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Biomedical subjects

D Wilkinson

Publications and source records attributed to D Wilkinson.

At least 325 records · Page 18Linked to original sources
PubMed1967

Pneumonia in Indian and Eskimo infants and children. I. A clinical study.

Ninety-seven Indian and Eskimo infants and children who suffered 112 episodes of pneumonia were the subjects of a prospective study carried out at the Charles Camsell Hospital, Edmonton, Alberta, from August 1963 until August 1964. Investigation included viral studies and an evaluation 10 days after admission. The patients were divided into four diagnostic categories and a comparison was made between cases of bacterial and viral origin. The frequency of right-sided disease, particularly of the upper lobe and/or dependent segment involvement, is described. An evaluation of physical signs is attempted. The problem of recurrent pneumonia and the differential diagnosis of tuberculosis in Indian and Eskimo children with pneumonia is discussed.

Adolescent↗
PubMedDate not supplied

HSV-2 specific serology should not be offered routinely to antenatal patients.

The proposal to introduce antenatal screening for HSV has no evidence for a public or individual health benefit; indeed, it has the potential to increase anxiety for patients, with a minimal likelihood of reducing the risk of neonatal herpes infection. Antenatal screening of an essentially healthy population of women must be validated in settings of different rates of neonatal HSV infection and the purposes and limitations of screening clearly outlined. Identification of pregnant women at risk of acquiring genital herpes in pregnancy is also dependent upon being able to obtain the serostatus of the male sexual partner which will reduce the practical application of the test if both patient and partners need to be screened. We recommend that efforts to improve on the currently established mechanisms for reducing the morbidity of neonatal herpes, namely early diagnosis and prompt treatment, must take priority for resources over new and unevaluated screening programmes, such as routine testing of antenatal patients.

Antibodies, Viral↗
PubMedDate not supplied

Resistance to antituberculosis drugs in rural South Africa: rates, patterns, risks, and transmission dynamics.

This study describes the rate, pattern, and transmission dynamics of, and risk factors for, isolates of Mycobacterium tuberculosis resistant to antituberculosis drugs in a rural South African health district. Twenty-one of 254 (7.6%; 95% confidence interval [CI] 4.8-11.4) isolates from incident cases were resistant to at least one drug (isoniazid, rifampicin, streptomycin, ethambutol). A random sample of 28 otherwise susceptible isolates and all 21 resistant isolates were susceptible to pyrazinamide. There was one case of combined isoniazid/rifampicin resistance. The rate of initial resistance was 8.1% (95% CI 4.9-12.4) and of acquired resistance 6.2% (95% CI 1.9-14.2). Age, sex, known human immunodeficiency virus status, and previous treatment history were not associated with drug resistance. Restriction fragment length polymorphism (RFLP) analysis of 13 of the 21 resistant specimens showed 12 different banding patterns. Rates of drug resistance were low in this representative sample of patients from a defined geographical area. Previous treatment history was probably not a risk factor because of the use of multiple drug regimens, directly observed therapy, and high completion rates in those previously treated. Although limited in number, the RFLP data suggested that recent local transmission of resistant strains was not occurring to a significant extent.

Adult↗
PubMedDate not supplied

Diagnosing tuberculosis in a resource-poor setting: the value of sputum concentration.

Diagnosis of tuberculosis in resource-poor settings is hampered by the insensitivity of the direct Ziehl-Neelsen (ZN) smear. Liquefaction and concentration of sputum before preparing a ZN smear has been proposed as a way of increasing diagnostic sensitivity. A field trial of this technique was done in a district hospital in South Africa among 166 consecutive tuberculosis suspects. Correlation between the 2 types of smear was high, but the extra cases diagnosed after concentration was offset by a similar number that, initially positive, were negative after concentration. Overall diagnostic sensitivity of smear microscopy was not increased by sputum liquefaction and concentration. The value of this technique may lie in combining it with direct microscopy. Limiting specimen examination to one per patient and making an initial direct smear with subsequent concentration only if the direct smear was negative increased sensitivity from 43% to 55% without any reduction in specificity. However, overall diagnostic sensitivity remained disappointing.

Humans↗
PubMedDate not supplied

Diagnosing tuberculosis in a resource-poor setting: the value of a trial of antibiotics.

