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1.
Acute Med ; 18(2): 112-119, 2019.
Article in English | MEDLINE | ID: mdl-31127800

ABSTRACT

Cellulitis is an acute localised skin infection, usually accompanied by symptoms such as fever and rigors, nausea, and vomiting. It most commonly affects the lower limbs, although it can involve any part of the skin. It presents as area of redness and inflammation of the skin, with associated pain and swelling.


Subject(s)
Cellulitis , Edema , Acute Disease , Cellulitis/complications , Cellulitis/therapy , Edema/etiology , Fever/etiology , Humans , Lower Extremity , Pain
2.
Biomarkers ; 24(2): 127-130, 2019 Mar.
Article in English | MEDLINE | ID: mdl-30051724

ABSTRACT

BACKGROUND: Procalcitonin levels may be raised in bacterial infections and have been used to guide antibiotic therapy. There is little data on procalcitonin and limb cellulitis. OBJECTIVES: Within a clinical trial of antibiotic therapy, we examined the correlation between clinical observations, blood tests and local measurements of skin damage, with serum procalcitonin levels. METHODS: The data is from a subset of the patients recruited into a clinical trial of antibiotic therapy for cellulitis (clindamycin for cellulitis, NCT01876628) whose procalcitonin levels were correlated with clinical and laboratory measurements. We selected the variables strongly correlated with procalcitonin and evaluated the predictive value of the baseline procalcitonin on the primary trial outcome. RESULTS: 136 patients provided 307 procalcitonin levels which were correlated with 8 variables. The strongest correlations (correlation coefficient of >0.5) with procalcitonin were the affected skin area (0.537), C-reactive protein (0.574) and neutrophil:lymphocyte ratio (0.567). Receiver operator characteristic curves demonstrated poor sensitivity and specificity of procalcitonin in predicting primary outcome. Procalcitonin baseline levels were low but decreased as patients recovered. CONCLUSIONS: Procalcitonin levels are generally low in limb cellulitis and cannot be used to confirm the diagnosis or the need for antibiotic therapy. Procalcitonin is a poor predictor of early improvement.


Subject(s)
Cellulitis/blood , Cellulitis/drug therapy , Clindamycin/administration & dosage , Procalcitonin/blood , Anti-Bacterial Agents/administration & dosage , Cellulitis/pathology , Extremities/physiopathology , Female , Humans , Male , Middle Aged , Skin/drug effects , Skin/physiopathology
4.
J Hum Hypertens ; 30(12): 755-760, 2016 12.
Article in English | MEDLINE | ID: mdl-27334523

ABSTRACT

Substantial evidence links exaggerated mental stress induced blood pressure reactivity to future hypertension, but the results for heart rate reactivity are less clear. For this reason multivariate cluster analysis was carried out to examine the relationship between heart rate and blood pressure reactivity patterns and hypertension in a large prospective cohort (age range 55-60 years). Four clusters emerged with statistically different systolic and diastolic blood pressure and heart rate reactivity patterns. Cluster 1 was characterised by a relatively exaggerated blood pressure and heart rate response while the blood pressure and heart rate responses of cluster 2 were relatively modest and in line with the sample mean. Cluster 3 was characterised by blunted cardiovascular stress reactivity across all variables and cluster 4, by an exaggerated blood pressure response and modest heart rate response. Membership to cluster 4 conferred an increased risk of hypertension at 5-year follow-up (hazard ratio=2.98 (95% CI: 1.50-5.90), P<0.01) that survived adjustment for a host of potential confounding variables. These results suggest that the cardiac reactivity plays a potentially important role in the link between blood pressure reactivity and hypertension and support the use of multivariate approaches to stress psychophysiology.


Subject(s)
Blood Pressure , Cardiovascular System/physiopathology , Heart Rate , Hypertension/etiology , Starvation/complications , Stress, Psychological/etiology , Chi-Square Distribution , Cluster Analysis , Female , Humans , Hypertension/diagnosis , Hypertension/physiopathology , Hypertension/psychology , Logistic Models , Male , Middle Aged , Multivariate Analysis , Pregnancy , Prenatal Exposure Delayed Effects , Prognosis , Risk Assessment , Risk Factors , Starvation/diagnosis , Starvation/physiopathology , Starvation/psychology , Stress, Psychological/diagnosis , Stress, Psychological/physiopathology , Stress, Psychological/psychology , Time Factors
5.
Eur J Surg Oncol ; 40(11): 1528-32, 2014 Nov.
Article in English | MEDLINE | ID: mdl-24915858

