First report of Myxobolus neurofontinalis (Bivalvulida: Myxobolidae) infecting anadromous Brook Trout from Prince Edward Island, Canada.

OBJECTIVE: During routine histological examination of tissues from mortality events of anadromous Brook Trout Salvelinus fontinalis from Prince Edward Island (PEI), Canada, myxospores consistent with Myxobolus were observed infecting the central nervous system. The objective of this study was to identify the species of Myxobolus infecting the nervous system of anadromous Brook Trout from PEI, Canada. METHODS: Myxospore morphology, small subunit (SSU) ribosomal DNA (rDNA) sequence data, and histology were used to identify myxospores isolated from infected Brook Trout. RESULT: Myxospore measurements from the PEI samples matched those reported in the description of Myxobolus neurofontinalis from North Carolina. A 1057-bp fragment of the SSU rDNA from myxospores collected from Brook Trout in PEI was identical to an isolate of M. neurofontinalis (MN191598) collected previously from the type locality, New River basin, North Carolina. Histological sections confirmed infections were intercellular in the central nervous system. Minimal host response was observed, with only sparse mononuclear inflammatory infiltrates present at the periphery of and within dispersed myxospores, suggesting that infections are not pathogenic to Brook Trout. CONCLUSION: Myxospores were identified as M. neurofontinalis, which was previously described from the central nervous system of Brook Trout from the New River basin, North Carolina, USA. This constitutes the first time M. neurofontinalis has been documented outside of the New River basin in North Carolina.

Occurrence and control of equine strongyle nematode infections in Prince Edward Island, Canada.

Widespread overuse of anthelmintics has produced a growing population of intestinal parasites resistant to control measures. A paradigm shift in equine parasite control is warranted to prevent continued resistance development and maintain equine health. Small strongyles, which are ubiquitous in horses, are currently the most important intestinal parasites of adult horses. Sustainable management programs consider the variation in egg shedding by individual horses, and varied risks associated with age, use, density, climate, and environment. To develop regional recommendations for Prince Edward Island (PEI), Canada, it is important to first characterize strongyle egg shedding patterns and parasite management practices in use. Study objectives were to conduct a cross-sectional observational survey and risk factor analysis of parasite control programs, strongyle egg shedding and Strongylus vulgaris serology. A total of 339 horses from 40 PEI farms were sampled. Mean farm size was 8 horses and ranged from 2 to 30. Mean horse age was 11.6 years (Std. Dev. =7.2) and ranged from 2 months to 32 years. Mean fecal egg count (FEC) was 322 eggs per gram (EPG) (Std. Dev. =648). On average, 32% (Std. Dev. =16%) of horses shed 80% of strongyle eggs across 32 eligible farms. When considering all horses (n = 313) as one large herd, 18.7% of horses shed 80% of strongyle eggs. Use of FEC was identified in 4.6% of horses at 15% (n = 6) of PEI farms. Reported deworming intervals included 37.4% (n = 123) every 2-3 months and 58% (n = 191) every 3-4 months. Positive S. vulgaris titers were identified in 60% of horses (n = 200). Univariate analysis revealed that months since last deworming, age, and body condition score (BCS) were associated with strongyle shedding. The estimated odds of being in the high FEC category (>500 EPG) was 1.4 (95% CI, 1.1-1.8) times higher when last deworming increased by one month. Under-conditioned (BCS <4.5) horses had 3.6 (95% CI, 1.2-10.6) times odds of being in the higher FEC category than over-conditioned horses. Non-racing horses had 5.4 times odds of having a positive S. vulgaris titer than racehorses. This cross-sectional observational study is the first to report on the occurrence, risk factors and control of equine strongyle nematode infections in PEI, Canada. We conclude that the 80:20 rule can be used to develop control recommendations in PEI. Very few farms in PEI currently use FEC to guide parasite management. These findings provide a basis for future client education and investigations aimed at providing region specific recommendations.

Babesia vulpes in a dog from Prince Edward Island, Canada.

A 12-year-old neutered male American Staffordshire terrier dog was referred to the Atlantic Veterinary College, Prince Edward Island, Canada, for suspected immune-mediated hemolytic anemia. Babesiosis (Babesia vulpes) was confirmed using polymerase chain reaction testing. The dog was successfully treated with a 10-day protocol of atovaquone/proguanil (TEVA Pharmaceutical Industries, Toronto, Ontario), 13.5 mg/kg BW, PO, q8h and azithromycin (Pharmascience, Montreal, Quebec), 10 mg/kg BW, PO, q24h. To the authors' knowledge, this report is the first documented case of babesiosis caused by Babesia vulpes in a dog from Canada.

