Reversal of abnormalities of neutrophil adhesion molecule expression in HIV infection following protease inhibitor therapy.
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Anti-HIV Agents↗
Biomedical subjects
D A Moore
Publications and source records attributed to D A Moore.
Persistence of Pseudomonas aeruginosa strains in respiratory infection in AIDS patients.
OBJECTIVES: To establish the clinical pattern of Pseudomonas aeruginosa respiratory infections in HIV-seropositive patients and to determine whether repeated isolation of the organism represents reinfection or recurrence and to assess whether common source, nosocomial infection occurred. DESIGN AND METHODS: Evaluation of the clinical pattern of P. aeruginosa respiratory infections by case note review and epidemiological characterization of P. aeruginosa by serotype determination and Xbal DNA macrorestriction analysis. Serum sensitivity testing of strains was performed to further define phenotypic characteristics of the isolated organisms. RESULTS: Seventy-three per cent (29 out of 40) of individuals had P. aeruginosa isolated on two or more occasions in the setting of clinical respiratory infection. Overall, 85% had evidence of P. aeruginosa to within 2 months of study completion or death. Epidemiological characterization revealed persistence of unique single strains in 93% of individuals where multiple isolates were available for testing, whereas only two patients harboured a common strain. The serotype distribution of strains was similar to that reported from non-HIV-positive patients. CONCLUSIONS: Once established, eradication of P. aeruginosa from the respiratory tract of HIV-seropositive individuals with advanced immunosuppression is problematic and a chronic infective state appears common. There was no evidence of nosocomial transmission. Serotype loss and development of sensitivity to normal human serum were both observed and were highly correlated. This represents truncation of O-antigenic lipopolysaccharide on the cell surface of P. aeruginosa and may reflect progression to phenotypes commonly associated with chronic infection in other clinical settings such as cystic fibrosis.
Acquired Immunodeficiency Syndrome↗
A sign of the times: THINK signs at sites of alcohol-related fatalities.
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Accidents, Traffic↗
Neutrophil adhesion molecules in HIV disease.
Neutrophil dysfunction in HIV disease is well described. We examined the expression of neutrophil adhesion molecules amongst 72 HIV-infected subjects using a whole blood flow cytometric assay with FITC- and R-PE-labelled isotype-specific MoAbs. We report lesser expression of CD11a (LFA-1) and L-selectin (CD62L) on the circulating neutrophils of HIV+ subjects compared with HIV- controls. Expression of CD11b (Mac-1) was unchanged. Shedding of L-selectin and up-regulation of CD11b in response to in vitro stimulation with N-formyl-methionyl-leucyl-phenylalanine (fMLP) were less in HIV+ compared with HIV- subjects, most markedly in subjects with CD4 cell counts < 100 cells/mm3. These results suggest that neutrophil dysfunction in HIV disease, which increases with disease progression, may be attributable to dysregulated adhesion molecule expression.
Adult↗
Paediatric enema syndrome in a rural African setting.
We have observed a distinct clinical syndrome amongst acutely unwell children frequently associated with the administration of a traditional medicine enema. We describe the clinicopathological features of this 'enema syndrome' based on retrospective case note review of 50 consecutive admissions to a South African rural district hospital. Admission was frequently prompted by sudden, marked clinical deterioration following enema administration (68% seen within 24 h). Respiratory distress with tachypnoea, abdominal distension, hypotonia and loss of consciousness occurred frequently. In-hospital mortality was 28% and was higher in those receiving herbal (43%) rather than chemical (21%) enemas. Hyperkalaemia, leucocytosis (> 15,000 mm3) and respiratory distress occurred more frequently in those who died. Diagnosis of an underlying illness was established in 78%. Whilst the majority of enemas are given without incident, children struggling with an underlying illness may be unable to tolerate rectally administered traditional medicines. Toxic chemical substances in frequent use may increase complication rates.
Child, Preschool↗
Use of physiologic variables to predict milk yield after clinical mastitis in dairy cattle.
