Non-tuberculous mycobacteria related infectious crystalline keratopathy.
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Adult↗
Biomedical subjects
F Donald
Publications and source records attributed to F Donald.
A protocol for low contamination risk of autologous serum drops in the management of ocular surface disorders.
AIM: To assess microbial contamination of 20% autologous serum (AS) eye drops used in a hospital inpatient setting. METHOD: 14 patients received autologous serum drops from 4 to 14 days with a cumulative total of 67 days. For each day the first and last drop (total 134 samples) was cultured on broth and blood agar. RESULTS: Four patients (9 samples) grew Staphylococcus epidermidis only. One patient (1 sample) showed Staphylococcus epidermidis and a scanty growth of viridans streptococci in the same sample, and on different days the same patient grew Staphylococcus aureus in one sample and Staphylococcus epidermidis in another sample. One patient (1 sample) grew micrococcus. There was no clinical or microbial evidence of infection in any of these six patients. CONCLUSION: This study shows that autologous serum drops can be safely used in an inpatient setting, under a strict protocol of preparation and storage, without significant risk of bacterial contamination and consequent infection.
Adult↗
Kingella kingae endocarditis in a sixteen-month-old-child.
We report the case of a child with acute neurologic symptoms who was found to have bacterial endocarditis caused by Kingella kingae. The case alerts microbiologists and pediatricians to an organism that has rarely been reported to cause endocarditis in children.
Endocarditis, Bacterial↗
Compressive cervical myelopathy due to calcium pyrophosphate dihydrate deposition disease: report of a case and review of the literature.
Calcium pyrophosphate dihydrate (CPPD) deposition disease is an inflammatory arthropathy that is defined by the deposition of CPPD crystals in articular and periarticular structures. The deposition of CPPD in hyaline cartilage and fibrocartilage leads to the chondrocalcinosis that is characteristic of the disease. It can occur independently or in association with any of a number of inflammatory or endocrine disorders. This form of crystal-induced arthritis tends to affect the peripheral joints, particularly the knees, ankles, shoulders, wrists, and second and third metacarpophalangeal joints, but involvement of the lumbar spine is not uncommon. Cervical spine disease due to CPPD deposition is, however, rare. We report a case of compressive cervical myelopathy due to CPPD deposition disease of the cervical spine in a woman with long-standing rheumatoid arthritis. We also, from a review of the English-language literature, describe the collective reported clinical experience with CPPD deposition disease of the cervical spine.
Aged↗
Pneumocystis carinii pneumonia in patients with connective tissue diseases: the role of hospital experience in diagnosis and mortality.
OBJECTIVE: Pneumonia due to Pneumocystis carinii has been increasingly reported in patients with connective tissue diseases, but the frequency of this complication is not known. We sought to determine the frequency of P carinii pneumonia (PCP) in patients with connective tissue diseases, and to determine the role that a hospital's acquired immunodeficiency syndrome (AIDS)-related experience may have in the diagnosis of PCP in these patients. METHODS: We used a state hospitalization registry to identify all patients with PCP and either rheumatoid arthritis, systemic lupus erythematosus, Wegener's granulomatosis, polymyositis, dermatomyositis, polyarteritis nodosa, or scleroderma who had an emergent or urgent hospitalization in California from 1983 to 1994. We compared patient and hospital characteristics between these patients and patients with connective tissue diseases hospitalized with other types of pneumonia. RESULTS: Two hundred twenty-three patients with connective tissue diseases were diagnosed with PCP in the 12-year study period. The frequency of PCP ranged from 89 cases/10,000 hospitalizations/year in patients with Wegener's granulomatosis to 2 cases/10,000 hospitalizations/year in patients with rheumatoid arthritis. Compared with 5,457 patients with connective tissue diseases and pneumonia due to other organisms, patients with PCP were more likely to be younger, to be male, to have private medical insurance, and to have systemic lupus erythematosus, Wegener's granulomatosis, inflammatory myopathy, or polyarteritis nodosa rather than rheumatoid arthritis, and were less likely to be African American. Hospital size, teaching status, urban/rural location, proportion of admissions due to AIDS or PCP, and proportion of patients with pneumonia undergoing bronchoscopy were each associated with the likelihood of diagnosis of PCP in univariate analyses, but only the number of patients with PCP being treated at a hospital (odds ratio [OR] 1.03 for each additional 10 cases/year, 95% confidence interval [95% CI] 1.01-1.05) was associated with the likelihood of diagnosis of PCP in multivariate analyses. Patients were also somewhat more likely to be diagnosed with PCP if there had previously been a case of PCP in a patient with a connective tissue disease at the same hospital (OR 135, 95% CI 0.98-1.85). In-hospital mortality was 45.7%, and was unrelated to hospital characteristics. CONCLUSION: PCP is an uncommon, but often fatal, occurrence in patients with connective tissue disease. A hospital's prior experience with patients with PCP is associated with the likelihood that this condition is diagnosed in patients with connective tissue diseases who present with pneumonia, suggesting that diagnostic suspicion is an important factor in the correct identification of affected patients.