ABSTRACT

AIMS: Increasing use of 18F-Fluorodeoxy glucose (FDG) Positron Emission Tomography Computed Tomography (PET CT) has resulted in an increased frequency of incidentally discovered areas of focally increased FDG uptake within the thyroid gland - thyroid incidentalomas. We aimed to compare radiological characteristics of thyroid incidentalomas with cytology, histology and ultrasound findings. MATERIALS AND METHODS: We examined all FDG PET CT scan reports for all patients undergoing this investigation over a 6 year period in a single tertiary cancer centre. All PET CT scans followed an agreed proforma allowing reports mentioning "thyroid" to be identified. Reports commenting on a positive finding within the thyroid gland were investigated further manually. Incidental mentions of thyroid with no underlying abnormality were discounted from analysis. RESULTS: In the study period, 7221 patients underwent FDG PET CT scanning in our unit. Within this group 75 (1%) showed diffuse FDG uptake and 81 (1.1%) showed focal uptake (thyroid incidentalomas). Only 30 patients (37%) with incidentalomas had further investigation and malignancy rate was 23% (7/30). Median Standardised Uptake Values (SUV) in malignant lesions was 9.9 (range 3.5-17.8) whilst in benign lesions and diffuse lesions it was 5.4 (2.8-32) and 4.2 (2.1-25.6) respectively (p = 0.0013, Kruskal Wallis). CONCLUSION: There remains a need to develop a standardised approach to the investigation and management of thyroid incidentalomas discovered on FDG PET CT scanning. Up to 1 in 4 of these patients will harbour thyroid malignancy.


Subject(s)
Adenocarcinoma, Follicular/diagnostic imaging , Carcinoma/diagnostic imaging , Incidental Findings , Lymphoma/diagnostic imaging , Thyroid Gland/diagnostic imaging , Thyroid Neoplasms/diagnostic imaging , Adenocarcinoma, Follicular/pathology , Aged , Carcinoma/pathology , Carcinoma, Papillary , Cohort Studies , Female , Fluorodeoxyglucose F18 , Humans , Lymphoma/pathology , Male , Multimodal Imaging , Positron-Emission Tomography , Radiopharmaceuticals , Retrospective Studies , Thyroid Cancer, Papillary , Thyroid Gland/pathology , Thyroid Neoplasms/pathology , Tomography, X-Ray Computed
6.
Interv Neuroradiol ; 16(1): 103-6, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20377988

ABSTRACT

SUMMARY: We describe a 65-year-old woman with an asymptomatic idiopathic lingual artery aneurysm which is suspected to be congenital. We review the literature on external carotid artery branch aneurysms, diagnostic evaluation and discuss treatment options for the various types and the specific chosen in the case presented.


Subject(s)
Aneurysm/diagnostic imaging , Aneurysm/surgery , Embolectomy/methods , Tomography, X-Ray Computed/methods , Tongue/blood supply , Tongue/surgery , Aged , Embolectomy/instrumentation , Female , Humans , Tongue/diagnostic imaging , Treatment Outcome
7.
Trans R Soc Trop Med Hyg ; 103(12): 1285-7, 2009 Dec.
Article in English | MEDLINE | ID: mdl-19070877

ABSTRACT

Malaria, both Plasmodium falciparum and P. vivax, is a major cause of morbidity in Vanuatu. As P. vivax is more prevalent in seasonal climates and P. falciparum in areas of more consistent rainfall, it is postulated that there will be a correlation between the ratio of vivax:falciparum and the El Niño Southern Oscillation (ENSO), which affects sea surface temperatures and rainfall. With changes in global climate, the frequency, duration and strength of the ENSO are expected to alter, influencing the pattern of malaria. The data showed no obvious correlation between ENSO and either cases of malaria or the vivax:falciparum ratio.