Babesia vulpes chez un chien de l'Île-du-Prince-Édouard, Canada. Un chien American Staffordshire terrier mâle castré de 12 ans a été référé au Atlantic Veterinary College, Île-du-Prince-Édouard, Canada, pour suspicion d'anémie hémolytique à médiation immunitaire. La babésiose (Babesia vulpes) a été confirmée à l'aide d'un test d'amplification en chaîne par la polymérase. Le chien a été traité avec succès avec un protocole de 10 jours d'atovaquone/proguanil (TEVA Pharmaceutical Industries, Toronto, Ontario), 13,5 mg/kg BW, PO, q8h et azithromycine (Pharmascience, Montréal, Québec), 10 mg/kg BW, PO, q24h. À la connaissance des auteurs, ce rapport est le premier cas documenté de babésiose causée par Babesia vulpes chez un chien du Canada.(Traduit par Dr Serge Messier).

Prevalence of anthelmintic resistant cyathostomins in Prince Edward Island, Canada.

Cyathostomins are the most common parasites of adult horses worldwide. Currently, the three classes of anthelmintics used to treat cyathostomin infections includes benzimidazoles, pyrimidines and macrocyclic lactones. However, due to widespread overuse, cyathostomins have developed varying degrees of resistance to all classes of anthelmintics. Fecal egg count reduction tests (FECRT) are currently used to determine the presence of anthelmintic resistance (AR), while egg reappearance periods (ERP) are used to investigate early macrocyclic lactone resistance. The objective of this study was to investigate the prevalence of cyathostomin pyrantel pamoate and ivermectin resistance, and to determine ERP at Prince Edward Island (PEI), Canada horse farms. In addition, fecal cultures and larval identification were performed to evaluate the prevalence of small and large strongyle egg shedding in PEI. Fecal egg counts (FEC) were performed on 270 horses on 14 horse farms across PEI. Horses with≥ 200 eggs per gram (EPG) met the inclusion criteria and were enrolled in the study (n = 101). The median (range) horses per farm was 7.5 (4-11) and 6.0 (4-8) for pyrantel pamoate and ivermectin groups, respectively. Horses were initially treated with 6.6 mg/kg of pyrantel pamoate orally (n = 101). Fecal egg counts were conducted every two weeks for 8 weeks post treatment. Once individual FEC were ≥ 200 EPG, horses were dewormed with 0.2 mg/kg of ivermectin orally (n = 80), and FEC were performed every 2-3 weeks for seven weeks. In this study the ERP was defined as the week the mean FECR were 10% below the initial mean two-week post treatment FECR. Fecal egg count reduction tests and ERP were used to evaluate the efficacy of each anthelmintic. Fecal culture was performed to confirm the shedding of cyathostomin eggs. Fecal egg count reduction tests detected pyrantel pamoate resistance on 5/14 farms. No signs of ivermectin AR were detected, while reappearance of eggs occurred at 4-6 weeks and 7-9 weeks for pyrantel pamoate and ivermectin, respectively. Fecal culture detected large strongyles on 5/14 farms, which accounted for 0.3% of strongyle type eggs cultured. The prevalence of Strongylus vulgaris among individual horses in this study was 2.8% and was detected on 2/14 farms. These findings will allow us to educate owners and veterinarians on appropriate anthelmintic protocols in PEI and can be used as a baseline for continued monitoring of ERP and anthelmintic resistance in this region.

Compliance with the Code of Practice for the Care and Handling of Equines on 50 horse farms in Prince Edward Island.

The objective of this study was to determine the proportion of horse farms on Prince Edward Island, Canada that comply with the requirements of the Code of Practice for the Care and Handling of Equines (Code). An investigator performed on-farm assessments while administering a questionnaire to owners of 50 horse farms. The percentage of farms in compliance with specific requirements in the Code ranged from 20% to 100% per requirement. The largest areas of non-compliance regarding facilities and housing were the lack of the ability to segregate sick or injured animals and the lack of an emergency action plan. It was determined that 72% of farms were in compliance with body condition scores and 54% reported to have taken corrective action when required. Farm owners who were aware of the Code were more likely to have good quality air in their barns as well as an emergency action plan in place.

L'objectif de la présente étude était de déterminer la proportion de fermes équines sur l'Île-du-Prince-Édouard, Canada qui se conforme aux exigences du Code de pratiques pour les soins et la manipulation des chevaux (Code). Un enquêteur effectua des évaluations à la ferme tout en procédant à un questionnaire auprès des propriétaires de 50 fermes équines. Le pourcentage de fermes en conformité avec des exigences spécifiques du Code variait de 20 % à 100 % selon l'exigence. Les secteurs les plus importants de nonconformité en regard des facilités et de logement étaient l'absence de la capacité à isoler les animaux malades ou blessés et l'absence d'un plan d'action d'urgence. Il fut déterminé que 72 % des fermes étaient en conformité pour les pointages d'état de chair et 54 % rapportèrent d'avoir pris les actions correctives lorsque requises. Les propriétaires de ferme qui étaient au courant du Code étaient plus susceptibles d'avoir un air de bonne qualité dans leurs fermes ainsi qu'un plan d'action d'urgence en place.(Traduit par Dr Serge Messier).

