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Biomedical subjects

D Lennon

Publications and source records attributed to D Lennon.

At least 37 records · Page 2Linked to original sources
PubMed1996

The microbiology of chronic otitis media with effusion in a group of Auckland children.

AIMS: To determine the microbiology of chronic otitis media with effusion in a group of Auckland children. To determine the antimicrobial sensitivities of isolated bacterial pathogens to commonly used antibiotics for this condition. METHODS: A descriptive study recruiting subjects from otherwise well children with chronic otitis media with effusion having insertion of ventilation tubes at Starship Children's Health, Auckland. Tympanocentesis was performed, the middle ear aspirate cultured and antimicrobial sensitivities obtained. RESULTS: Sixty seven children (11mo to 8yr) with chronic otitis media with effusion had tympanocentesis of 105 ears. 38/105 (36%) of the middle ear aspirate cultures were positive. Forty nine organisms were isolated with 10 ears having two or more different bacteria identified. Isolated were 17 Haemophilus influenzae (16 nontype b and 1 type b), 13 Moraxella catarrhalis, nine Streptococcus pneumoniae and 10 'others'. All S pneumoniae(9/9), most H influenzae(14/17) and no M catarrhalis(0/13) were sensitive to amoxycillin. More than 80% of subjects had either a sterile effusion or an organism sensitive to amoxycillin or cotrimoxazole. CONCLUSIONS: Middle ear effusions were culture positive in a third of cases of chronic otitis media with effusion. The commonest organisms were H influenzae nontype b, M catarrhalis and S pneumoniae. This is similar to reports from other countries. Sensitivity data obtained supports the continued recommendation of amoxycillin or cotrimoxazole as first line therapy for the antimicrobial treatment of this condition.

Amoxicillin↗
PubMed1996

Prevalence and impact of chronic childhood conditions in Auckland, New Zealand.

OBJECTIVE: To establish the prevalence of specific chronic conditions of childhood in the Auckland area and to quantify resource use by these children. METHODOLOGY: Estimates were made from available registry data and published data sources of the population of children with selected chronic conditions resident in the Auckland Area Health Board area. Resource use data were extracted for admissions to Auckland public hospitals and from providers of community based technology services. RESULTS: The largest community prevalence groups are those with asthma, intellectual handicap, congenital heart disease and epilepsy. Children aged 0-14 with chronic conditions accounted for at least 14,340 hospital days stay in Auckland in 1992 at an estimated minimum cost of $7.9 million. Over 200 children are dependent on technological aids at home. CONCLUSIONS: There are sparse data on the numbers and needs of children with chronic conditions in the population. A non-categorical approach which crosses disease entities may be the best method of meeting common needs.

Child↗
PubMed1996

Repertoire of transcribed peripheral blood T-cell receptor beta chain variable-region genes in acute rheumatic fever.

Patients with severe group A streptococcal infections have abnormalities in the Vbeta repertoire of peripheral blood T cells that are consistent with superantigen stimulation by cytoplasmic membrane proteins. The purpose of this study was to determine whether similar changes in Vbeta repertoire could be found for patients with acute rheumatic fever (ARF). The mean Vbeta repertoire of peripheral blood T cells in nine hospitalized ARF patients was similar to that of 34 controls and did not change during 6 months of follow-up in 6 of the ARF subjects. We were unable to detect changes in the Vbeta repertoire of peripheral blood T cells from patients with ARF that could be attributed to the influence of a superantigen.

Acute Disease↗
PubMed1995

Meningococcal disease epidemiology and control in New Zealand.

Epidemiology, surveillance and research New Zealand has a high quality surveillance system for meningococcal disease that successfully integrates notification and laboratory data. Since 1991, New Zealand has had elevated incidence rates of meningococcal disease rising to 6.2 per 100,000 population in 1994. This represents a rate that is four times that recorded in 1989/90. Serogroup B infection predominates and international experience suggests that these elevated rates may continue for 5 to 15 years. Rates of meningococcal disease in Maori and Pacific Islands populations were three times higher than in Europeans at 10.0 and 12.3 per 100,000 respectively in 1994. The rates were particularly high for infants with the rate in Maori infants under 1 year reaching 120 per 100,000. The case fatality rate at 5.3% for 1994 would appear to be relatively low by international standards. Case control studies could be used to investigate potentially modifiable primary risk factors for disease. Intensive case review studies to investigate the role of such factors as preadmission antibiotics in reducing severe outcomes may be of benefit. The Ministry of Health or research funding organisations should consider the potential value of such studies in more detail.