Subject(s)
El Nino-Southern Oscillation , Malaria, Falciparum/epidemiology , Malaria, Vivax/epidemiology , Plasmodium falciparum , Plasmodium vivax , Female , Humans , Male , Prevalence , Vanuatu/epidemiology
8.
BMC Pulm Med ; 1: 2, 2001.
Article in English | MEDLINE | ID: mdl-11737875

ABSTRACT

BACKGROUND: Since the sterilising activity of new antituberculosis drugs is difficult to assess by conventional phase III studies, surrogate methods related to eventual relapse rates are required. METHODS: A suitable method is suggested by a retrospective analysis of viable counts of Mycobacterium tuberculosis in 12-hr sputum collections from 122 newly diagnosed patients with pulmonary tuberculosis in Nairobi, done pretreatment and at 2, 7, 14 and 28 days. Treatment was with isoniazid and streptomycin, supplemented with either thiacetazone (SHT) or rifampicin + pyrazinamide (SHRZ). RESULTS: During days 0-2, a large kill due to isoniazid occurred, unrelated to treatment or HIV status; thereafter it decreased exponentially. SHRZ appeared to have greater sterilising activity than SHT during days 2-7 (p = 0.044), due to rifampicin, and during days 14-28, probably due mainly to pyrazinamide. The greatest discrimination between SHRZ and SHT treatments was found between regression estimates of kill over days 2-28 (p = 0.0005) in patients who remained positive up to 28 days with homogeneous kill rates. No associations were found between regression estimates and the age, sex, and extent of disease or cavitation. An increased kill in HIV seropositive patients, unrelated to the treatment effect, was evident during days 2-28 (p = 0.007), mainly during days 2-7. CONCLUSIONS: Surrogate marker studies should either be in small groups treated with monotherapy during days 2 to about 7 or as add-ons or replacements in isoniazid-containing standard regimens from days 2 to 28 in large groups.

9.
Int Dent J ; 50(1): 13-20, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10945175

ABSTRACT

AIMS: To investigate rates of dental caries and periodontal disease, available dental services and resources and perceived needs in a rural South African community. DESIGN: A cross-sectional field study including situational analysis and focus group discussions. SETTING: KwaZulu/Natal, South Africa. PARTICIPANTS: A total of 520 children, adolescents and adults. METHODS: WHO caries scores and periodontal CPI score were determined through clinical examinations in five age groups, 5-6 years, 12 y, 15 y, 35-54 y, 55 y+. Focus groups included ten 15-year-old children and ten adults. RESULTS: Caries prevalences and (mean scores) were 5-6 y 64% (dmft 3.0), 12 y 24% (DMFT 0.4), 15 y 27% (DMFT 0.8), 35-54 69% (DFT 2.6) and 55 y+ 80% (DFT 2.7). Most caries was untreated and where present, treatment had been extraction. Dental caries rates were low and except for 5-6 y were within WHO targets for the year 2000. Periodontal disease prevalence was high but would respond to improved oral hygiene. Knowledge of oral health was rudimentary. CONCLUSIONS: A district-wide oral health promotion programme is required preceded by research to define effective health education messages. Access to simple but effective preventive and curative services would seem reasonable. In view of the lack of resources ART is suggested as caries treatment.


Subject(s)
Dental Caries/epidemiology , Oral Health , Periodontal Diseases/epidemiology , Rural Health/statistics & numerical data , Adolescent , Adult , Attitude to Health , Child , Child, Preschool , Dental Health Services , Dental Health Surveys , Dental Restoration, Permanent/statistics & numerical data , Health Education, Dental , Health Services Needs and Demand/statistics & numerical data , Humans , Middle Aged , Prevalence , South Africa/epidemiology , Tooth Extraction/statistics & numerical data
10.
Cell Mol Biol (Noisy-le-grand) ; 46(1): 29-39, 2000 Feb.
Article in English | MEDLINE | ID: mdl-10726969

ABSTRACT

The peroxisome proliferator (PPs) class of non-genotoxic rodent hepatocarcinogens induce mouse hepatocyte DNA synthesis and suppress apoptosis. This phenotype can be reproduced in vitro using exogenous tumour necrosis factor alpha (TNFalpha), suggesting a role for TNFalpha in mediating the liver growth response to PPs. In hepatocytes isolated from the peroxisome proliferator activated receptor alpha (PPARalpha) null mouse, PPs are unable to stimulate DNA synthesis or to suppress either spontaneous or TGFbeta1-induced apoptosis. However, the ability of TNFalpha to modulate hepatocyte survival and growth is unaltered, suggesting that TNFalpha acts independently or downstream of PPARalpha to mediate the growth changes associated with PPARalpha activation. Since PPARalpha is a ligand activated transcription factor, we determined if TNFalpha gene expression was altered by PP treatment during an early time window preceding PP-induced growth changes. However there was no induction of TNFalpha expression by nafenopin over the constitutive levels noted in control cultured cells. In summary, TNFalpha acts downstream or independently of PPARalpha to mediate the suppression of apoptosis and induction of DNA synthesis by PPs. In this in vitro model, the PP nafenopin do not appear to mediate de novo TNFalpha gene expression suggesting that the response to nafenopin may be mediated by bioactivation or release of pre-existing TNFalpha protein from Kupffer cells.


