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Antigonish, Canada

Cheng A.,British Columbia Childrens Hospital | Farrell C.,CHU Sainte Justine | Friedman J.N.,Hospital for Sick Children | Gauthier M.,CHU Sainte Justine | And 2 more authors.
Paediatrics and Child Health

The present guideline paper addresses the emergency management of generalized convulsive status epilepticus (CSE) in children and infants older than one month of age. It replaces the previous statement from 1996, and includes a new treatment algorithm and table of recommended medications, reflecting new evidence and the evolution of clinical practice over the past 15 years. The document focuses on the acute pharmacological management of CSE, but some issues regarding supportive care, diagnostic approach and treatment of refractory CSE are discussed. Source

Williams B.,Dalhousie University | Taylor B.A.,Dalhousie University | Clifton N.,St. Marthas Regional Hospital | Bance M.,Dalhousie University
Journal of Otolaryngology - Head and Neck Surgery

Background: Eustachian tube dysfunction (ETD) is a common medical issue, occurring in at least 1 % of the adult population. Patients suffering from ET dysfunction typically present with complaints of hearing loss or sensation of pressure or plugged ear, which can lead to impaired quality of life. Over time ETD can result in conductive hearing loss or choleastatoma formation. Effective theraputic options for ET dysfunction are few. Eustachian tube balloon dilation is a novel surgical technique being used to treat ETD. The aim of our study is to objectively measure the success of Eustachian tube balloon dilation by comparing pre and post-operative middle ear pressures using tympanometric testing. Methods: RA retrospective chart review was preformed on all patients who underwent balloon dilation of the Eustachian tube by authors NC or MB from 2010 to 2014. Pre and post-operative tympanograms were analyzed and categorized based on type (Type A, Type B, Type C). Success was defined by an improvement in tympanogram type: Type B or C to Type A, or Type B to type C. Pre and post-operative tympanograms were further analyzed using middle ear pressure values. Follow-up ranged from 3 to 15 months. Results: Twenty-five ears (18 patients) were included in the study. Overall 36 % of ears had improvement in tympanogram type, and 32 % had normalization of tympanogram post-operatively. The Jerger tympanogram type improved significantly following the procedure (p = 0.04). Patients also had statistically significant improvement in measured middle ear pressure post-operatively (P = 0.003). Conclusion: The natural history of Eustachian tube dysfunction is poorly understood, and evidence for current treatments are limited. Eustachian tube balloon dilation is a safe procedure, and produces significant improvement in tympanogram values up to 15 months post-operatively. Further refinement of patient selection and standardization of technique is required to optimize the effect of this therapy. Longterm follow-up data will clarify the persistence of the effect. © 2016 Williams et al. Source

Cheng A.,British Columbia Childrens Hospital | Farrell C.,Sainte Justine UHC | Friedman J.,Hospital for Sick Children | Gauthier M.,Sainte Justine UHC | And 2 more authors.
Paediatrics and Child Health

Acute gastroenteritis is the most common cause of emergency room visits. Although it is usually a self-limited infection, vomiting related to this illness can cause various degrees of dehydration, leading to intravenous insertion, electrolyte abnormalities and/or hospital admission. Ondansetron is a highly potent antiemetic drug that is effective in preventing chemotherapy- and radiation-induced nausea and vomiting with a very low risk of adverse effects. Recently, ondansetron has been used to control vomiting related to acute gastroenteritis. The present article examines evidence for the use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children, and provides a recommendation for treatment based on the evidence-based review. Source

Cheng A.,British Columbia Childrens Hospital | Farrell C.,CHU Sainte Justine | Friedman J.,Hospital for Sick Children | Gauthier M.,CHU Sainte Justine | And 2 more authors.
Paediatrics and Child Health

Anaphylaxis is a severe, acute and potentially life-threatening condition, often in response to an allergen. Patients experiencing anaphylaxis can present with cutaneous, respiratory, cardiovascular or gastrointestinal manifestations. Epinephrine given intramuscularly remains the mainstay of treatment for this condition. Other second-line therapies, such as inhaled beta-2 agonists, H1 and H2 receptor antagonists and corticosteroids, may play a role in resolving respiratory and cutaneous signs and symptoms. Biphasic reactions may occur during the resolution phase of symptoms and, thus, all patients should be observed for a minimum of 4 h to 6 h before discharge from hospital. On discharge, all patients should be prescribed epinephrine autoinjectors, and referred to an allergist or immunologist for further evaluation and education. Source

Dawes M.G.,McGill University | Kaczorowski J.,University of British Columbia | Swanson G.,McMaster University | Hickey J.,St. Marthas Regional Hospital | Karwalajtys T.,McMaster University
Family Practice

Purpose: Home blood pressure (BP) monitoring is increasingly prevalent. The Canadian Hypertension Education Program (CHEP) developed a Family Practice BP tracking diary for home readings with an educational booklet. We evaluated the effectiveness of these tools compared with the standard approach of a hypertension information leaflet on BP-related knowledge, attitudes and behaviours of hypertensive family practice patients. Method: Single-blind randomized control trial on patients with raised BP. Results: Three practices in Ontario, Quebec and Nova Scotia recruited a total of 109 eligible patients. The average age was 66.1 (SD 9.3) years and 58 (54.7%) were male. There was a statistically significant increase in the mean number of correct responses to 20 hypertension knowledge questions of 1.14 from 15.3 (SD 2.2) at baseline to 16.4 (SD 2.2) at 3 months in both groups (n = 72, P < 0.001). Patients frequently did not realize that usually more than one drug plus lifestyles changes were necessary to reduce BP to target or that it might take 6 weeks for some drugs to achieve their full effect. The BP tracking diary and the booklet had positive evaluation from the patients. Conclusions: Most patients have a good baseline of knowledge about hypertension but there are still important areas that need to be addressed. The booklet and tracker were well received by patients but the simple leaflet was as effective at improving knowledge. © The Author 2010. Published by Oxford University Press. All rights reserved. Source

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