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Biomedical subjects

D F Brown

Publications and source records attributed to D F Brown.

At least 37 records · Page 2Linked to original sources
PubMed2001

Rapid screening technique for class 1 integrons in Enterobacteriaceae and nonfermenting gram-negative bacteria and its use in molecular epidemiology.

A screening technique for integrons in members of the family Enterobacteriaceae and nonfermenting gram-negative bacteria by real-time PCR is reported. A total of 226 isolates of gram-negative bacteria obtained from a variety of clinical specimens were screened for class 1 integrons by real-time PCR performed on a LightCycler instrument. This technique used a primer pair specific for a 300-bp conserved region at the 5' ends of class 1 integrons. The screening assay was evaluated by comparison with results obtained by the conventional, thermal-block PCR (long PCR) by using established conditions and primers for the detection of class 1 integrons, and the real-time PCR technique was thus shown to be both sensitive and specific. DNA from 50 of 226 (22%) isolates screened was identified as containing an integron by the screening PCR, and sequence data were obtained across the integron for 34 of 50 (68%) of these isolates. In an attempt to study the molecular epidemiology of antimicrobial resistance genes carried within integrons, a comparison of the types of gene cassettes carried by isolates from different patients was made. Adenyltransferase genes conferring resistance to streptomycin and spectinomycin were the predominant gene cassettes amplified in the study. Resistance to trimethoprim was also frequently found to be encoded within integrons. Furthermore, multiple bacterial isolates obtained from one patient over a 5-month period were all shown to carry an integron containing the same single adenyltransferase gene cassette, suggesting that these elements were relatively stable in this case.

Community-Acquired Infections↗
PubMed2000

Stridor.

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Adult↗
PubMed2000

Cyanosis.

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Adult↗
PubMed1999

A multicenter, randomized study of argatroban versus heparin as adjunct to tissue plasminogen activator (TPA) in acute myocardial infarction: myocardial infarction with novastan and TPA (MINT) study.

OBJECTIVES: This study examined the effect of a small-molecule, direct thrombin inhibitor, argatroban, on reperfusion induced by tissue plasminogen activator (TPA) in patients with acute myocardial infarction (AMI). BACKGROUND: Thrombin plays a crucial role in thrombosis and thrombolysis. In vitro and in vivo studies have shown that argatroban has advantages over heparin for the inhibition of clot-bound thrombin and for the enhancement of thrombolysis with TPA. METHODS: One hundred and twenty-five patients with AMI within 6 h were randomized to heparin, low-dose argatroban or high-dose argatroban in addition to TPA. The primary end point was the rate of thrombolysis in myocardial infarction (TIMI) grade 3 flow at 90 min. RESULTS: TIMI grade 3 flow was achieved in 42.1% of heparin, 56.8% of low-dose argatroban (p = 0.20 vs. heparin) and 58.7% of high-dose argatroban patients (p = 0.13 vs. heparin). In patients presenting after 3 h, TIMI grade 3 flow was significantly more frequent in high-dose argatroban versus heparin patients: 57.1% versus 20.0% (p = 0.03 vs. heparin). Major bleeding was observed in 10.0% of heparin, and in 2.6% and 4.3% of low-dose and high-dose argatroban patients, respectively. The composite of death, recurrent myocardial infarction, cardiogenic shock or congestive heart failure, revascularization and recurrent ischemia at 30 days occurred in 37.5% of heparin, 32.0% of low-dose argatroban and 25.5% of high-dose argatroban patients (p = 0.23). CONCLUSIONS: Argatroban, as compared with heparin, appears to enhance reperfusion with TPA in patients with AMI, particularly in those patients with delayed presentation. The incidences of major bleeding and adverse clinical outcome were lower in the patients receiving argatroban.

Adult↗
PubMed1999

Plain abdominal radiographs and abdominal CT scans for nontraumatic abdominal pain--added value?

We conducted a retrospective descriptive study to determine the value of plain abdominal radiographs in emergency department (ED) patients also receiving abdominal computed tomography scans (CT) for the evaluation of nontraumatic abdominal, back and flank pain (NTAP). Cases were identified through radiology log books. Medical records and radiology reports were reviewed to determine whether the CT confirmed the findings of the plain abdominal radiographs, and whether the clinical course confirmed the results of either. Test characteristics for the plain abdominal radiograph and for the CT, using the clinical course including subsequent invasive procedures as the gold standard, were calculated. Of 177 patients who received CTs, 97 (55%) also received plain abdominal radiographs. Among the 74 patients who were admitted to the hospital and had complete data, the sensitivity and specificity for the plain abdominal radiographs were .43 and .75 respectively, compared to .91 and .94 for the CT scan (P(sens.) < .05, P(spec.) < .05). In 4 patients (5%), both studies failed to identify pathology shown in a subsequent procedure. In ED patients with NTAP, the plain abdominal radiograph may have some value as a screening tool; however, in patients in whom a CT is likely to be ordered anyway, a plain abdominal radiograph is unhelpful and often misleading.

Abdominal Pain↗
PubMed1999

Progressive supranuclear palsy with dementia: cortical pathology.