Subject(s)
Apoptosis/drug effects , Nafenopin/pharmacology , Peroxisome Proliferators/pharmacology , Peroxisomes/metabolism , Tumor Necrosis Factor-alpha/metabolism , Animals , Cells, Cultured , DNA Replication/drug effects , Gene Expression Regulation/drug effects , Liver/metabolism , Mice , Mice, Knockout , Peroxisomes/drug effects , RNA, Messenger/metabolism , Receptors, Cytoplasmic and Nuclear/genetics , Transcription Factors/genetics , Transforming Growth Factor beta/pharmacology
11.
J Chromatogr A ; 858(2): 133-53, 1999 Oct 15.
Article in English | MEDLINE | ID: mdl-10551347

ABSTRACT

The dynamic behavior of two n-hexyl fluorenyl phases (fluorene-6A [3a(Tn)(Qm)y], fluorene-6B [3b(Tn)(Qm)y]) and three n-decyl fluorenyl phases (fluorene-10A [4a(Tn)(Qm)y], fluorene-10B [4b(Tn)(Qm)y], and fluorene-10C [4c(M1)(Qm)y]) is investigated by solid-state nuclear magnetic resonance (NMR) spectroscopy using the dipolar filter technique with both 13C and 1H detection. These results are compared with those from other dynamic measurements, like the relaxation times in the rotating frame (T1pH) and the variation of the contact time (T(CH)). Additionally, another type of a fluorenyl phase [5a(Tn)(Qm)y], which has an aromatic moiety connected to the silica gel by amido couplings, was also investigated by the dipolar filter method. The solid-state NMR dynamic measurements indicate an increased mobility of the n-alkyl fluorenyl phases compared to the amido coupled fluorenyl phase. The lower the ligand density of the studied n-alkyl fluorenyl phases, the higher their mobility. The separation behavior of the respective phases in high-performance liquid chromatography was investigated with samples containing polycyclic aromatic hydrocarbons and nitro explosives. Depending on the amount of the chemically bound aromatic moiety and the length of their n-alkyl spacer groups, pi-pi interactions with the solute molecules are involved in the separation process and cause it to proceed at a different rate. Therefore, n-alkyl fluorenyl phases can be classified as mixed-mode phases.


Subject(s)
Chromatography, High Pressure Liquid/methods , Fluorenes/chemistry , Magnetic Resonance Spectroscopy
12.
Hepatology ; 30(6): 1417-24, 1999 Dec.
Article in English | MEDLINE | ID: mdl-10573520

ABSTRACT

Peroxisome proliferators (PPs) cause rodent liver enlargement and tumors. In vitro, PPs induce rat and mouse hepatocyte DNA synthesis and suppress apoptosis, a response mimicked by exogenous tumor necrosis factor alpha (TNFalpha). Here, we determine the role of TNF receptor 1 (TNFR1), TNF receptor 2 (TNFR2), and nuclear factor kappa beta (NFkappaB) in the response of mouse hepatocytes to the PP, nafenopin. Nafenopin (50 micromol/L) induced DNA synthesis as measured by bromodeoxyuridine (BrdU) incorporation, suppressed cell death as measured by Hoechst 33258 staining, induced peroxisomal beta-oxidation as measured by cyanide insensitive palmitoyl CoA oxidation (PCO) and caused activation of nuclear factor kappa beta (NFkappaB) as determined by electrophoretic mobility gel shift assay (EMSA). The induction of DNA synthesis and the suppression of apoptosis in response to nafenopin was abrogated completely by blocking antibodies to TNFR1 but not to TNFR2. In contrast, the induction of peroxisomal beta-oxidation by nafenopin was not blocked by the anti-TNFR1 antibody. Next, we evaluated the response of hepatocytes to interleukin-1 (IL-1), another proinflammatory cytokine. IL-1alpha (2.5 ng/mL) and, to a lesser extent, IL-1beta (5 ng/mL), shared the ability of TNFalpha to induce DNA synthesis and suppress apoptosis. In addition, anti-IL-1 receptor, type 1/p80 (IL-1R) antibodies were able to abrogate the response to nafenopin. IL-1alpha was still able to perturb hepatocyte growth in the presence of the anti-TNFR1 antibody suggesting that IL-1alpha acts independently rather than by elaborating TNFalpha. In summary, these data provide additional evidence for a role for hepatic cytokines in the perturbation of hepatocyte growth by PPs such as nafenopin.