Diagnosis of smear-negative but culture-positive pulmonary tuberculosis in resource-poor settings is difficult. To determine the value of assessing response to a trial of antibiotics in the identification of patients with positive cultures but negative Ziehl-Neelsen (ZN) smears, we compared clinicians' diagnoses with culture in 334 consecutive adults with suspected tuberculosis in rural South Africa; 142 patients (43%) had culture-positive pulmonary tuberculosis. Diagnosis by ZN smear alone was insensitive (61%) but highly specific (94%). Only half of the smear-negative but culture-positive cases were correctly identified by failing to respond to a broad spectrum antibiotic. The remainder responded to therapy and were discharged. Diagnostic sensitivity therefore increased to 80%, but specificity fell to 78%. A more rigorous algorithm may improve diagnosis of smear-negative pulmonary tuberculosis in resource-poor settings.

Adult↗
PubMedDate not supplied

Efficacy of twice weekly treatment for tuberculosis given under direct observation in Africa.

The efficacy of a 6 months course of twice weekly therapy with 4 drugs for tuberculosis, preceded by a 2-3 weeks intensive daily phase, is unknown. Implementation of this regime as community-based directly observed therapy in Africa is highly effective (85% completion rate); it is important to estimate the efficacy of the regime before advocating its widespread use and before conducting prospective trials. We retrospectively evaluated 109 consecutive adults with culture-positive pulmonary tuberculosis who had documented completion of treatment; 84 (77%) were traced and in 15 (14%) a history was obtained from a close relative; 10 (9%) had left the area. Nineteen patients were producing sputum and 4 of these were culture-positive for Mycobacterium tuberculosis, giving an estimated cure rate of 95% (95% confidence interval, 89-98%). Follow-up specimens revealed no acquired drug resistance and restriction fragment length polymorphism analysis of patient-paired specimens showed them to be nearly identical, indicating that treatment had failed or there had been early relapse. This preliminary study suggested that generally twice weekly 4-drug treatment for tuberculosis, given under direct observation, is curative in an acceptable proportion of patients. Prospective trials are indicated.

Adult↗
PubMedDate not supplied

Directly observed therapy for tuberculosis given twice weekly in the workplace in urban South Africa.

Effective models of delivery of directly observed therapy (DOT) for tuberculosis in resource-poor settings are needed. Intermittent chemotherapy may be an important component of DOT delivered in the community as it means fewer visits to supervisors. There is no published evidence on the efficacy of twice weekly therapy given from the start of treatment without an intensive daily phase. We analysed data from 3 large cohort studies in a migrant, urban workforce in South Africa between 1975 and 1983. All patients received 4 drugs (isoniazid, rifampicin, pyrazinamide and streptomycin) twice weekly under direct observation by a nurse in the workplace. Of 444 patients, 378 (85.1%) completed treatment. Cure could be assessed in 362, and 348 (96.1%, 95% confidence interval 93.7-97.8%) were bacteriologically cured. Sputum status was assessed at 2-3 months in 343 patients and 309 (90.1%) were sputum negative. Eighteen patients relapsed (5.7%; 2.9/100 patient-years of observation). DOT can be effectively delivered to a migrant, urban workforce, and 4-drug therapy given twice weekly under direct observation is efficacious.

Adult↗
PubMedDate not supplied

Increasing frequency of tuberculosis among staff in a South African district hospital: impact of the HIV epidemic on the supply side of health care.

To describe the changing frequency of tuberculosis among staff in a South African hospital, and to compare incidence in health workers with that in ancillary staff, the number and type of cases of tuberculosis among staff diagnosed between 1991 and 1996 were ascertained. The incidence rate of tuberculosis among health workers and ancillary staff was compared with the age-specific rate in the community (20-59 years old). In 1991-1992, 2 cases of tuberculosis were diagnosed among hospital staff; but in 1993-1996 there were 20 cases diagnosed (annualized incidence rates 138/100,000 and 690/100,000; P < 0.0001). Of 14 cases tested (64%), 12 (86%) were infected with human immunodeficiency virus (HIV). Most cases (82%) successfully completed treatment, but 4 died (18%). The incidence of tuberculosis amongst health workers (558/100,000 person-years of observation [PYO]) and ancillary staff (445/100,000 PYO) was not significantly different (P = 0.7), but it was lower than the incidence rate among 20-59 years old people in the community (1543/100,000). Tuberculosis has increased amongst hospital staff, secondary to the impact of HIV. The HIV epidemic is having a substantial impact on the health of hospital staff and interventions to counter this are urgently needed.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

High incidence of early anaphylactoid reaction to SAIMR polyvalent snake antivenom.

