in the rectum for men (OR, 2.4; 95% CI, 1.2-4.8). These data indicate that increased eCarb and total carbohydrate consumption are both associated with increased risk of CRC in both sexes, and that among women, relative risk appears greatest for the right colon, whereas among men, relative risk appears greatest for the rectum.

Asian↗
PubMed2005

Multiple outbreaks of severe acute BVDV in North America occurring between 1993 and 1995 linked to the same BVDV2 strain.

The first reported outbreak of bovine viral diarrhea (BVD) in 1946 described a transmissible acute disease characterized by severe leukopenia, high fever, gastrointestinal erosions and hemorrhages. However, in the ensuing years, the most commonly observed acute form of BVD was clinically mild. There was limited viral shed and spread following these acute infections. This led to the assumptions that acute infections with BVD viruses (BVDV) were clinically unimportant, spread of the virus within a group was always due to the presence of a persistently infected animal and transmission between healthy immunocompetent cattle was insignificant. These assumptions were challenged when outbreaks of severe acute BVDV were observed in North America starting in the late 1980s. This study demonstrates that widespread outbreaks of severe acute BVD observed in 1993 in North America can be traced to a single strain of BVDV that apparently spread explosively following acute infection. These findings are notable in that they draw into question management of acute BVD infection, design of studies examining virulence and nomenclature used to identify strains for GenBank submission.

Acute Disease↗
PubMed2003

Pathogen of occurrence and susceptibility patterns associated with pneumonia in hospitalized patients in North America: results of the SENTRY Antimicrobial Surveillance Study (2000).

Antimicrobial selection for patients diagnosed with pneumonia is a major therapeutic challenge and dilemma to the clinical practitioner. In the community setting, patients usually receive empiric oral therapy based upon multiple patient risk factors and locally prevalent pathogen susceptibilities. For patients admitted to the hospital with pneumonia, or who acquire pneumonia while in the hospital, therapy can be initially empiric and then become directed once culture and susceptibility results are known. The SENTRY Antimicrobial Surveillance Program since 1997, has monitored pathogen frequency and antimicrobial susceptibilities in hospitalized patients with pneumonia in North America. In this Study 2,712 pathogens were studied from 30 medical centers (25 in the United States and 5 in Canada). Over 30 species of organisms were recovered with Staphylococcus aureus comprising 28.0% of all isolates and with four other species (Pseudomonas aeruginosa 20.0%, Streptococcus pneumoniae 9.1%, Klebsiella spp. 7.5% and Haemophilus influenzae 7.3%) constituted 71.9% of isolates submitted. Methicillin (oxacillin)-resistant S. aureus accounted for 43.7% of all S. aureus isolates. Antimicrobials demonstrating significant (>80%) activity against S. aureus were: chloramphenicol (81.6%), tetracycline (91.4%), rifampin (96.4%) and quinupristin/dalfopristin (99.7%); and no isolate was resistant to glycopeptides or linezolid. North American isolates of P. aeruginosa were most susceptible to amikacin (93.7%) > tobramycin (90.2%) > meropenem (89.1%) > imipenem = piperacillin/tazobactam (85.6%) > piperacillin (82.1%) > cefepime (80.5%). Overall, 32.1% of S. pneumoniae were penicillin non-susceptible while erythromycin susceptibility was only 74.8%. Fluoroquinolones and recent generation cephalosporins retained excellent activity (gatifloxacin [99.2%] > levofloxacin = cefepime [98.8%] > ceftriaxone [97.2%]) against S. pneumoniae. Klebsiella spp. were 100.0% susceptible to the carbapenems (meropenem and imipenem) but extended spectrum beta-lactamases were detected at a rate of 5.4%. The beta-lactamase-positive rate in H. influenzae was 28.6% in North America (71.4% ampicillin-susceptible). The SENTRY Antimicrobial Surveillance Program continues to identify important North American patterns of pathogen frequency and resistance. Additionally, the provision of multi-year longitudinal data and associated reports allow for comparisons, which function as critical tools for effective patient management and antimicrobial interventions.