Subject(s)
Antigens, CD/physiology , Apoptosis/drug effects , Liver/cytology , Nafenopin/antagonists & inhibitors , Nafenopin/pharmacology , Peroxisome Proliferators/antagonists & inhibitors , Receptors, Interleukin-1/physiology , Receptors, Tumor Necrosis Factor/physiology , Animals , Antibodies , Antigens, CD/chemistry , Antigens, CD/classification , Cell Nucleus/drug effects , Cell Nucleus/metabolism , Cell Survival/drug effects , Cells, Cultured , DNA/biosynthesis , DNA/genetics , DNA/metabolism , Interleukin-1/antagonists & inhibitors , Interleukin-1/pharmacology , Liver/drug effects , Male , Mice , NF-kappa B/metabolism , Oxidation-Reduction/drug effects , Peroxisome Proliferators/pharmacology , Peroxisomes/drug effects , Peroxisomes/metabolism , Receptors, Interleukin-1/antagonists & inhibitors , Receptors, Tumor Necrosis Factor/chemistry , Receptors, Tumor Necrosis Factor/classification , Receptors, Tumor Necrosis Factor, Type I , S Phase/drug effects , Transforming Growth Factor beta/antagonists & inhibitors , Transforming Growth Factor beta/pharmacology , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/physiology
14.
Toxicol Lett ; 102-103: 91-6, 1998 Dec 28.
Article in English | MEDLINE | ID: mdl-10022238

ABSTRACT

Peroxisome proliferators (PPs) are a class of non-genotoxic rodent hepatocarcinogens that act by perturbing liver growth regulation. We have demonstrated previously that PPs suppress both spontaneous rat hepatocyte apoptosis and that induced by exogenous stimuli such as transforming growth factor-beta1 (TGF beta1). More recently, we have demonstrated that PPs can suppress apoptosis induced by more diverse stimuli such as DNA damage or ligation of Fas, a receptor related to the tumour necrosis factor alpha (TNF alpha) family of cell surface receptors. PPs transcriptionally activate the peroxisome proliferator activated receptor-alpha, PPAR alpha, a member of the nuclear hormone receptor superfamily. We investigated whether activation of PPAR alpha mediates the suppression of rat hepatocyte apoptosis induced by PPs. We isolated a naturally occurring variant form of PPAR alpha (hPPAR alpha-6/29) from human liver by PCR cloning. hPPAR alpha-6/29 shared the ability of mPPAR alpha to bind to DNA but, unlike mPPAR alpha, could not be activated by PPs. Furthermore, hPPAR alpha-6/29 could act as a dominant negative regulator of PPAR-mediated gene transcription. When introduced into primary rat liver cell cultures by transient transfection, hPPAR alpha-6/29 prevented the suppression of hepatocyte apoptosis by the PP nafenopin, but not that seen in response to phenobarbitone (PB), a non-genotoxic carcinogen whose action does not involve PPAR alpha. The suppression of hepatocyte apoptosis was abrogated completely even though only 30% of hepatocytes were transfected, suggesting the involvement of a soluble factor. Recent data have suggested that TNF alpha, perhaps released by liver Kupffer cells in response to PPs, may play a key role in mediating the effects of PPs on hepatocyte growth regulation.