Prevalence of feline herpesvirus-1, feline calicivirus, Chlamydia felis, and Bordetella bronchiseptica in a population of shelter cats on Prince Edward Island.

The prevalence of the causative agents of feline upper respiratory tract disease (URTD) has been previously documented in many regions worldwide, but has yet to be reported in eastern Canada. The objectives of this study were to determine the prevalence of feline herpesvirus-1 (FHV-1), feline calicivirus (FCV), Chlamydia felis (C. felis), and Bordetella bronchiseptica (B. bronchiseptica) in a population of shelter cats with clinical signs related to URTD on Prince Edward Island, Canada; to compare the prevalence of FHV-1 and FCV as detected by polymerase chain reaction (PCR) and virus isolation (VI) in this population; and lastly, to determine whether factors, such as co-infections, time of year, concurrent feline leukemia virus (FeLV)- or feline immunodeficiency virus (FIV)-positive status, or clinical signs, were associated with prevalence of particular pathogens. Conjunctival, nasal mucosal, and oropharyngeal swabs were collected from 82 cats with clinical signs consistent with URTD. Samples were pooled in transport medium and PCR was used to detect FHV-1, FCV, and C. felis and VI was also used to detect FHV-1 and FCV. A separate swab was submitted for aerobic bacterial culture to detect B. bronchiseptica. Feline herpesvirus-1 (FHV-1) was the most prevalent in this population, followed by C. felis, B. bronchiseptica, and FCV. Of the 4 cats that were positive for B. bronchiseptica, 3 were concurrently positive for FHV-1. All positive B. bronchiseptica cultures were resistant to cefovecin. The prevalence for FHV-1 was lowest in autumn (seasons P < 0.001) and was positively associated with the presence of nasal discharge (P = 0.018) and coughing (P = 0.043).

La prévalence des agents causals de maladies du tractus respiratoire supérieur félin (URTD) a été préalablement documentée dans plusieurs régions du monde mais n'a pas encore été rapportée dans l'est du Canada. Les objectifs de la présente étude étaient de déterminer la prévalence d'herpès virus félin-1 (FHV-1), du calicivirus félin (FCV), de Chlamydia felis et de Bordetella bronchiseptica dans une population de chats de refuge de l'Île-du-Prince-Édouard, Canada avec des signes cliniques reliés au URTD; de comparer la prévalence de FHV-1 et FCV telle que détecter par réaction d'amplification en chaîne par la polymérase (PCR) et l'isolement viral (VI) dans ces populations; et finalement, déterminer si des facteurs, tels que les co-infections, la période de l'année, le statut concomitant positif pour le virus de la leucémie féline (FeLV) ou le virus de l'immunodéficience féline (FIV) ou les signes cliniques étaient associés avec la prévalence d'un agent pathogène en particulier. Des écouvillons de la conjonctive, de la muqueuse nasale et de l'oropharynx furent obtenus de 82 chats avec des signes cliniques compatibles avec URTD. Les échantillons étaient regroupés dans un milieu de transport et la PCR utilisée pour détecter FHV-1, FCV et C. felis et l'isolement viral fut également utilisé pour détecter FHV-1 et FCV. Un écouvillon séparé fut soumis pour culture bactérienne aérobie afin de détecter B. bronchiseptica. Le FHV-1 était le plus prévalent dans cette population, suivi par C. felis, B. bronchiseptica et FCV. Des quatre chats qui étaient positifs pour B. bronchiseptica, trois étaient positifs également pour FHV-1. Tous les isolats de B. bronchiseptica obtenus étaient résistants au céfovecin. La prévalence de FHV-1 était à son plus bas en automne (P < 0,001 pour les saisons) et était associée positivement avec la présence d'écoulement nasal (P = 0,018) et de la toux (P = 0,043).(Traduit par Docteur Serge Messier).

Development and implementation of a risk assessment and management program for enzootic bovine leukosis in Atlantic Canada.