Anti-Bacterial Agents↗
PubMed2001

First report of the invasive eel pest Pseudodactylogyrus bini in North America and in wild American eels.

We detected 2 species of monogenean gill worms, Pseudodactylogyrus bini (Kikuchi, 1929) Gusev, 1965 and P. anguillae (Yin & Sproston, 1948) Gusev, 1965 (Monopisthocotylea: Pseudodactylogyridae), on American eel Anguilla rostrata in 2 rivers in South Carolina, USA. One of these, P. anguillae, was reported 5 yr ago from Nova Scotia; as well as in South Carolina, we also discovered it in 2 localities in Chesapeake Bay. Differences in the morphologies of specimens of either species of worm from North America and northeastern Asia were negligible. Similarly, the level of variation in sequences in the ITS2 (internal transcribed spacers) region of ribosomal RNA was minor, and not consistent with geographical origin. These data indicate that these monogeneans invaded North America only recently, possibly in parallel with the nematode Anguillicola crassus (which is known to have been introduced with commercial imports of foreign eels). We map the current global occurrence of these monogeneans, and conclude that their dispersal from northeastern Asia was largely as a result of the eel trade, and has probably been secondarily augmented by longshore migration of infected eels, and possibly also by transport in ballast waters. With present technology, all eel stocks must still be collected from the wild; unless shipments are disinfected at quarantine, these and other eel pathogens (such as A. crassus) are likely to continue to colonise other regions of the world.

Animals↗
PubMed2005

Mercury in freshwater fish of northeast North America--a geographic perspective based on fish tissue monitoring databases.

As part of an initiative to assemble and synthesize mercury (Hg) data from environmental matrices across northeastern North America, we analyzed a large dataset comprised of 15,305 records of fish tissue Hg data from 24 studies from New York State to Newfoundland. These data were summarized to provide mean Hg concentrations for 40 fish species and associated families. Detailed analyses were carried out using data for 13 species. Hg in fishes varied by geographic area, waterbody type, and waterbody. The four species with the highest mean Hg concentrations were muskellunge (Esox masquinongy), walleye (Sander vitreus), white perch (Morone americana), and northern pike (Esox luscius). Several species displayed elevated Hg concentrations in reservoirs, relative to lakes and rivers. Normalized deviations from mean tissue levels for yellow perch (Perca flavescens) and brook trout (Salvelinus fontinalis) were mapped, illustrating how Hg concentrations in these species varied across northeastern North America. Certain geographic regions showed generally below or above-average Hg concentrations in fish, while significant heterogeneity was evident across the landscape. The proportion of waterbodies exhibiting exceedances of USEPA's criterion for fish methylmercury ranged from 14% for standard-length brook trout fillets to 42% for standard-length yellow perch fillets. A preliminary correlation analysis showed that fish Hg concentrations were related to waterbody acidity and watershed size.

Animals↗
PubMed1991

Asthma in New Zealand: implications for North America.

In the early 1980s, reports of a significant rise in asthma mortality emanated from New Zealand. Difficulties in accessing medical care, noncompliance with medication, inadequate medical management, lack of patient education, and inadequate recognition of asthma severity have been suggested as factors that may have contributed to the excess of asthma mortality. Asthma mortality has now declined significantly in New Zealand. We traveled to New Zealand to examine why the incidence of asthma deaths declined in that country at the time where it may have continued to rise in North America. We hypothesize that increased patient and physician education, targeting of high-risk socioeconomic groups, and increased public awareness have played a large role in these improved statistics. The measures taken in New Zealand which have involved a cooperative approach between lay organizations, the pharmaceutical industry, government agencies, and medical personnel may be adapted to North America with, it is hoped, similar results.

Ambulatory Care↗