Search PubMed⌕ Search

Biomedical subjects

E G Smith

Publications and source records attributed to E G Smith.

At least 19 recordsLinked to original sources
PubMed1998

Regional microbiology of the cystic fibrosis lung: a post-mortem study in adults.

Although the majority of patients with cystic fibrosis (CF) become chronically colonized with Pseudomonas aeruginosa, the mode of acquisition of infection remains unclear. Epidemiological studies using genotyping techniques suggest that person-to-person transmission of this organism may occur. All these studies have utilized sputum or throat swab samples. We have studied the regional microbiological flora of the lungs of five CF patients at post-mortem and genotyped P. aeruginosa strains found therein and in the major airway. We have shown that although in most cases major airway secretions accurately reflect the peripheral lung flora, in cases of multiple strain carriage, major airway cultures may not reflect all strains present in the periphery of the lung. This finding has implications for the interpretation of epidemiological studies that use genotyping of strains from sputum and throat swab samples to assess possible routes of transmission.

Adult↗
PubMed1998

Post-infection fatigue syndrome following Q fever.

In 1989, 147 individuals in the West Midlands, UK, were infected with Q fever. Five years later, following anecdotal reports of fatigue, we used a questionnaire-based case-control study to determine the prevalence of chronic fatigue syndrome symptoms in this group. Replies from 71 patients were compared with those from 142 age- and sex-matched controls. Increased sweating (52.9% vs. 31.6%, p = 0.006), breathlessness (50.7% vs. 30.6%, p = 0.006), blurred vision (34.3% vs. 17.8%, p = 0.016) and undue tiredness (68.7% vs. 51.5%, p = 0.03) were found in controls compared to cases. These findings were similar to those in Australian abbatoir workers occupationally exposed to Q fever. CDC criteria for chronic fatigue syndrome were fulfilled by 42.3% of cases and 26% of controls. Using visual analogue scores, symptoms were more severe in cases than in controls. Our findings support the existence of a chronic fatigue state following acute Q fever, in a group of patients exposed just once to the organism, and in circumstances free of such confounding factors as lawsuits over compensation.

Acute Disease↗
PubMed1998

Reference laboratory surveillance of syphilis in England and Wales, 1994 to 1996.

Routine surveillance of syphilis of public health importance (infectious, congenital, and neurosyphilis) began in England and Wales in 1994, using reports from six PHLS laboratories that undertook serological and other reference work. One hundred and thirty-one cases were reported in the first two years, including 100 cases of infectious syphilis, with all regions reporting some infectious syphilis. Reports from PHLS laboratories represented one sixth of the number of cases seen in genitourinary clinics (KC60 data), but both systems produced comparable results. Laboratory reports provided more data on risk factors, which were not available elsewhere. This study documents the risk in England and Wales from infections originating in eastern Europe, where sexually transmitted infections including syphilis have reached epidemic proportions. Forty-five per cent of cases of infectious syphilis were reported to have been acquired in the United Kingdom (UK) and 59% of people with infectious syphilis were reported to have been born in the UK. Twenty per cent of the infectious cases were associated directly or indirectly with transmission in Russia or elsewhere in eastern Europe. The majority of infectious cases were from the white ethnic group. Eighty-five per cent of cases of infectious syphilis were reported to have been acquired heterosexually; 26% of male cases were reported to have been acquired homosexually. The PHLS laboratory reporting system is now well established, and could usefully be expanded to include other, non PHLS, laboratories that undertake reference work. It has the capacity to detect changes in the national epidemiology of syphilis, including imported infections.

Adult↗
PubMed1998

A large outbreak of Q fever in the West Midlands: windborne spread into a metropolitan area?

The largest outbreak of the zoonotic disease Q fever recorded in the United Kingdom (UK) occurred in Birmingham in 1989. One hundred and forty-seven cases were identified, 125 of whom were males, and 130 of whom were between 16 and 64 years of age. Fewer cases of Asian ethnic origin were observed than expected (p < 0.01), and more smokers (p < 0.005). A case control study (26 cases and 52 matched controls) produced no evidence that direct contact with animals or animal products had caused the outbreak. The epidemic curve suggested a point source exposure in the week beginning 10 April. The home addresses of cases were clustered in a rectangle 11 miles (18.3 km) north/south by 4 miles (6.7 km) east/ west, and attack rates became lower towards the north. Directly south of this area were farms engaged in outdoor lambing and calving, a potent source of coxiella spores. A retrospective computerised analysis showed that the geographical distribution of cases was associated with a source in this area (p < 0.00001). On 11 April, unusual southerly gales of up to 78 mph (130 km/h) were recorded. The probable cause of the outbreak was windborne spread of coxiella spores from farmland to the conurbation.

Adolescent↗
PubMed1997

PHLS mycobacteriology reference services in England and Wales.