OBJECTIVE: To determine the association between intramammary infections caused by various bacteria and hepatic damage, as measured by serum sorbitol dehydrogenase (SDH) activity, WBC counts, and PCV and the association of clinical variables with milk production after a case of clinical mastitis. DESIGN: Prospective, cohort study. ANIMALS: 82 cows with clinical mastitis. PROCEDURE: Information on milk production, mastitis status, and selected physiologic variables was collected during a 1-year period. Milk samples for bacteriologic evaluation were collected on day 1 of an episode of clinical mastitis. Physical examination was performed and blood samples for laboratory evaluation were collected on days 1, 5, and 9. Primary outcome was mature equivalent 305-day (ME305) milk production. Correlations were assessed using a multiple regression model. RESULTS: Higher WBC counts were associated with higher ME305 values. For cows with coliform mastitis, increases in SDH values were associated with higher ME305 values. For cows with coliform and streptococci/staphylococci mastitis, PCV was associated with ME305 values. Higher PCV values were associated with lower ME305 values for streptococci/ staphylococci and coliform infections. CLINICAL IMPLICATIONS: The association between milk production and WBC count indicated that cows mobilizing WBC were better able to neutralize mammary gland infections, which may result in better milk production. The association between milk production and PCV suggested that maintaining hydration in cows with clinical mastitis may be a critical aspect of treating all cows with mastitis.
Animals↗
Central venous line infections in AIDS.
UNLABELLED: The relative infection rates of Port-a-Cath and Hickman lines used for the maintenance treatment of cytomegalovirus retinitis were studied by retrospective casenote review. Seventy-five lines were inserted over an 18 month period. The overall infection rates were significantly greater for Hickman lines: 0.97/100 line-days compared to 0.39/100 line-days for Port-a-Caths, with a trend towards higher infection rates in those prescribed ganciclovir. A total of 56 episodes of septicaemia were recorded with a significantly greater incidence of septicaemia within 1 month of line insertion in those with a neutrophil count < 1.0 x 10(3)/mm3. Ten infectious episodes were associated with death, six of which were due to Pseudomonas spp. CONCLUSIONS: In HIV seropositive patients, use of a Port-a-Cath is associated with a significantly lower rate of line associated sepsis than use of a Hickman line. Insertion of long term central venous catheters should be avoided if possible when the neutrophil count is < 1.0 x 10(3)/mm3.
AIDS-Related Opportunistic Infections↗
Using a portable bladder scan to reduce the incidence of nosocomial urinary tract infections.
An innovative technology, BladderScan, was introduced to reduce urinary tract infections and care costs in hospitalized adults. Evaluation revealed reductions in infection rates and overall benefits exceeding costs.
Adult↗
Evaluation of the results of a survey of dairy producers on dairy herd biosecurity and vaccination against bovine viral diarrhea.
A survey on biosecurity and vaccination practices was sent to 632 dairy producers in Pennsylvania to determine the proportion of the approximately 12,500 dairy herds in Pennsylvania that might be at risk for outbreaks of vaccine-preventable diseases. Most producers relied on their veterinarian for vaccination information and vaccine purchases, but administered the vaccine to the cattle themselves. Many producers did not vaccinate all susceptible groups of cattle in their herd. Also, many producers did not administer a booster vaccination after administration of an initial killed-virus vaccine, as recommended by vaccine manufacturers. As a result, although 309 of 376 (82.2%) dairy producers indicated that they routinely vaccinated their herds, only 73 of 266 (27.4%) herds were considered adequately vaccinated. Veterinarians were as likely to administer vaccines to cattle in adequately vaccinated herds as to cattle in inadequately vaccinated herds. Adequately vaccinated herds were more likely to be larger herds (> 121 cattle) than smaller herds. Analysis of survey results indicated that veterinarians are not taking full advantage of their pivotal role in dairy herd vaccination programs.
Animal Husbandry↗
Effect of participation by veterinarians in a dairy production medicine continuing education course on management practices and performance of client herds.
OBJECTIVE: To determine what effect participation by veterinarians in a dairy production medicine continuing education course would have on herd performance and management practices of client herds. DESIGN: Cohort study. SAMPLE POPULATION: 56 dairy herds for which health services were provided by veterinarians enrolled in a dairy production medicine continuing education program (treatment herds) and 97 dairy herds for which health services were provided by veterinarians not enrolled in the program (control herds). PROCEDURE: Management practices were evaluated every year for 4 years (1991 through 1994) by mail questionnaire. Herd performance was evaluated by reviewing Dairy Herd Improvement Association records. RESULTS: Mean age at first calving for the treatment herds decreased by 2 months over the course of the study. At the end of the study, treatment herds were 3 times more likely to review herd performance with their veterinarian and monitor heifer growth, and 2 times more likely to set goals and conduct adequate estrus detection than were control herds. CLINICAL IMPLICATIONS: Effective professional continuing education in production medicine can have a positive impact on health and performance of client herds.
Animal Husbandry↗
HIV-related tuberculosis in South Africa--clinical features and outcome.