Subject(s)
Liver Neoplasms/chemically induced , Peroxisome Proliferators/toxicity , Receptors, Cytoplasmic and Nuclear/physiology , Transcription Factors/physiology , Animals , Apoptosis/drug effects , Cell Division/drug effects , Cytokines/physiology , Humans , Liver/cytology , Liver/drug effects , Mice , Rats
15.
AIDS ; 11(7): 911-8, 1997 Jun.
Article in English | MEDLINE | ID: mdl-9189217

ABSTRACT

OBJECTIVES: To describe the epidemiological and clinical characteristics of HIV-related tuberculosis in a female cohort, and to investigate the relative importance of recently transmitted infection and reactivation in the pathogenesis of adult HIV-related tuberculosis. DESIGN: Members of an established cohort of female sex workers in Nairobi were enrolled in a prospective study. Women were followed up regularly and seen on demand when sick. METHODS: Between October 1989 and September 1992 we followed 587 HIV-infected and 132 HIV-seronegative women. Standard protocols were used to investigate common presentations. Cases of tuberculosis were identified clinically or by culture. All available Mycobacterium tuberculosis strains underwent DNA fingerprint analysis. RESULTS: Forty-nine incident and four recurrent episodes of tuberculosis were seen in HIV-infected women; no disease was seen in seronegative sex workers (P = 0.0003). The overall incidence rate of tuberculosis was 34.5 per 1000 person-years amongst HIV-infected participants. In purified protein derivative (PPD) skin test-positive women the rate was 66.7 per 1000 person-years versus 18.1 per 1000 person-years in PPD-negative women. Twenty incident cases (41%) were clinically compatible with primary disease. DNA fingerprint analysis of strains from 32 incident cases identified two clusters comprising two and nine patients; allowing for index cases, 10 patients (28%) may have had recently transmitted disease. Three out of 10 (30%) patients who were initially PPD skin test-negative became PPD-positive. Taken together, 26 incident cases (53%) may have been recently infected. DNA fingerprint analysis also identified two (50%) of the four recurrent tuberculosis episodes as reinfection. CONCLUSIONS: Substantial recent transmission of tuberculosis appears to be occurring in Nairobi amongst HIV-infected sex workers. It may be incorrect to assume in other regions of high tuberculosis transmission that active HIV-related tuberculosis usually represents reactivation of latent infection.


PIP: A 3-year (1989-92) prospective study of 587 HIV-positive and 132 HIV-negative commercial sex workers in Nairobi, Kenya, revealed substantial recent transmission of tuberculosis in the HIV-infected group. The cohort was enrolled at a community clinic that provides counseling, sexually transmitted disease services, and free condoms. In HIV-positive women, 49 incident and 4 recurrent episodes of tuberculosis were diagnosed during the study period; there were no tuberculosis cases among HIV-negative women. The overall incidence rate of tuberculosis was 34.5/1000 person-years among HIV-positive women. 20 incident cases (41%) met the clinical case definition of primary disease. DNA fingerprint analysis of strains from 32 incident cases suggested 10 women (28%) may have had recently transmitted disease. 3 of 10 women who were initially purified protein derivative (PPD) skin test-negative became PPD-positive. Clinical presentation, tuberculin skin testing, and strain clustering data all independently suggested that substantial Mycobacterium tuberculosis transmission was occurring in HIV-infected prostitutes during the study period. As many as 26 (53%) of the 49 patients with incident disease may have recently acquired tuberculosis and DNA fingerprint analysis identified 2 (50%) of the 4 recurrent tuberculosis episodes as reinfection. These findings challenge the assumption that tuberculosis in HIV-infected individuals represents reactivation of latent endogenous infection.


Subject(s)
AIDS-Related Opportunistic Infections/transmission , HIV-1 , Sex Work , Tuberculosis/transmission , AIDS-Related Opportunistic Infections/epidemiology , AIDS-Related Opportunistic Infections/microbiology , Adult , CD4 Lymphocyte Count , Cohort Studies , Female , Follow-Up Studies , HIV-1/isolation & purification , Humans , Kenya/epidemiology , Mycobacterium tuberculosis/classification , Mycobacterium tuberculosis/isolation & purification , Prospective Studies , Tuberculin Test , Tuberculosis/epidemiology , Tuberculosis/microbiology
16.
AIDS ; 11(5): 669-72, 1997 Apr.
Article in English | MEDLINE | ID: mdl-9108949