Tuberculosis (TB) is the most important cause of infectious disease in the world, with eight million new cases and three million deaths each year. The increasing incidence of TB in the developed and the developing world, increasing drug resistance, and the occurrence of nosocomial outbreaks of drug sensitive as well as drug resistant TB has led the PHLS to establish TB as a priority area. This article reviews the enhanced reference services for mycobacteriology provided by the PHLS in England and Wales. These include microscopy and culture on solid and liquid media, rapid culture systems, identification of mycobacteria using macroscopic, microscopic, growth, and biochemical characteristics, and molecular DNA analysis. The Mycobacterium Reference Unit (MRU) provides rapid molecular DNA amplification techniques to identify Mycobacterium tuberculosis in specimens. All four PHLS Regional Centres test isolates for drug susceptibility. This work is quality controlled by MRU, which is one of the World Health Organisation's reference centres for global surveillance on drug resistance in tuberculosis. National data on drug resistance are collated through 'Mycobnet', a surveillance scheme run through the collaboration of PHLS and other UK reference centres and the PHLS Communicable Disease Surveillance Centre.

Bacteriological Techniques↗
PubMed1997

Serum IgG response to an outer membrane porin protein of Burkholderia cepacia in patients with cystic fibrosis.

Early and accurate diagnosis of Burkholderia cepacia infection is important, particularly if segregation is to prevent patient-to-patient transmission. We have examined the serum response to a B. cepacia-specific 80-kDa outer membrane protein. 21 patients colonised with B. cepacia and Pseudomonas aeruginosa for 2-51 months (mean 11 months) were age- and sex-matched with 21 patients colonised with P. aeruginosa but not B. cepacia. The 80-kDa protein was recovered by electroelution from outer membrane proteins, separated by SDS-PAGE, coated onto ELISA plates, reacted with patient sera diluted 1:200, protein A-peroxidase and chromogenic substrate. We found that 19/24 patients colonised with B. cepacia and P. aeruginosa had high values, 2/24 patients had intermediate values, and 2/24 patients had a low value. 20/21 patients colonised with P. aeruginosa alone had low values and 1/21 had an intermediate value. We found that in the longitudinal serum samples studied from four patients only one patient developed high values after the first isolation of B. cepacia suggesting that seroconversion does not occur immediately after the first sputum culture of B. cepacia. We conclude that an ELISA test using B. cepacia-specific 80-kDa outer membrane protein can distinguish B. cepacia colonised and non-colonised patients and may be useful in the early diagnosis of B. cepacia infection.

Adolescent↗
PubMed1997

Information processing through the first year of life: a longitudinal study using the visual expectation paradigm.

This Monograph uses a developmental function approach to describe age-related change and individual differences in infant information processing during the first year of life. The Visual Expectation Paradigm (VExP) is used to measure speed of information processing, response variability, and expectancy formation. Eye-movement reaction times and anticipatory saccades were gathered from 13 infants assessed monthly from 2 to 9 months and then again at 12 months. Analysis of response patterns demonstrated the applicability of the paradigm throughout the age range studied. Converging operations strongly indicate that the traditional estimate of the minimum time required for infants to initiate a saccade to a peripheral stimulus may be as much as 100 milliseconds (ms) too long. Moreover, the newly estimated minimum of 133 ms does not appear to change during the 2-12-month period. Reanalysis of the present data and past research reveals that the new, shorter minimum reaction time is unlikely to affect findings based on mean reaction time. However, using the traditional minimum reaction time will inflate estimates of percentage anticipation, especially in infants older than 5 months. Group and individual growth curves are described through quantitative models of four variables: reaction time, standard deviation of reaction time, percentage anticipation, and anticipation latency. Developmental change in reaction time was best described by an asymptotic exponential function, and evidence for a local asymptote during infancy is presented. Variability in reaction time was found to decline with age, independent of mean reaction time, and was best described by a polynomial function with linear and quadratic terms. Anticipation showed little lawful change during any portion of the age span, but latency to anticipate declined linearly throughout the first year. Stability of individual differences was strong between consecutive assessments of mean reaction time. For nonconsecutive assessments, stability was found only for the 6-12-month period. Month-to-month stability was inconsistent for reaction-time variability and weak for both anticipation measures. Analyses of individual differences in growth curves were carried out using random regressions for the polynomial models. The only significant individual difference (in growth curves) was found for reaction-time variability. Parameter estimates from the exponential models for reaction time suggested two or three developmental patterns with different exponential trajectories. This finding indicates that the strong form of the exponential growth hypothesis, which states that processing speed develops at the same rate for all individuals, does not hold for the first year of life. In the concluding chapter, Grice's Variable Criterion Model (Grice, 1968) is used to integrate three key findings: regular age changes in mean reaction time and variability but no age change in the minimum reaction time. It is argued that the rate of growth of sensory-detection information is developmentally constant during much of the first year but that age changes occur in the level and spread of the distribution of response threshold values. The unique strengths of the paradigm are discussed, and future directions are suggested for further developing the paradigm itself and for using it as a tool to study broad issues in infant cognition.

Eye Movements↗
PubMed1996

Antibiotic resistance and serotypes of Streptococcus pneumoniae at Birmingham Public Health Laboratory, 1989-94.