Patients with progressive supranuclear palsy (PSP) often develop dementia, and cortical pathology has been documented in PSP. However, there are no reports correlating dementia in PSP with cortical pathology. We hypothesized that cases of PSP presenting with cognitive impairment would have more severe cortical tau pathology than those without. We compared 7 cases of PSP presenting with cognitive deficits (group 1) with 4 cases of PSP that did not (group 2). The subcortical tau pathology was almost identical in both groups. The cortical tau pathology was strikingly different in group 1, in which it was on average moderate, compared with group 2, in which it was minimal. The accumulation of cortical neuronoglial tau in PSP cases with dementia suggests that neurofibrillary pathology is central to the cause of dementia in PSP.

Aged↗
PubMed1999

Variation in structure and location of VanA glycopeptide resistance elements among enterococci from a single patient.

Forty-six VanA glycopeptide-resistant enterococci (GRE) from a single patient were investigated for variation in structure and location of VanA resistance elements. Together with identification to species level and pulsed-field gel electrophoresis, these data divided the GRE into 10 groups and subgroups. Combining data in this manner appears helpful when investigating the epidemiology of GRE.

Bacterial Proteins↗
PubMed1999

Lewy body dementia.

Although Lewy body dementia (LBD) has received a considerable amount of interest in the last decade, there still exists a certain level of confusion concerning the clinical and neuropathological features associated with this disorder. According to many researchers, LBD represents a distinct dementing illness with specific clinical features. The neuropathological hallmark for this disorder is the Lewy body, a spherical intraneuronal cytoplasmic inclusion originally described in brainstem nuclei in Parkinson's disease. In LBD, Lewy bodies are found in subcortical nuclei, such as the substantia nigra, as well as diffusely in the neocortex. Recently, a consortium on dementia with Lewy bodies was held that established consensus guidelines for the clinical and pathological diagnosis of LBD. This review will focus on the newest developments in LBD, addressing specifically clinical and neuropathological features, diagnostic classification, genetics and potential pharmacotherapy.

Diagnosis, Differential↗
PubMed1998

European Glycopeptide Susceptibility Survey of gram-positive bacteria for 1995. European Glycopeptide Resistance Survey Study Group.

In the European Glycopeptide Susceptibility Survey 7078 Gram-positive isolates collected in 1995 from 70 centers in 9 countries of Western Europe were examined, using a standardized, quantitative susceptibility testing method. Of the 7078 isolates, 6824 (96.4%) were tested by the national coordinating centers. Teicoplanin (mode MIC 0.5 microgram/mL) was generally twice as active as vancomycin (mode MIC 1 microgram/mL) against Staphylococcus aureus (n = 2852). All isolates were susceptible to vancomycin (MIC < or = 4 micrograms/mL) and all but four to teicoplanin (MIC < or = 8 micrograms/mL); these four isolates were of intermediate susceptibility (MIC 16 micrograms/mL). With coagulase-negative staphylococci (n = 1444), the distribution of MIC of teicoplanin was wider than for vancomycin. Two and two-tenths percent of coagulase-negative staphylococci excluding Staphylococcus haemolyticus required 16 micrograms/mL teicoplanin for inhibition (intermediate) and 0.4% > or = 32 micrograms/mL (resistant). Among isolates of S. haemolyticus, 4.4% were of intermediate susceptibility (MIC 16 micrograms/mL) and 3.3% were resistant (MIC > or = 32 micrograms/mL) to teicoplanin. However, this species represented only 6.3% of the isolates of coagulase-negative Staphylococcus spp. Generally, teicoplanin (mode MIC < or = 0.12 microgram/mL) was four to eight times more active than vancomycin (mode MIC < or = 0.5 microgram/mL) against the 770 streptococcal isolates. Glycopeptide-susceptible Enterococcus spp. (n = 1695) were generally four times more susceptible to teicoplanin (mode MIC 0.25 microgram/mL) than to vancomycin (mode MIC 1 microgram/mL). Combined vancomycin and teicoplanin (VanA phenotype) resistance was observed more frequently (9.3%) in isolates of Enterococcus faecium than in Enterococcus faecalis (0.8%). Four isolates of unspeciated enterococci (1.4%) also expressed this resistance phenotype. Four isolates of E. faecium and four of E. faecalis expressed the VanB-type (low-level, vancomycin only) resistance. Spain was the only country not to submit resistant E. faecium strains while resistant E. faecalis isolates came only from Spain and Italy.

Anti-Bacterial Agents↗
PubMed1998

Mastitis control programme in the developing dairy industry of tropical lowland Bolivia.

Mastitis is an important disease in developing dairy industries. This paper describes a commercial mastitis control programme in Santa Cruz, Bolivia, based upon the five-point mastitis control plan and bulk tank somatic cell count (BTSCC) monitoring. Twelve farms which participated on the programme for 6 years are considered. Mean annual BTSCC fell steadily from 1,200,000 cells/ml to 461,000 cells/ml over this time. This progressive improvement was probably a result of increasing use of and attention to detail in mastitis control practices. The control of subclinical mastitis improved in both hand-milked and machine-milked herds, though hand-milked herds consistently produced milk of higher BTSCC. The mastitis programme did not appear to influence the incidence of clinical mastitis. The concludes that a simple mastitis programme based on the five-point plan and BTSCC monitoring can be commercially implemented and effectively control subclinical mastitis in a tropical, developing country.

Animals↗