During a prospective study of 147 patients with snakebite presenting to a rural South African hospital, 13 of 17 patients (76%) treated with South African Institute for Medical Research (SAIMR) polyvalent antivenom experienced potentially severe early (anaphylactoid) reactions. The most common reaction was generalized urticaria (12; 71%), but 3 cases of angio-oedema (18%), 2 of bronchospasm (12%), and 2 of hypotension (12%) were also observed. Reactions were controlled with adrenaline, antihistamines, and resuscitation. All patients fully recovered from envenoming although the full dose of antivenom was not given to most. Indications for the use of this antivenom should be reconsidered and patients should be given antivenom in a high care setting if possible. Use of antivenom by lay people outside hospital should be discouraged and antivenom manufacturing processes could usefully be reviewed.

Adolescent↗
PubMedDate not supplied

The role of general practitioners in the diagnosis and treatment of Alzheimer's disease: a multinational survey.

Alzheimer's disease (AD) is a growing healthcare problem. Early diagnosis and effective treatment would benefit patients and caregivers, as well as having economic implications. We conducted a survey of 741 caregivers of patients with AD in Australia, France, Italy, Spain and the UK to assess the current situation regarding the diagnosis and treatment of AD in routine clinical practice. The average time from when symptoms were first noticed by the caregiver to making the first doctor's appointment was 4 months, but 22% of caregivers waited more than 1 year before consulting a doctor. Although the majority of patients (74%) consulted their general practitioner first, the diagnosis was more likely to be made by a specialist; on average, there was a 1-year delay from when symptoms were first noticed by the caregiver to diagnosis. Access to AD care is restricted by many national healthcare systems. The delay in diagnosis imposed by such restrictions impacts on access to early and effective treatment.

Alzheimer Disease↗
PubMedDate not supplied

Accessibility to general practitioners in rural South Australia. A case study using geographic information system technology.

OBJECTIVE: To demonstrate the potential of GIS (geographic information system) technology and ARIA (Accessibility/Remoteness Index for Australia) as tools for medical workforce and health service planning in Australia. DESIGN: ARIA is an index of remoteness derived by measuring road distance between populated localities and service centres. A continuous variable of remoteness from 0 to 12 is generated for any location in Australia. We created a GIS, with data on location of general practitioner services in non-metropolitan South Australia derived from the database of RUMPS (Rural Undergraduate Medical Placement System), and estimated, for the 1170 populated localities in South Australia, the accessibility/inaccessibility of the 109 identified GP services. MAIN OUTCOME MEASURES: Distance from populated locality to GP services. RESULTS: Distance from populated locality to GP service ranged from 0 to 677 km (mean, 58 km). In all, 513 localities (43%) had a GP service within 20 km (for the majority this meant located within the town). However, for 173 populated localities (15%), the nearest GP service was more than 80 km away. There was a strong correlation between distance to GP service and ARIA value for each locality (0.69; P < 0.05). CONCLUSIONS: GP services are relatively inaccessible to many rural South Australian communities. There is potential for GIS and for ARIA to contribute to rational medical workforce and health service planning. Adding measures of health need and more detailed data on types and extent of GP services provided will allow more sophisticated planning.

Databases, Factual↗
PubMedDate not supplied

A comparison of three imaging techniques in the assessment of an abdominal aortic aneurysm.

Twenty-five patients undergoing elective surgery for large abdominal aortic aneurysms (AAAs) were investigated by preoperative ultrasonography (US), computed tomography (CT) or intravenous digital subtraction angiography (IV-DSA). The accuracy of each modality in assessing the upper and lower extent of aneurysmal disease was then compared. IV-DSA proved 100% accurate in assessing the relationship of the renal arteries to the aneurysm sac. Both CT and US overestimated the incidence of juxta or suprarenal AAAs and only had a predictive value for suprarenal disease of 13% and 14% respectively. If, however, US or CT stated the aneurysm to be infrarenal this was likely to be true though both investigations classified one suprarenal aneurysm as infrarenal. The distal extent of aneurysmal disease was again most accurately predicted by IV-DSA (predictive value 88%). Bowel gas frequently prevented US from visualizing the iliac arteries (19 of 25 cases). IV-DSA is a safe and accurate method for defining the relationship of an aneurysm to the renal arteries and should be adopted as a routine preoperative investigation of abdominal aneurysmal disease.

Aged↗