Antibiotic resistance of 1515 consecutive laboratory isolates of Streptococcus pneumoniae between 1989 and 1994 was analyzed. Overall, 39 (2.6%) isolates were resistant to penicillin, 102 (6.7%) resistant to erythromycin and 52 (3.4%) resistant to tetracycline. There was a higher proportion of penicillin resistant isolates from sterile sites compared with "non-sterile sites" (5% vs. 2.2%; P < 0.02). This same pattern occurred with erythromycin (12.5% vs. 5.6%; P < 0.001). From 1989-90 to 1993-94 the penicillin resistance rate increased from 0.8% to 8% and the erythromycin from 5.7% to 8.4%, whereas the tetracycline resistance rate fell from 3.7% to 2.8%. The increase in resistance to penicillin largely occurred in the final 12 months of this study period. One hundred and fifty isolates (9.9%) were serotyped, including isolates from sterile sites and those with penicillin resistance. The commonest serotypes of penicillin-sensitive pneumococci were 14, 19, 9 and 6. The majority of penicillin-resistant pneumococci (PRP) were of serotype 9 (64%) followed by 6, 23 and 19. Overall 95% of these isolates were of serotypes represented in the 23-valent pneumococcal polysaccharide vaccine (Pneumovax II). PRP were more likely to have resistance to erythromycin (23%) or tetracycline (23%) compared to penicillin-sensitive pneumococci (6% and 3% respectively). Most of the PRP were isolated from patients aged over 50 years including 11 isolates from blood cultures of patients with pneumonia or septicaemia. There was a possible epidemiological association between four patients with PRP but surveillance cultures of hospital contacts revealed no extra cases. These results show a worrying increase in infections due to PRP which has implications for clinical and laboratory staff in the diagnosis and treatment of serious pneumococcal infections.

Humans↗
PubMed1996

Outcome for patients colonised with Burkholderia cepacia in a Birmingham adult cystic fibrosis clinic and the end of an epidemic.

BACKGROUND: There has been increasing concern since 1979 about the emergence of Pseudomonas cepacia (Burkholderia cepacia) in patients with cystic fibrosis in the UK and elsewhere. Colonisation of the sputum has been shown to be associated with increased morbidity and mortality. Evidence suggests person to person transmission and some centres have segregated those colonised with B cepacia from other patients with cystic fibrosis. The outcome of patients colonised by B cepacia has been studied, together with the effects of strict segregation. METHODS: The outcome in 18 patients with sputum colonised by B cepacia was compared with that in age, sex, and severity matched controls with no evidence of B cepacia colonisation by a retrospective case note study. RESULTS: No difference between cases or controls were found in the 24 month period prior to colonisation by B cepacia in lung function, number of days in hospital, or outpatient visits. Colonisation led to an increased rate of loss of lung function and utilisation of hospital services. There was an increase in the numbers of transplants and deaths amongst the cases. Since 1992 there have been only three new cases of B cepacia colonisation and the incidence and prevalence of the organism has fallen dramatically since segregation commenced. CONCLUSIONS: B cepacia appears to be linked to the decline in colonised individuals. There was no evidence that colonisation occurred in patients declining for other reasons. B cepacia colonisation confers a worse prognosis than Pseudomonas aeruginosa alone. Segregation appears to limit the spread of the organism from infected individuals to other patients with cystic fibrosis.

Adult↗
PubMed1994

NMR studies of molecular mobility and diffusion in porous systems.

The uptake, partitioning, and release of ingredients such as water, oil, surfactant, and ions are important factors to understand and control in the design and manufacture of detergent and personal products. Although conventional pulse NMR (PNMR) spectroscopy continues to be used to analyse bulk molecular mobility and phase composition, more recently MR imaging techniques have created unique opportunities for gaining spatial information about these processes in ways that are noninvasive and potentially quantitative. This paper describes the evaluation of MRI and associated PNMR techniques to study transport in three relevant cases: ion diffusion (e.g., fluoride) in concentrated dispersions, oil transport through powders, and water ingress into porous powders (zeolite). Results are presented to illustrate the potential of multiple pulse and gradient echo MRI methods for dealing with the short T2 scenarios that represent a common problem in quantitative imaging of water in solid-containing composites involving, for instance, zeolite, or silica. Pore-size characterisation results are also presented.

Diffusion↗
PubMed1994

The characterization of porous solids by NMR.

We are using a novel NMR method, that has been developed in our laboratory and employs the depression of the freezing point (delta Tm) of confined liquid within porous media, to investigate the effect of pre-drying silica with average pore diameter ranging from 60 A to 1000 A. Cyclohexane was the confined liquid. Pre-drying was found to affect only the smallest pores. A study to compare partially filled and over-filled samples showed that the average delta Tm for partially filled samples is greater than for over-filled. We have also investigated the use of water as the absorbed liquid and compared results with those obtained from cyclohexane studies. Reasonable agreement was found but cyclohexane was more sensitive. The method is fast and is suitable for monitoring pore size distributions in the range of 50-1000 A.

Cyclohexanes↗