Adult↗
Clinical and laboratory features of patients of Vietnamese descent with systemic lupus erythematosus.
The prevalence rate and disease manifestations of systemic lupus erythematosus (SLE) have been noted to vary among different ethnic groups. There has been no description in the English literature of SLE in the Vietnamese population. This is the first report, which details the clinical and laboratory features as well as an estimation of the prevalence of SLE in patients with a Vietnamese ancestry living in the United States. We performed a retrospective chart review of clinical and laboratory features of patients of Vietnamese descent with SLE. The case finding was performed by a review of the rheumatology clinic records at two large teaching hospitals in Santa Clara County searching for patients with SLE with a Vietnamese surname. In addition, we recruited patients by contacting all of the rheumatologists practicing in the county. Twenty-three patients of Vietnamese descent were identified with SLE in Santa Clara County. The estimated prevalence of SLE in the patients of Vietnamese descent was 42 cases per 100 000 persons. Eighty-seven per cent of the cases were born in Vietnam. The clinical and laboratory features of SLE were similar to prior published reviews except for a relatively high prevalence of anti-RNP antibody (54%). The patients with anti-RNP antibody exhibited features of overlap syndrome. There was a high rate of exposure to tuberculosis (TB). Fifty-eight per cent of patients had a positive purified protein derivative (PPD) skin test and 27% of patients had a history of clinical TB. Forty-four per cent of patients had evidence of hepatitis B exposure. The prevalence of SLE in the Vietnamese population in Santa Clara County is similar to that of other Asian populations. There was a relatively high prevalence of anti-RNP antibody in our patient group which was associated with overlap features. As expected in an immigrant population from Southeast Asia, there was a high rate of prior exposure to tuberculosis and hepatitis B. Clinicians should diligently screen for these infections and appropriately prophylaxe and treat patients.
Adult↗
Evaluative laboratory testing practices of United States rheumatologists.
OBJECTIVE: Several laboratory tests can be used to monitor disease activity in patients with rheumatic diseases. We sought to learn how rheumatologists use evaluative laboratory tests in the care of patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. METHODS: We surveyed United States rheumatologists by mailed questionnaire. Of the 976 rheumatologists who received the questionnaire, 575 responded, for a response rate of 59%. RESULTS: Eighty-six percent of the respondents reported using either the erythrocyte sedimentation rate (ESR) or C-reactive protein level to monitor patients with RA, 92% used either the anti-DNA antibody level or complement C3 level to monitor patients with SLE, and 95% used either the ESR or ANCA levels to monitor patients with ANCA-associated vasculitis. The frequency of testing was distributed over a broad range, but testing was common. Testing on 50% of the visits or more was reported by 52% of respondents for RA, 59% of respondents for SLE, and 64% of respondents for ANCA-associated vasculitis. Between 7% and 11% of respondents reported testing patients on every visit, regardless of clinical disease activity. The majority of respondents reported not altering the treatment of clinically stable patients based on these test results. CONCLUSION: Evaluative laboratory testing is common, and is rarely used as an independent guide for treatment.
Antibodies, Antineutrophil Cytoplasmic↗
Influence of secondary structure on the decay kinetics of fluorescent donor-acceptor labelled peptides.
Time-resolved fluorescence decays from a series of methoxynaphthalene labelled peptides in ethyl acetate were monitored over the temperature range -40 to 60 degrees C. The quenching effect of a piperidone acceptor group placed at various positions along the peptide chain relative to the fluorescent methoxynaphthalene donor was studied. In this moderately polar solvent the mechanism of quenching is most likely electron transfer, although a Dexter exchange mechanism cannot be ruled out. Both donor and acceptor moieties were covalently attached to the side-chains of glutamic acid residues. These were either placed adjacently, in the case of a dipeptide, or separated by three and six amino acids within a 12 and 15 amino-acid oligopeptide, respectively. The presence of the piperidone group resulted in a reduction in the fluorescence lifetime and a change from a simple monoexponential decay to more complex behaviour. This was found to vary reversibly with temperature and not to be caused by impurities. Modelling of the fluorescence decays was carried out using either the sum of two exponentials or a distribution of decays. For the dipeptide the best fit was a distribution while in the case of the 12-mer two clearly distinguishable populations could be observed. The results for the 15-mer were equivocal. Importantly, regardless of the fitting method used the quenching rate was found to be fastest for the 12-mer. The slower quenching rates observed for the dipeptide compared to the oligopeptides provide strong evidence that secondary structure promotes better electronic coupling between the donor and acceptor. The biexponential fluorescence behaviour for the 12 amino-acid oligopeptide is ascribed to two slowly (> 10 ns) interconverting conformational states. Comparison with circular dichroism and infrared obtained in acetonitrile indicates these two conformers are likely to be an alpha-helix and a 3(10)-helix with electronic coupling strongest in the latter case.
Fluorescence↗
Musculoskeletal complaints and fibromyalgia in patients attending a respiratory sleep disorders clinic.