ABSTRACT

OBJECTIVE: To define the risks of disseminated bacille Calmette-Guérin (BCG) or disseminated Mycobacterium tuberculosis in adults with AIDS who were immunized with BCG in childhood. DESIGN: HIV-infected patients with CD4 < 200 x 10(6)/l were enrolled from five study sites (New Hampshire, Boston, Finland, Trinidad and Kenya). Prior BCG immunization was determined and blood cultures for mycobacteria were obtained at study entry and at 6 months. Acid-fast bacilli were identified as Mycobacterium tuberculosis complex (MTBC) using DNA probes. MTBC isolates were then typed by both IS6110 restriction fragment length polymorphism and polymerase chain reaction/restriction enzyme analysis. SETTING: Most patients in New Hampshire and Finland were outpatients; most patients in Trinidad were inpatients with terminal illness; and most patients in Kenya were outpatients, although 44 were inpatients with terminal illness. PARTICIPANTS: A total of 566 patients were enrolled, including 155 with childhood BCG immunization; 318 patients had a single study visit and culture, and 248 patients had two study visits and cultures. MAIN OUTCOME MEASURES: Isolation and identification of mycobacteria from blood cultures. RESULTS: Blood cultures were positive for MTBC in 21 patients; none were positive for M. bovis BCG, and 21 were M. tuberculosis-positive. In Trinidad, seven (87%) out of eight isolates of M. tuberculosis were indistinguishable by IS6110 typing; BCG immunization was associated with a decreased risk of bacteremic infection with M. tuberculosis (P = 0.05). CONCLUSIONS: The risk of disseminated BCG among adult AIDS patients with childhood BCG immunization is very low. Childhood BCG immunization is associated with protection against bacteremia with M. tuberculosis among adults with advanced AIDS in Trinidad.


Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Mycobacterium tuberculosis/immunology , Tuberculosis/epidemiology , AIDS-Related Opportunistic Infections/prevention & control , Adult , Child, Preschool , Humans , Immunization , Immunologic Memory , Infant , Time Factors , Tuberculosis/prevention & control
17.
Solid State Nucl Magn Reson ; 9(2-4): 191-201, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9477449

ABSTRACT

Stationary interphases with long n-alkyl chains (n = 18, 22, 30, 34) have been examined by solid-state NMR spectroscopy. The determination of the silane functionality and the degree of cross-linking of silane ligands on the silica surface was performed by 29Si CP/MAS NMR spectroscopy. High-speed 1H MAS and 13C CP/MAS NMR spectroscopy were utilized to assess alkyl chain order and mobility of the different bonded phases. For this purpose, 1H NMR line widths and 13C chemical shifts have been evaluated. It is shown that stationary phase order and rigidity increase with alkyl chain length. In addition, the temperature-dependent trans/gauche conformational change occurs at higher temperatures for a polymeric C34 phase compared with a C30 sorbent. This behaviour is discussed in the context of previously reported chromatographic (HPLC) shape selectivity differences.


Subject(s)
Magnetic Resonance Spectroscopy , Carbon Isotopes , Isotopes , Silicon , Temperature
18.
Epidemiol Infect ; 117(1): 139-44, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8760961

ABSTRACT

We undertook a retrospective descriptive comparison of the spectrum of pathogens responsible for bacteraemia and diarrhoea in HIV antibody positive and negative patients over 4 years (1988-92), in Nairobi, Kenya. The study population was recruited from primary to tertiary centres of clinical care and consisted of 2858 adults (15 years or older). There were 415 significant blood culture isolates, 192 from 1785 HIV negative patients and 223 from 953 HIV positive patients. There were 233 significant faecal isolates, 22 from 115 HIV negative patients and 211 from 531 HIV positive patients. The most common pathogens detected in blood were Streptococcus pneumoniae and Salmonella typhimurium and in faeces Shigella flexneri, S. typhimurium and Cryptosporidium parvum. The agents causing illness in HIV positive patients in Nairobi are similar to those prevalent in the HIV negative community and the investigation of a febrile illness with or without diarrhoea in an HIV positive patient should reflect this.