Over the past 30 yr, the prevalence of bovine leukemia virus (BLV) infection has increased in North America, including Atlantic Canada, at both the herd and individual cow levels. This has occurred despite increased awareness of the disease and its deleterious effects and despite implementation of management practices aimed at reducing disease transmission. Our objectives were to identify risk factors associated with the within-herd prevalence of BLV-infected cows by using a risk assessment and management program workbook, as well as to determine the current level of BLV prevalence in the Atlantic Canada region. We hypothesized that previously established risk factors, including management practices associated with calf rearing and fly control, would affect within-herd BLV prevalence. Bulk tank milk (BTM) samples were collected in January and April of 2016 and again during the same months in 2017 and 2018 from all dairy farms shipping milk in the region. Samples were tested with ELISA for levels of anti-BLV antibodies to estimate within-herd prevalence. Regional BLV prevalence at the herd level was 88.39% of dairy herds infected in 2016 and 89.30% in 2018. All dairy farms shipping milk and who had BTM samples collected in 2017 (n = 605) were eligible to participate in the risk assessment and management program questionnaire (RAMP), which was developed and distributed to all bovine veterinarians in Atlantic Canada. One hundred and six RAMP were returned, with representation from all 4 provinces. The RAMP results were combined with the mean BTM ELISA results, and univariable logistic regression followed by multivariable logistic regression was performed to investigate the association between RAMP risk factors and the estimated within-herd BLV prevalence. Factors in the multivariable model significantly associated with the odds of a herd being classified as >25% estimated within-herd prevalence included history of diagnosis of clinical BLV and calves receiving colostrum from cows with unknown BLV status. Differences in within-herd prevalence were not associated with hypodermic needle and injection practices, rectal sleeve practices, or using bulls for natural breeding, based on these 106 dairy farms.

Management factors associated with perinatal lamb mortality in Prince Edward Island flocks.

The objective of this observational cohort study was to identify management factors associated with lamb mortality risk for sheep flocks in Prince Edward Island, Canada. Data were collected from 50 lambing groups from 36 sheep flocks during 3 farm visits before, during and after the lambing seasons in 2014-15. Variables of interest included flock management practices, ewe health indicators, ewe nutrition, litter size and lamb birth weight. Principal component analysis was performed and resulting component scores were used for further analysis using a mixed Poisson regression model with lamb mortality risk as the outcome. The median group-level lamb mortality in the first 8 weeks of life was 10.0 % (0 %-30.3 %), with 25 groups having lamb mortality greater than 10 %, which is considered higher than the standard productivity goal. Four principal component scores were retained in the final model identifying generalized factors associated with lamb mortality: 1) flock factors, 2) forage factors, 3) lamb health factors, and 4) general health factors. Specifically, the following management factors were indirectly through the 4 principal components associated with lower lamb mortality: using goal setting; having a strong working relationship with a veterinarian; seeking veterinary advice for animal treatment; using benzimidazole-class anthelmintics; feeding forage with high crude protein, digestible energy, and net energy for maintenance and low acid detergent fiber to late-gestation ewes; applying visual lamb identification methods; using anti-coccidial prophylactic medication to lambs; administering clostridial vaccines to lambs; avoiding separation of hypothermic lambs from their dams; and treatment/prevention of neurological and/or wasting disease. Although this study is exploratory, and confirmation is required, the results should help sheep farmers and researchers direct attention to management variables that could reduce lamb mortality in sheep flocks.

Endoparasites in dogs and cats diagnosed at the Veterinary Teaching Hospital (VTH) of the University of Prince Edward Island between 2000 and 2017. A large-scale retrospective study.

Although many studies on the frequency of endoparasites in dogs and cats in Canada have been reported, seasonal and/or annual patterns are often not evaluated. The frequency and risk factors of endoparasite infections from fecal samples of cats and dogs submitted to the Veterinary Teaching Hospital of the Atlantic Veterinary College, University of Prince Edward Island-Canada were determined, using univariable and multivariable logistic regression analyses. Investigated predictors of endoparasitism available in the 2000-2017 database included sex, age, geographic origin and seasonality. A total of 15,016 dogs and 2,391 cats were evaluated for endoparasite status using specific diagnostic tests: direct smear, Baermann, and/or 33 % zinc sulfate solution in a standardized centrifugal flotation method. Overall, twelve and eight parasite genera were detected in dogs and cats, respectively. The overall proportional infection was 14.6 %, and the cat population showed a higher frequency of positivity to parasites compared to the dog population (P < 0.001). The most frequent genera recovered in the whole population (dogs and cats), were Giardia duodenalis (5.2 %), Cystoisospora spp. (3.3 %) and Toxocara spp. (3.2 %). Endoparasitism levels were diagnosed more in feces submitted from young, female intact dogs from PEI compared to the baselines of mature, sterilized male dogs from other provinces, respectively, and diagnoses occurred more often in autumn months than in winter months. There was no significant diagnostic trend across the years for the individual parasites models. The frequency of detected potentially zoonotic parasites in this study highlights the veterinary public health and One Health context of parasitic infections in pets. Although the presented results are not from a random sample and therefore frequency results should be interpreted with caution, the model relationship results may still be relevant. In addition, results are of value to estimate parasite impact and to assist researchers, veterinarians and pet-owners with suitable information to control parasites.

Detection and Preliminary Characterization of Phocine Distemper Virus in a Stranded Harp Seal (Pagophilus groenlandicus) from the Gulf of St. Lawrence, Canada.