Adolescent↗
PubMed1995

Local anesthetic use by dentists in Ontario.

A mail survey to obtain data on the annual use of local anesthetics in dentistry was sent to each of the 6,271 certified dentists in Ontario in 1993. The survey asked dentists to identify the different types and total amounts of local anesthetics used in their practice yearly. A total of 2,426 dentists responded to the survey. Based on extrapolation of the data collected, it is estimated that more than 11,000,000 cartridges of local anesthetic are administered annually by dentists in Ontario. The distribution of use of specific types of local anesthetics and vasoconstrictors was also determined. Lidocaine with 1:100,000 epinephrine accounted for 23.4 per cent of all cartridges used, followed by articaine with 1:200,000 epinephrine (19.9 per cent), articaine with 1:100,000 epinephrine (17.9 per cent), prilocaine with 1:200,000 epinephrine (16.4 per cent), mepivacaine with 1:20,000 levonordefrin (6.4 per cent), and mepivacaine plain (6.3 per cent). Other anesthetics were used to a lesser degree. Further analysis revealed no statistically-significant differences in the use of local anesthetics among dentists who responded to the survey and non-responders. The results of this survey document the current use of local anesthetics in dentistry.

Anesthesia, Dental↗
PubMed1995

A 21 year retrospective study of reports of paresthesia following local anesthetic administration.

A retrospective study of paresthesia following the injection of local anesthetic in dentistry was conducted by examining every report of paresthesia recorded by Ontario's Professional Liability Program from 1973 to 1993, inclusive. Only those cases where surgery was not conducted were considered in this study. The parameters examined included patient age and gender, needle gauge, site of injection, area affected, report of pain or any additional symptoms, and the type of local anesthetic used. From 1973 to 1993, there were 143 reports of paresthesia not associated with surgery. There were no significant differences found with respect to patient age, patient gender, or needle gauge. All reports involved anesthesia of the mandibular arch, with the tongue most frequently reported to be symptomatic, followed by the lip. Pain was reported in 22 per cent of the cases. Paresthesia was reported most often following the injection of articaine and prilocaine. In 1993 alone, there were 14 reports of paresthesia not associated with surgery. This can be projected to an incidence of 1:785,000 injections. Articaine was administered in 10 of these cases or prilocaine in the other four. The observed frequencies of paresthesia following the administration of articaine (p < 0.002) or prilocaine (p < 0.025) were significantly greater than the expected frequencies for these agents, based on the distribution of local anesthetic use in Ontario in 1993. These results are consistent with the suggestion that local anesthetic formulations may have the potential for mild neurotoxicity. Further studies are needed to investigate the mechanisms for this, and to determine whether similar findings would be found elsewhere.

Adult↗
PubMed1994

Acute rheumatic fever in Auckland, New Zealand: spectrum of associated group A streptococci different from expected.

Annual specific rates for acute rheumatic fever (ARF) in Auckland children less than 15 years were 22/100,000 for the years 1980 to 1984. From 1984 to 1992 the rates remained relatively constant with an average of 45 (range, 30 to 70) children annually admitted with ARF to the Auckland Children's Hospital. This study examined retrospectively Group A streptococci identified from hospitalized pediatric patients during these 9 years. The total of 2410 isolates included 32 isolates from well-documented cases of ARF and an additional 6 from siblings of cases. Results of M typing indicated that streptococci associated with ARF are generally different from those described overseas and involved types which cause more skin than throat infections in the community.

Adolescent↗
PubMed1994

Invasive pneumococcal disease in a pediatric population, Auckland, New Zealand.

Streptococcus pneumoniae is one of the major invasive pathogens in childhood. The increasing worldwide prevalence of penicillin-resistant strains makes management of invasive infections difficult and underscores the need for effective vaccines. Currently available vaccines are of limited value in the pediatric age group. Trials are taking place to evaluate conjugated pneumococcal vaccines and in view of this it is important to establish local epidemiology of pneumococcal disease. The aims of this population-based study were to review all of the cases of invasive pneumococcal disease occurring during a 9-year period (1984 to 1992) in Auckland, New Zealand. Through the use of laboratory records and hospital discharge codes, 413 isolates from 407 patients were found. Age-specific incidence for all invasive disease was 22.0/100,000 for children less than 15 years old but 56.0/100,000 for children less than 5 years old (chi 2 Yates corrected 18.20; P = 0.001). Two-thirds were less than 2 years old. The rates were higher in Maori and Pacific Island children than in Caucasian children. A total of 70 isolates from 68 patients with meningitis occurred. The majority were less than 5 years old (incidence of meningitis was 10.0/100,000) and 84% were less than 2 years old. The overall mortality from meningitis was 4.3%. Of the 129 isolates serogrouped or serotyped, 14, 6 and 19 accounted for 23%, 16% and 16%, respectively, of cases. Although 98% of serotypes identified would be covered by the currently available 23-valent vaccine, two-thirds of the children affected by these isolates would be unprotected because of poor immunogenicity of polysaccharide vaccines in children less than 2 years old.