PIP: Researchers conducted a retrospective analysis of stool specimens from 646 adult patients and of blood cultures from 2738 adult patients to examine the etiology of opportunistic infection in HIV-positive individuals in Nairobi, Kenya, and to compare this etiology with the range of pathogens causing disease in the HIV-negative population. Adults at least 15 years old contributed the stool and blood samples that were received at the Wellcome Trust-Kenya Medical Research Institute during 1988-92. The 415 significant blood culture isolates comprised 192 from 1785 HIV-negative patients and 223 from 953 HIV-positive patients. The most frequently detected pathogens in blood included Streptococcus pneumoniae (58 in HIV-positive cases and 25 in HIV-negative cases) and Salmonella typhimurium (56 in HIV-positive cases; 5 in HIV-negative cases). There were 233 significant stool isolates, 211 from 531 HIV-positive patients and 22 from 115 HIV-negative patients. 20 blood cultures and 21 stool cultures had more than 1 significant pathogen. The most commonly detected organisms in the stools were Shigella flexneri (49 for HIV-positive cases and 9 in HIV-negative cases), S typhimurium (40 in HIV-positive cases and 3 in HIV-negative cases), and Cryptosporidium parvum (45 in HIV-positive cases and 0 in HIV-negative cases). With two exceptions, the spectrum of pathogens associated with infection in HIV-positive patients was the same as that for HIV-negative patients. Physicians should consider this when they investigate and manage febrile illness with or without diarrhea in an HIV-positive patient.


Subject(s)
AIDS-Related Opportunistic Infections/microbiology , Bacteremia/microbiology , Diarrhea/microbiology , HIV Infections/complications , AIDS-Related Opportunistic Infections/complications , Adult , Bacteremia/complications , Diarrhea/complications , Diarrhea/parasitology , Feces/microbiology , Feces/parasitology , Humans , Kenya , Retrospective Studies
19.
AIDS ; 10(9): 1025-32, 1996 Aug.
Article in English | MEDLINE | ID: mdl-8853737

ABSTRACT

OBJECTIVE: To determine rates of disseminated Mycobacterium avium complex (MAC) infection among AIDS patients in developed and developing countries, and to determine whether different rates reflect differences in exposure or immunity, or both. DESIGN: Prospective cohort study. SETTING: University hospitals and outpatient AIDS programs. METHODS: HIV-infected subjects with CD4 counts < 200 x 10(6)/l were interviewed and had CD4 lymphocyte counts, blood cultures for mycobacteria (baseline and at 6 months), and skin tests with purified protein derivative (PPD) and M. avium sensitin. RESULTS: Among 566 study patients rates of disseminated MAC were 10.5-21.6% in New Hampshire, Boston and Finland compared to 2.4-2.6% in Trinidad and Kenya (P < 0.001). PPD skin test reactions > or = 5 mm were present in 20% of patients from Kenya compared to 1% at other sites (P < 0.001). Among patients from the United States and Finland, multiple logistic regression indicated that occupational exposure to soil and water was associated with a decreased risk of disseminated MAC, whereas the following were associated with an increased risk of disseminated MAC: low CD4 count, swimming in an indoor pool, history of bronchoscopy, regular consumption of raw or partially cooked fish/shellfish and treatment with granulocyte colony-stimulating factor. CONCLUSIONS: Rates of disseminated MAC in AIDS are higher in developed than developing countries and are due to both differences in exposure and differences in immunity. These data provide a rationale for prevention of MAC through both active immunization and reduction in exposure to the organism.


Subject(s)
AIDS-Related Opportunistic Infections/epidemiology , Mycobacterium avium/isolation & purification , Tuberculosis/epidemiology , Academic Medical Centers , Adolescent , Adult , Aged , Cohort Studies , Finland/epidemiology , Humans , Kenya/epidemiology , Middle Aged , Multivariate Analysis , Prospective Studies , Risk Factors , Trinidad and Tobago/epidemiology , Tuberculosis/etiology
20.
Solid State Nucl Magn Reson ; 6(3): 251-66, 1996 Jun.
Article in English | MEDLINE | ID: mdl-8863379

ABSTRACT

Chemically modified silica gels used as stationary phases in chromatography have been investigated by means of solid-state 1H magic angle spinning (MAS) NMR spectroscopy. Since the organosilanes are bonded to the surface of the silica gel, their protons are diluted and possess a higher mobility in comparison to protons in pure organic solids. Thereby the usually strong homonuclear dipole-dipole interactions among the protons are reduced and it is possible to obtain well-resolved 1H NMR spectra of the organic interphases with MAS-only techniques. Effects of temperature and magnetic field strength on the resolution of the spectra are examined as well as the dependence of T1 and T1pH relaxation times on temperature and spinning speed.


Subject(s)
Chromatography/methods , Magnetic Resonance Spectroscopy/methods , Silicon Dioxide/chemistry , Chemical Phenomena , Chemistry, Physical , Gels/chemistry , Magnetics , Protons , Structure-Activity Relationship , Temperature , Time Factors
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