A lethargic juvenile male harp seal (Pagophilus groenlandicus) in poor nutritional condition was found on the beach on the north shore of Prince Edward Island, Canada, in June 2017. Microscopic examination revealed a severe nonsuppurative encephalitis positive for morbillivirus antigen on immunohistochemistry. Virus isolation attempts were negative. However, phocine distemper virus (PDV) was detected in brain tissue RNA extracts by a seminested reverse transcription PCR that targeted the paramyxovirus RNA-dependent RNA polymerase (pol) gene. Comparison of the resulting partial PDV pol nucleotide sequence revealed it was nearly identical to PDV strains isolated from eastern Atlantic harbor seals (Phoca vitulina vitulina) during a 1988 epizootic in the Wadden and Irish seas, and a western Atlantic harbor seal (Phoca vitulina concolor) that stranded in Maine, US, in 2006. Our study confirmed that closely related PDV strains are circulating in multiple seal species along the coastlines of North America and Europe.

A Multiple Streams Approach to Understanding the Issues and Challenges of Lyme Disease Management in Canada's Maritime Provinces.

This study examines potential challenges facing Lyme disease patients in Canada's Maritime provinces-New Brunswick, Nova Scotia, Prince Edward Island-and considers how issues could be addressed. Reviews of both the academic and grey literature are complemented by surveys targeting both medical professionals and decision makers in government. Combined, the literature reviews and surveys demonstrate that there is considerable debate surrounding the effectiveness of testing, treatment options, and the existence of chronic Lyme disease. As the focus on the Maritimes demonstrates, these debates often pit the medical community against patients and patient advocates and, thus far, governments have been unable to produce policy that entirely pleases either side. Moving forward, this study recommends the creation of a discussion forum via a federal Commission of inquiry to review best practise guidelines for Lyme disease. The key is to foster an unbiased probe of central issues surrounding treatment and diagnosis without alienating stakeholders. This course of action will not necessarily solve the issue of Lyme disease, but would foster a greater understanding through dialogue that includes and validates the experiences of stakeholders, which is something that is currently missing.

Incidence and Carrier Frequency of CFTR Gene Mutations in Pregnancies With Echogenic Bowel in Nova Scotia and Prince Edward Island.

OBJECTIVE: Fetal echogenic bowel (echogenic bowel) is associated with cystic fibrosis (CF), with a reported incidence ranging from 1% to 13%. Prenatal testing for CF in the setting of echogenic bowel can be done by screening parental or fetal samples for pathogenic CFTR variants. If only one pathogenic variant is identified, sequencing of the CFTR gene can be undertaken, to identify a second pathogenic variant not covered in the standard screening panel. Full gene sequencing, however, also introduces the potential to identify variants of uncertain significance (VUSs) that can create counselling challenges and cause parental anxiety. To provide accurate counselling for families in the study population, the incidence of CF associated with echogenic bowel and the carrier frequency of CFTR variants were investigated. METHODS: All pregnancies for which CF testing was undertaken for the indication of echogenic bowel (from Nova Scotia and Prince Edward Island) were identified (January 2007-July 2017). The CFTR screening and sequencing results were reviewed, and fetal outcomes related to CF were assessed. RESULTS: A total of 463 pregnancies with echogenic bowel were tested. Four were confirmed to be affected with CF, giving an incidence of 0.9% in this cohort. The carrier frequency of CF among all parents in the cohort was 5.0% (1 in 20); however, when excluding parents of affected fetuses, the carrier frequency for the population was estimated at 4.1% (1 in 25). CFTR gene sequencing identified an additional VUS in two samples. CONCLUSION: The incidence of CF in pregnancies with echogenic bowel in Nova Scotia and Prince Edward Island is 0.9%, with an estimated population carrier frequency of 4.1%. These results provide the basis for improved counselling to assess the risk of CF in the pregnancy, after parental carrier screening, using Bayesian probability. Counselling regarding VUSs should be undertaken before gene sequencing.

Early Successes in an Open Access, Provincially Funded Hepatitis C Treatment Program in Prince Edward Island.

INTRODUCTION: The availability of curative hepatitis C therapies has created an opportunity to improve treatment delivery and access. Local providers, government, industry, and community groups in Prince Edward Island developed an innovative province-wide care model. Our goal was to describe the first year of program implementation. MATERIAL AND METHODS: Using a communitybased prospective observational study design, all chronic hepatitis C referrals received from April 2015 to April 2016 were recorded in a database. Primary analysis assessed the time from referral to assessment/treatment, as well as the number of referrals, assessments, and treatment initiations. Secondary objectives included: (1) treatment effectiveness using intention-to-treat analysis; and (2) patient treatment experience assessed using demographics, adverse events, and medication adherence. RESULTS: During the study period 242 referrals were received, 123 patients were seen for intake assessments, and 93 initiated direct-acting antiviral therapy based on medical need. This is compared to 4 treatment initiations in the previous 2 years. The median time from assessment to treatment initiation was 3 weeks. Eighty-two of 84 (97.6%, 95% CI 91.7 - 99.7%) patients for whom outcome data were available achieved sustained virologic response at 12 weeks post-treatment; 1 was lost to follow-up and 1 died from an unrelated event. In the voluntary registry, 39.7% of patients reported missed treatment doses. CONCLUSION: In conclusion, results from the first 12 months of this multi-phase hepatitis C elimination strategy demonstrate improved access to treatment, and high rates of safe engagement and cure for patients living with chronic hepatitis C genotype 1 infections.

Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time.

BACKGROUND: Changing patterns of referral and management of pediatric surgical conditions, including hypertrophic pyloric stenosis (HPS), have recently been described and often relate to comfort with early nonoperative management, anesthesia and corrective surgery. Travelling distance required for treatment at pediatric centres can also be burdensome for families. We assessed referral patterns for HPS in the maritime provinces of Canada over 10 years to quantify the burden on families travelling for surgical care. METHODS: We reviewed the charts of all patients with HPS in the Maritimes. Length of hospital stay (LOS) and complication rates were analyzed in regards to resuscitation and management at a pediatric centre and/or peripheral centres. We used postal codes for each patient to track distance travelled for management. RESULTS: We assessed 751 cases of HPS. During the study period (Jan. 1, 2001-Dec. 31, 2010), referral to pediatric centres increased from 49% to 71%. Postoperative complications were 2.5-fold higher in peripheral centres. Infants referred to pediatric centres were 78% less likely to have an LOS longer than 3 days. Laparoscopic pyloromyotomy, which was performed only in pediatric centres, was associated with a shorter postoperative LOS. CONCLUSION: Our study supports the current literature demonstrating improved outcomes, shorter overall LOS and decreased risk of complications when infants with HPS are treated in pediatric centres. This should be considered when planning access to pediatric surgical resources.

CONTEXTE: Une évolution des tendances dans les pratiques d'orientation des patients et de prise en charge des affections pédiatriques nécessitant une intervention chirurgicale, telles que la sténose hypertrophique du pylore (SHP), a récemment été décrite; elle dépend souvent du degré d'acceptation de la prise en charge non chirurgicale précoce, de l'anesthésie et de la chirurgie correctrice. Le traitement en centre pédiatrique peut exiger des déplacements pénibles pour les familles. Nous avons évalué les pratiques d'orientation des cas de SHP dans les provinces maritimes du Canada sur une période de 10 ans pour quantifier l'ampleur du fardeau qui incombe aux familles devant voyager pour obtenir des soins chirurgicaux. MÉTHODES: Nous avons étudié le dossier de tous les patients atteints de SHP dans les Maritimes et avons comparé la durée de séjour et le taux de complications associés à la réanimation et à la prise en charge dans les centres pédiatriques et les centres périphériques. Nous avons aussi utilisé les codes postaux des patients pour déterminer la distance de déplacement des familles. RÉSULTATS: Nous avons analysé 751 cas de SHP. Pendant la période à l'étude (2001­2010), le taux d'orientation des patients vers les centres pédiatriques est passé de 49 % à 71 %. Les complications postopératoires étaient 2,5 fois plus courantes dans les centres périphériques, et les séjours de plus de 3 jours étaient 78 % moins fréquents chez les nourrissons traités en centre pédiatrique. La pyloromyotomie par laparoscopie, réalisée dans les centres pédiatriques seulement, a été associée à une réduction de la durée de séjour postopératoire. CONCLUSION: Notre étude va dans le même sens que la littérature actuelle, qui indique que le traitement des nourrissons atteints de SHP en centre pédiatrique est associé à de meilleurs résultats postchirurgicaux, à une durée d'hospitalisation moins longue et à un risque de complications plus faible que le traitement dans un centre périphérique. Ces résultats devraient être pris en compte dans la planification de l'accès aux ressources dans le domaine de la chirurgie pédiatrique.

A cross-sectional study of Tritrichomonas foetus infection in feral and shelter cats in Prince Edward Island, Canada.

A cross-sectional study examined the occurrence of Tritrichomonas foetus, and other intestinal parasites, in feral and shelter cats in Prince Edward Island (PEI). Fecal samples were collected from 100 feral cats, 100 cats from the PEI Humane Society, and 5 cats from a private residence. The occurrence of T. foetus, based on fecal culture, was 0% in feral and shelter cats. A single positive sample was obtained from an owned Abyssinian cat that was imported to PEI. Intestinal parasites were identified via fecal flotation in 76% of feral cats and 39% of cats from the humane society. Feral cats had a higher incidence of Toxocara cati than cats from the humane society (P < 0.001), conversely, shelter cats had a higher incidence of Cystoisospora spp. (P < 0.001). These results suggest that while T. foetus is not of importance in feral and shelter cats in PEI, imported cats could serve as reservoirs.

