The purpose of this annotated chronology is to help provide a framework for research into the history of the first five years of the AIDS epidemic in Canada but especially as it unfolded in Toronto, Canada. The chronological entries can be used to identify the order and relationship of particular themes, while the sources listed in the chronology can be used as points of reference for further investigations. This chronology is primarily derived from reports in key newspapers based in the Toronto region. Each chronological entry lists the sources which reported on the particular event.
Filicide is the tragic crime of murdering one's own child. Previous research has found that the offending parents are commonly depressed and that suicide is often associated as an actual act or an intention. Yet, filicide is an underreported crime and previous studies have been strained with methodological problems. No comprehensive international studies on filicide have been presented in the literature until now.
This was a descriptive, comprehensive, register-based study of all filicides in Austria and Finland during 1995-2005. Filicide-suicide cases were also included.
Most of the perpetrators were the biological mothers; in Austria 72%, in Finland 52%. Suicide followed filicide either as an attempt or a fulfilled act in 32% and 54% of the cases in Austria and Finland, respectively. Psychotic mood disorders were diagnosed for 10% of the living perpetrators in Austria, and 12% in Finland. Non-psychotic depression was diagnosed in 9% of surviving perpetrators in Austria, 35% in Finland.
The data from the two countries demonstrated that filicide is such a multifaceted and rare phenomenon that national data from individual countries seldom offer sufficient scope for its thorough study. Further analyses are needed to produce a complete picture of filicide.
Severe acute respiratory syndrome (SARS) is a condition of unknown cause that has recently been recognized in patients in Asia, North America, and Europe. This report summarizes the initial epidemiologic findings, clinical description, and diagnostic findings that followed the identification of SARS in Canada.
SARS was first identified in Canada in early March 2003. We collected epidemiologic, clinical, and diagnostic data from each of the first 10 cases prospectively as they were identified. Specimens from all cases were sent to local, provincial, national, and international laboratories for studies to identify an etiologic agent.
The patients ranged from 24 to 78 years old; 60 percent were men. Transmission occurred only after close contact. The most common presenting symptoms were fever (in 100 percent of cases) and malaise (in 70 percent), followed by nonproductive cough (in 100 percent) and dyspnea (in 80 percent) associated with infiltrates on chest radiography (in 100 percent). Lymphopenia (in 89 percent of those for whom data were available), elevated lactate dehydrogenase levels (in 80 percent), elevated aspartate aminotransferase levels (in 78 percent), and elevated creatinine kinase levels (in 56 percent) were common. Empirical therapy most commonly included antibiotics, oseltamivir, and intravenous ribavirin. Mechanical ventilation was required in five patients. Three patients died, and five have had clinical improvement. The results of laboratory investigations were negative or not clinically significant except for the amplification of human metapneumovirus from respiratory specimens from five of nine patients and the isolation and amplification of a novel coronavirus from five of nine patients. In four cases both pathogens were isolated.
SARS is a condition associated with substantial morbidity and mortality. It appears to be of viral origin, with patterns suggesting droplet or contact transmission. The role of human metapneumovirus, a novel coronavirus, or both requires further investigation.
Comment In: N Engl J Med. 2003 Aug 14;349(7):709-11; author reply 709-1112917312
Comment In: N Engl J Med. 2003 May 15;348(20):1948-5112748314
One of the complications associated with insertion of central venous catheters (CVCs) is pneumothorax (PTX). Because of housestaff inexperience, it was hypothesised that rates of PTX after insertion of CVCs in teaching hospitals would be highest in July and August and in the first week of the month (beginning of intensive care unit (ICU) rotation).
In a retrospective analysis of data from patients admitted to the ICU in two tertiary care teaching hospitals in British Columbia from 1999 to 2005, rates of PTX occurring after insertion of CVCs were calculated, and it was evaluated whether rates were increased during certain times of the year/month.
During this period, 3548 patients were admitted to these ICUs and had at least one CVC placed. 5816 CVCs were inserted; 113 PTX occurred within 2 days after insertions (1.9% per CVC). The rate during the last week of the month was greater (2.7%) than during the first, second or third weeks (1.7%, 1.8% and 1.4%, respectively). This effect persisted after controlling for the Acute Physiology and Chronic Health Evaluation II score, the number of catheters placed per patient, gender, age and hospital. Rates of PTX after catheter placement did not vary by the month of the year.
The rate of PTX after insertion of CVCs is greatest in the last week of the month. If this effect can be verified in other centres, increased supervision of residents at the end of ICU rotations when placing CVCs should be considered. Whether this effect applies to other patient safety outcomes in the ICU also needs further study.
Cites: Clin Infect Dis. 2001 May 1;32(9):1249-7211303260
Cites: BMJ. 2001 Nov 24;323(7323):1222-311719413
Cites: Crit Care Med. 2002 Feb;30(2):454-6011889329
Cites: J Gen Intern Med. 2003 Aug;18(8):639-4512911646
Cites: J Crit Care. 2006 Jun;21(2):142-5016769457
Cites: N Engl J Med. 2004 Oct 28;351(18):1829-3715509816
Cites: JAMA. 1990 Feb 16;263(7):953-72299762
Cites: Crit Care Med. 2005 Aug;33(8):1694-70016096443