Adolescent↗
PubMed1994

Epidemiology, management, and prevention of meningococcal infections.

Neisseria meningitidis is the cause of significant morbidity and mortality worldwide, both in epidemic and endemic disease form. The use of serotyping, subtyping, and multilocus electrophoresis has had a significant impact on determination of the epidemiology of meningococcal disease. Recent advances in understanding the pathogenesis of meningococcal disease, include information on the role of cytokines and other inflammatory mediators, which may contribute to establishment of additional diagnostic and treatment options. Early treatment is required to improve outcome along with the use of prophylaxis to prevent secondary disease. Vaccines against groups A, C, Y, and W135, are available but have limitations, with regard to efficacy and duration of protection. Over the past decade there has been rapid progress in the development of a vaccine against group B disease, with protective trials underway in several countries. However, varying results have been found and these vaccines have not reached a stage of providing universal protection against group B meningococcal disease.

Adolescent↗
PubMed1994

Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever.

BACKGROUND: The incidence of acute rheumatic fever in New Zealand remains relatively high. Reliable early diagnosis of carditis is difficult and important in management. AIM: To determine if Doppler echocardiography contributed to the early diagnosis of carditis in acute rheumatic fever. METHODS: Forty-seven patients admitted to hospital with suspected acute rheumatic fever and 19 control patients, with a febrile illness due to a documented non-cardiac bacterial infection, were assessed two days and two weeks following admission. Presence or absence of clinical carditis was determined by a cardiologist unaware of the suspected diagnosis, from clinical examination, chest radiograph, electrocardiogram (ECG) and two dimensional echocardiogram. Doppler echocardiography was then performed and interpreted by a second cardiologist unaware of the diagnosis. After completion of the study the Jones criteria were applied, to categorise the patients with suspected acute rheumatic fever into four groups for the final diagnosis: no acute rheumatic fever, possible acute rheumatic fever, definite acute rheumatic fever without carditis, and definite acute rheumatic fever with carditis. RESULTS: In 19 patients with a final diagnosis of acute rheumatic fever and carditis at the baseline assessment carditis was detected by clinical assessment in 15 patients, compared with 19 patients with evidence of significant valve regurgitation by Doppler echocardiography. Following the two week assessment, all 19 patients had both clinical and Doppler evidence of carditis. Five patients with a final clinical diagnosis of possible acute rheumatic fever or definite acute rheumatic fever without carditis, had a Doppler abnormality detected. There was no clinical or Doppler abnormality in the febrile controls. CONCLUSIONS: Doppler echocardiography is more sensitive than clinical assessment in the detection of carditis in acute rheumatic fever, and can contribute to earlier diagnosis.

Acute Disease↗
PubMed1993

Control of epidemic group A meningococcal disease in Auckland.

AIM: To study group A meningococcal vaccine delivery to infants less than 2 years of age in Auckland in 1987 to control epidemic disease. METHODS: Mechanisms of vaccine delivery and its facilitation are described. A detailed audit of delivery of vaccine to children less than two years using signed consent forms determined delivery source. This was the age group at highest risk, and poorly covered by routine childhood vaccines. Primary health care source of children presenting with disease was determined by telephone. RESULTS: The epidemic of group A meningococcal disease in the winters of 1985 and 1986 abated most likely due to the vaccination of high risk children (3 months-13 years) in 1987. 90% of the target population were vaccinated. In south Auckland the majority (92%) of vaccine doses for children less than two years of age was delivered by the Plunket Society with Department of Health backing aided by community health workers. By contrast delivery by, general practitioners was greater in north-west and central Auckland (approximately 25%, of dose 1), especially after the publicity over possible side effects (approximately 50% of dose 2). Coverage for dose 1 of children < 2 years was similar (89%) in south Auckland. Of children presenting with meningococcal disease 1 in 4 did not have an identifiable general practitioner. CONCLUSIONS: Vaccines to prevent serious paediatric illness are known to be highly cost effective. The best method of delivery of vaccinations may vary from area to area. Major community involvement including community health workers for the Maori and Pacific Island communities may have facilitated the dissemination of information in this campaign.

Adolescent↗