Étude transversale de l'infection parTritrichomonas foetuschez les chats féraux et de refuge à l'Île-du-Prince-Édouard, au Canada. Une étude transversale a examiné l'occurrence de Tritrichomonas foetus, et d'autres parasites intestinaux, chez les chats féraux et de refuge à l'Île-du-Prince-Édouard (Î.-P.-É.). Des échantillons de fèces ont été prélevés auprès de 100 chats féraux, de 100 chats de la PEI Humane Society et de cinq chats d'une résidence privée. En se basant sur la culture de fèces, l'occurrence de T. foetus était de 0 % chez les chats féraux et les chats de refuge. Un seul échantillon positif a été obtenu auprès d'un chat abyssinien qui avait été importé à l'Île-du-Prince-Édouard et appartenait à un propriétaire. Les parasites intestinaux ont été identifiés par flottaison fécale chez 76 % des chats féraux et 39 % des chats de la société de protection des animaux. Les chats féraux présentaient une incidence supérieure de Toxocara cati à celle des chats de la société de protection des animaux (P < 0,001), par contre, les chats de refuge avaient une incidence supérieure de Cystoisospora spp. (P < 0,001). Ces résultats suggèrent que même si T. foetus n'a pas une présence importante chez les chats féraux et les chats de refuge de l'Île-du-Prince-Édouard, les chats importés pourraient servir de réservoirs.(Traduit par Isabelle Vallières).

EUCOLEUS BOEHMI INFECTION IN THE NASAL CONCHAE AND PARANASAL SINUSES OF RED FOX (VULPES VULPES) ON PRINCE EDWARD ISLAND, CANADA.

Eucoleus boehmi (Nematoda: Capillariidae) occurs in the nasal conchae and paranasal sinuses of wild and domestic canids. We surveyed the red fox ( Vulpes vulpes ) on Prince Edward Island, Canada, for E. boehmi infection and characterized the associated histopathology. Nasal capillarid infections were detected based on histologic examination of three coronal sections of the nasal cavity and by centrifugal flotation examination (CFE) of rectal feces. Capillarids were detected in histologic sections in 28 of 36 (78%) foxes; detection occurred most frequently in the caudal section (28 foxes) and least in the rostral section (10 foxes). Adult worm morphology was typical for capillarids (stichosome esophagus, bacillary bands, bipolar plugged eggs); E. boehmi eggs were specifically identified based on the characteristic pitted shell wall surface. Adult worms were detected in histologic sections in all 28 and E. boehmi eggs in 21 of the positive foxes. No eggs of Eucoleus aerophilus were observed in any of the sections. Affected foxes had an eosinophilic and lymphoplasmacytic rhinitis with goblet cell hyperplasia. Eggs of E. aerophilus were detected on CFE in 20 of 36 (56%) foxes; 19 of the histologically positive foxes were coinfected with E. aerophilus. Eggs of E. boehmi were detected on CFE in 26 of 36 (72%) foxes and were consistent in size and morphology with those described from wild canids, but they differed from those reported from cases of infection in dogs. Prevalence based on identification of eggs on histologic section or CFE indicated 27 of 36 (75%) red foxes examined were infected with E. boehmi.

Injecting on the Island: a qualitative exploration of the service needs of persons who inject drugs in Prince Edward Island, Canada.

BACKGROUND: Few studies have investigated the service needs of persons who inject drugs (PWID) who live in less populated regions of Canada. With access to fewer treatment and harm reduction services than those in more urban environments, the needs of PWID in smaller centres may be distinct. As such, the present study examined the needs of PWID in Prince Edward Island (PEI), the smallest of Canada's provinces. METHODS: Eight PWID were interviewed about the services they have accessed, barriers they faced when attempting to access these services, and what services they need that they are not currently receiving. RESULTS: Participants encountered considerable barriers when accessing harm reduction and treatment services due to the limited hours of services, lengthy wait times for treatment, and shortage of health care practitioners. They also reported experiencing considerable negativity from health care practitioners. Participants cited incidences of stigmatisation, and they perceived that health care practitioners received insufficient training related to drug use. Recommendations for the improvement of services are outlined. CONCLUSIONS: The findings indicate that initiatives should be developed to improve PWID's access to harm reduction and treatment services in PEI. Additionally, health care practitioners should be offered sensitisation training and improved education on providing services to PWID. The findings highlight the importance of considering innovative alternatives for service provision in regions with limited resources.

Does the type of provider and the place of residence matter in the utilization of prenatal ultrasonography? Evidence from Canada.