OBJECTIVE: To assess the difference between human immunodeficiency virus (HIV)-infected and non-infected tuberculosis patients with regard to demographic characteristics, clinical features, case fatality rates and, particularly, compliance with therapy. DESIGN: Cohort study. SETTING: Hlabisa Hospital, KwaZulu-Natal, a 450-bed hospital serving a rural district containing 180,000 people. PATIENTS: Two hundred and ninety-seven consecutive adult patients ( > 15 years) diagnosed with tuberculosis. MAIN OUTCOME MEASURES: Age, sex, type of tuberculosis, case fatality rate and compliance with therapy. RESULTS: A total of 107 out of 297 (36%) adults tested HIV-positive (95% confidence interval (CI) 31-42%). Prevalence of HIV infection was higher in women than men (46% v. 29%, relative risk (RR) 1.6, 95% CI 1.2-2.2). HIV-positive patients were significantly younger than HIV-negative patients (mean age 31.2 years v. 38.7 years; P < 0.001). Extrapulmonary tuberculosis (EPTB) was more common in HIV-positive patients (41% v. 11%, RR 3.7, 95% CI 2.3-5.9). The case fatality rate was higher in HIV-positive patients (13% v. 9%, RR 1.5, 95% CI 0.7-3.0). Many more HIV-positive patients failed to complete treatment (21% v. 7%, RR 3.0, 95% CI 1.5-6.0). CONCLUSIONS: We found that HIV-positive patients with tuberculosis were three times more likely to fail to complete treatment than HIV-negative patients. HIV infection is clearly altering the epidemiological profile of tuberculosis in rural South Africa and poses an additional challenge to tuberculosis control programmes to maintain high case-holding rates among HIV-infected tuberculosis patients.
AIDS-Related Opportunistic Infections↗
Pelvic exenteration for malignant melanomas of the vagina or urethra with over 3 mm of invasion.
Pelvic exenteration has usually been employed as salvage treatment for gynecologic malignancies which have failed primary radiotherapy. The therapeutic mainstay for vulvar melanomas has become wide local excision with or without concurrent regional node dissection. Patients with primary melanoma of the vagina who undergo exenteration as primary therapy may experience 50% 5-year survival if the pelvic nodes are free of metastases. However, the overall 5-year survival for vaginal melanoma is 15%. In our patient population, there have been four patients with vaginal or urethral melanomas treated primarily with pelvic exenteration. The purpose of this study was to report that patients with vaginal or urethral melanomas over 3 mm in thickness may benefit from primary pelvic exenteration. Four patients underwent pelvic exenteration at Indiana University Medical Center for malignant melanoma of the vagina or urethra between 1986 and 1992. The pathologic specimens of all patients were analyzed for thickness, growth pattern, and nodal metastases. Patient age ranged from 50 to 71. Thickness of the melanomas ranged from > 3 to 12 mm. All four patients underwent exenterations, three total and one anterior. All patients had negative pelvic and inguinal nodes at the time of surgery. None of the patients has experienced a recurrence. Three of four patients are alive without evidence of disease at 31 to 97 months following their exenteration. One patient died postoperatively of cardiopulmonary complications. Patients with melanomas of the vagina and female urethra, greater than 3 mm in thickness, may benefit from primary pelvic exenteration.
Aged↗
How much alcohol is sensible?
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Alcohol Drinking↗
Prevalence of contagious pathogens of bovine mastitis and use of mastitis control practices.
A cross-sectional study of 1,032 dairy herds in Ohio was conducted to determine the prevalence of the major contagious pathogens of mastitis (Streptococcus agalactiae and Staphylococcus aureus) and the use of common mastitis control measures. Herd owners were surveyed by mail concerning their use of mastitis control measures. The survey focused on treatment of nonlactating cows, postmilking teat dipping, culling practices, milking machine maintenance, treatment for clinical mastitis, and premilking hygiene practices. Nearly 90% of questionnaires were returned. The prevalence of Streptococcus agalactiae and Staphylococcus aureus was determined by use of bulk-tank milk samples. Most herds (n = 802) met the criteria for classification into 1 of 4 groups: (1) Free of contagious pathogens, as determined by inability to isolate coagulase positive staphylococci (CPS) and esculin-negative CAMP positive streptococci (ENCPS) from 3 bulk-tank milk samples, (2) CPS, but not ENCPS, isolated from at least 1 sample, (3) ENCPS, but not CPS, isolated from at least 1 sample, (4) both ENCPS and CPS isolated from at least 1 sample. The number of herds in which both ENCPS and CPS were isolated was low; therefore, these herds were grouped with herds in which ENCPS alone was isolated for the evaluation of mastitis control practices related to herd pathogen status. Herd somatic cell count (SCC) was determined using Dairy Herd Improvement Association data by calculating the geometric mean SCC from individual cow test day SCC. Twelve months of SCC data from 741 herds were included in this study.(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Toxicosis in sheep following ingestion of natural gas condensate.
