CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne
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One of the risk factors for human papillomavirus (HPV) infection and subsequent lower genital tract neoplasias and cancers is impaired cell-mediated immunity. HIV-positive women with severe immunosuppression are 5 times more likely than HIV-negative women to have lower genital tract neoplasias. ⋯ In this review, we discuss recent advances in the understanding of the relation between HIV and HPV coinfection and the development of lower genital tract neoplasias and cancers in women. In addition, we present strategies for monitoring and treating noninvasive and invasive neoplasias of the lower genital tract in HIV-positive women.
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Community levels of air pollution have been associated with variability in mortality rates, but previous studies have inferred exposure to pollutants on a citywide basis. We investigated mortality in relation to neighbourhood levels of income and air pollution in an urban area. ⋯ Mortality rates varied by neighbourhood of residence in this cohort of people whose lung function was tested. Two of the broader determinants of health--income and air pollution levels--were important correlates of mortality in this population.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Comparing the quality of oral anticoagulant management by anticoagulation clinics and by family physicians: a randomized controlled trial.
There is growing evidence that better outcomes are achieved when anticoagulation is managed by anticoagulation clinics rather than by family physicians. We carried out a randomized controlled trial to evaluate these 2 models of anticoagulant care. ⋯ Anticoagulation clinics provided better oral anticoagulant management than family physicians, but the differences were relatively modest.
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Anaphylaxis is a severe systemic allergic reaction that is potentially fatal. It requires prompt recognition and immediate management. Anaphylaxis has a rapid onset with multiple organ-system involvement and is mostly caused by specific antigens in sensitized individuals. ⋯ Epinephrine is the treatment of choice and should be administered immediately. Secondary measures include circulatory support, H(1) and H(2) antagonists, corticosteroids and, occasionally, bronchodilators. Post-treatment observation of these patients is necessary, and they should remain within ready access of emergency care for the following 48 hours.
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Comparative Study
Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada.
Severe acute respiratory syndrome (SARS) was introduced into Canada by a visitor to Hong Kong who returned to Toronto on Feb. 23, 2003. Transmission to a family member who was later admitted to a community hospital in Toronto led to a large nosocomial outbreak. In this report we summarize the preliminary results of the epidemiological investigation into the transmission of SARS between 128 cases associated with this hospital outbreak. ⋯ Evidence to date suggests that SARS is a severe respiratory illness spread mainly by respiratory droplets. There has been no evidence of further transmission within the hospital after the elapse of 2 full incubation periods (20 days).