BACKGROUND: There has been a proliferation of repeat prenatal ultrasound examinations per pregnancy in many developed countries over the past 20 years, yet few studies have examined the main determinants of the utilization of prenatal ultrasonography. OBJECTIVE: The objective of this study was to examine the influence of the type of provider, place of residence and a wide range of socioeconomic and demographic factors on the frequency of prenatal ultrasounds in Canada, while controlling for maternal risk profiles. METHODS: The study utilized the data set of the Maternity Experience Survey (MES) conducted by Statistics Canada in 2006. Using an appropriate count data regression model, the study assessed the influence of a wide range of socioeconomic, demographic, maternal risk factors and types of provider on the number of prenatal ultrasounds. The regression model was further extended by interacting providers with provinces to assess the differential influence of types of provider on the number of ultrasounds both across and within provinces. RESULTS: The results suggested that, in addition to maternal risk factors, the number of ultrasounds was also influenced by the type of healthcare provider and geographic regions. Obstetricians/gynaecologists were likely to recommend more ultrasounds than family physicians, midwives and nurse practitioners. Similarly, birthing women who received their care in Ontario were likely to have more ultrasounds than women who received their prenatal care in other provinces/territories. Additional analysis involving interactions between providers and provinces suggested that the inter-provincial variations were particularly more pronounced for family physicians/general practitioners than for obstetricians/gynaecologists. Similarly, the results for intra-provincial variations suggested that compared with obstetricians/gynaecologists, family physicians/GPs ordered fewer ultrasound examinations in Prince Edward Island, British Columbia, Nova Scotia, Alberta and Newfoundland. CONCLUSION: After controlling for a number of socioeconomic and demographic factors, as well as maternal risk factors, it was found that the type of provider and the province of prenatal care were statistically significant determinants of the frequency of use of ultrasounds. Additional analysis involving interactions between providers and provinces indicated wide intra- and inter-provincial variations in the use of prenatal ultrasounds. New policy measures are needed at the provincial and federal government levels to achieve more appropriate use of prenatal ultrasonography.

Zoonotic potential of Giardia duodenalis and Cryptosporidium spp. and prevalence of intestinal parasites in young dogs from different populations on Prince Edward Island, Canada.

The prevalence of Giardia duodenalis, Cryptosporidium spp. and other intestinal parasites was determined in dogs <1 year old from Prince Edward Island, Canada. Fecal samples were collected from the local animal shelter (n=62), private veterinary clinics (n=78) and a pet store (n=69). Intestinal parasites isolated included G. duodenalis, Cryptosporidium spp., Toxocara canis, Isospora spp. and Uncinaria stenocephala. To estimate the zoonotic risk associated with these infections, genotypes of G. duodenalis and Cryptosporidium spp. were determined using 16S rRNA and Hsp70 gene sequencing, respectively. Dogs from the pet store had the highest prevalence of intestinal parasites (78%, 95% CI: 68-88%), followed by the private veterinary clinics (49%, 95% CI: 37-60%), and the local animal shelter (34%, 95% CI: 22-46%). The majority G. duodenalis belonged to host-adapted assemblages D (47%, 95% CI: 31-64%) and C (26%, 95% CI: 13-43%), respectively. Zoonotic assemblages A and B were isolated alone or in mixed infections from 16% (95% CI: 6-31%) of G. duodenalis-positive dogs. All Cryptosporidium spp. were the host-adapted C. canis. While host-adapted, non-zoonotic G. duodenalis genotypes were more common, the presence of G. duodenalis assemblages A and B, T. canis, and U. stenocephala suggests that these dogs may present a zoonotic risk. The zoonotic risk from Cryptosporidium-infected dogs was minimal.

Fecal shedding of Toxocara canis and other parasites in foxes and coyotes on Prince Edward Island, Canada.

Knowledge of parasites shed by wild canids can assist in recognizing risk to human and domestic animal health. Our aim was to estimate the prevalence of patent infections with Toxocara canis and other parasites in foxes (Vulpes vulpes) and coyotes (Canis latrans) in Prince Edward Island, Canada. Identification of parasite species was based on microscopic examination of feces, with the use of a sucrose fecal flotation method. Sample collection was performed in winter on carcasses of 271 and 185 hunted or trapped foxes and coyotes, respectively. One or more parasite species were observed in 242 (89%) foxes and 128 (69%) coyotes. Toxocara canis, Uncinaria stenocephala, Capillaria spp., Mesocestoides, Taenidd spp., Alaria spp., Cryptocotyle lingua, Sarcocystis spp., Neospora caninum-like coccidia, and other coccidia were identified. A third of juvenile foxes were shedding T. canis and had a high prevalence of Capillaria spp., especially in juvenile foxes (69%). Taenidd eggs, Alaria spp. and Sarcocystis spp. were more common in coyotes (24, 18, and 9%, respectively) than foxes (8, 11, and 1%, respectively). Despite the limitations of fecal flotation to identify parasite species, the high prevalence of T. canis warrants the attention of public health professionals.