Thirty of 200 ewes died or were euthanatized during a 21-day period following a 1-day accidental exposure to natural gas condensate, a complex mixture of hydrocarbons obtained during collection of natural gas from wells. Despite access to potable well water, the poisoned ewes willingly consumed toxic doses of condensate that contaminated surface water. Eight animals died without premonitory signs; the remainder became ill over the course of a few days to 3 weeks. The principal cause of mortality was aspiration pneumonia, but myocardial degeneration and necrosis, renal tubular damage, gastritis, enteritis, and meningeal edema and hyperemia were also observed. Gas chromatographic analysis identified chemical traces of the hydrocarbons in the tissues, and "fingerprinting," the process of matching chromatographic tracings, provided forensic proof of the contamination source. Atomic absorption spectroscopy and cholinesterase analyses were performed to eliminate the possibility of toxicosis by heavy metal contaminants or other constituents. This appears to be the first reported incidence of natural gas condensate toxicity involving sheep or other ruminants. Although the available literature presents a suggestive pattern of clinical signs and pathologic lesions of petroleum product poisoning, diagnostic investigations should employ detailed analytic examination because each source of petroleum hydrocarbons contains unique sets of components that may produce different toxic effects.
Adipose Tissue↗
Assessment of a school exclusion policy during a chickenpox outbreak.
Two Ohio schools experienced an outbreak of over 200 cases of chickenpox during the period from October 5 to December 21, 1988, despite adherence to the 1986 American Academy of Pediatrics' recommendation that children be excluded from school for 1 week or until all lesions have crusted. In grades kindergarten through four, the attack rate for susceptibles was 51% (167/329). With the use of person-time analysis, classmates of a child with chickenpox in grades kindergarten through four were 3.6 times more likely to become a case 12-17 days (the range of one incubation period) after the last day the child with subsequent chickenpox was in class than at any other time during the 2.5-month study period (95% confidence interval (Cl) 2.4-5.4). This was even more pronounced during the first half of the outbreak (relative risk (RR), 10.8; 95% Cl 4.4-26.5). Cases were not more likely to aggregate 12-17 days after a child returned to school after having chickenpox (RR, 0.9; 95% Cl 0.5-1.5). No cases occurred in classmates 12-17 days after the 15 children absent less than 5 days returned to class. Because substantial chickenpox transmission may occur before rash onset, exclusion practices may have a limited effect on outbreak control and increase the indirect costs associated with chickenpox.
Chickenpox↗
Cryptosporidiosis in neonatal calves: 277 cases (1986-1987).
From January 1986 through December 1987, 277 cases of cryptosporidiosis in calves were diagnosed by the South Dakota State University Diagnostic Laboratory. Cryptosporidium sp was the only pathogen identified in 142 (51.3%) of the calves. Concurrent infections with rotavirus, coronavirus, Escherichia coli, Salmonella sp, bovine viral diarrhea virus, or other pathogens were identified in the remaining 135 calves. After elimination of cases involving autolyzed specimens or calves with chronic diarrhea, records of 11 calves with acute, severe cryptosporidiosis were identified in which Cryptosporidium sp was the only pathogen.
Animals↗
Preliminary field evidence for the association of clinical mastitis with altered interestrus intervals in dairy cattle.
Clinical mastitis and reproductive records from two southern California dairy herds were used in a cross-sectional study to determine the risk of an altered interestrus interval following clinical mastitis. An altered interestrus interval was defined as cycles occurring at either less than 18 day or more than 24-day intervals. The data were stratified by herd to assess herd differences and by lactation number to assess confounding by cow parity. The predominant pathogen isolated from mastitis cases in Herd 1 was Staphylococcus aureus , whereas the predominant pathogens in Herd 2 were gram-negative isolates. Cows in Herd 1 which had coliforms cultured from mastitic milk were excluded in the analysis for comparison with Herd 2. In Herd 1, cows with clinical mastitis were less likely to have an altered interestrus interval (Relative Risk [RR]=0.9; 95% Confidence Interval [CI]=0.6,1.6) than herdmates without clinical mastitis. However, cows in Herd 2 were almost two times more likely to have an altered interestrus interval following an episode of clinical mastitis compared to herdmates without clinical mastitis (RR=1.6; 95% CI=1.3,2.0). Because herd management practices differ and could cause differences in mastitis and reproductive outcomes at the dairies, this preliminary field evidence should be followed by prospective studies of luteal function after clinical coliform mastitis.
Journal Article↗