OBJECTIVE: To determine the frequency of fibromyalgia (FM) syndrome and reporting of pain in an unselected group of patients attending a respiratory sleep disorders clinic, and to examine the association of physical activity and levels of reported pain. METHODS: 108 consecutive patients attending a respiratory sleep disorders clinic were interviewed and examined, blind to sleep disorder status. Assessment of musculoskeletal pain symptoms included patient history of pain, painful sites marked on a mannequin, visual analog scale (VAS) pain score, and tender point count. Daily physical activity was recorded, and all patients underwent nocturnal polysomnography, blind to clinical status. RESULTS: FM was identified in 3 patients (2.7%). Pain reporting was more strongly associated with reduced physical activity than with a specific sleep disorder. Patients with reduced physical activity were more likely to have pain symptoms than physically active patients: tender point count > or = 6 (p = 0.002), > or = 3 sites marked on mannequin (p = 0.008), axial pain (p = 0.003), and VAS pain score (p = 0.008). CONCLUSION: FM by defined criteria was uncommon in patients with a primary complaint of disturbed sleep, and in particular, patients with sleep apnea. Reduced physical activity was strongly associated with reported pain symptoms.
Ambulatory Care Facilities↗
A retrospective analysis of timing of mobilisation and start of enteral feeding in 19 patients treated non-surgically for splenic trauma.
PURPOSE: Analysis of outcome in terms of the moment at which mobilisation and enteral feeding may be started in patients undergoing non-surgical treatment for splenic trauma. MATERIALS & METHODS: 19 patients, median age 29 years, admitted to our hospital between 1988 and 1993. The diagnosis of splenic trauma was confirmed by abdominal computerized axial tomography and the lesions classified according to severity. Initial clinical and paraclinical diagnostic indices, evolution, duration of bed-rest and of nil by mouth-regimen, clinical follow-up at 30 months were recorded. RESULTS: 12 patients had type I or II lesions and 6 had type III lesions according to the Buntain classification [5]. 2 patients with type III lesions underwent laparotomy on the 4th day posttrauma. 11 patients had other associated lesions and 12 were admitted to the surgical intensive care unit (SIC). Bed rest was continued for an average of 2.7 days and enteral nutrition was restarted an average of two days after trauma when bowel sounds reappeared. All patients survived to leave hospital and 90% were alive at 30 months. CONCLUSIONS: Mobilisation and enteral feeding in patients treated non-surgically for Buntain type I, II and III splenic lesions should be restarted as soon as the clinical course allows.
Abdominal Injuries↗
Does the addition of morphine to brachial plexus block improve analgesia after shoulder surgery?
We have studied 40 patients undergoing elective shoulder surgery for chronically painful conditions. Patients were allocated randomly to two groups and received interscalene brachial plexus block with 0.5% bupivacaine and adrenaline 1/200,000 40 ml either alone or with the addition of morphine 5 mg. All patients also received a general anaesthetic. The quality of the block, analgesic requirements and any complications or side effects were noted in the intraoperative period and during the 48 h after operation. No significant difference was seen in quality of analgesia or patient satisfaction between the two groups.
Adult↗
Streptococcus milleri pulmonary disease: a review and clinical description of 25 patients.
BACKGROUND: Streptococcus milleri is increasingly being recognised as an important pulmonary pathogen which may lead to the development of empyema or lung abscess. Although several small series have been reported, the clinical and laboratory features have yet to be fully characterised. METHODS: Twenty five cases were identified and the clinical and laboratory data from case records were analysed. RESULTS: There were 16 empyemas, five lung abscesses, and four with both lung abscess and empyema. The mean age of the patients was 61 years (range 36-89) and 84% were men. The most common symptoms at presentation were shortness of breath, chest pain, cough, and weight loss; only 36% had a fever. Four of the nine patients with lung abscess required a diagnostic lobectomy because of suspected malignancy. Predisposing factors were present in 80% of patients and included the following: pneumonia, periodontal disease, excess alcohol intake, previous thoracic surgical procedures, and malignancy. Laboratory features of S milleri infection were leucocytosis, neutrophilia, anaemia, abnormal liver function tests, and hypoalbuminaemia. In the group with empyema five patients had a pneumothorax on initial presentation and pleural loculation occurred in 10 of these patients. The median stay in hospital was 34 days (range 11-88). Six patients died, five of whom had significant underlying illnesses. CONCLUSIONS: Pulmonary infection with S milleri may result in considerable morbidity and mortality, and is characterised by a strong male predominance, non-specific symptoms (often without toxicity), the presence of predisposing factors, pleural loculation, pneumothorax, and a protracted stay in hospital.
Adult↗
Cocci infections: managing a forgotten threat.
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Drug Resistance, Microbial↗
An evaluation of a combined spinal/epidural needle set utilising a 26-gauge, pencil point spinal needle for caesarean section.
We have conducted a prospective study into the ease of use and incidence of postdural puncture headache with the 'Portex' combined spinal/epidural set. The pack contains a 16-gauge Tuohy needle of standard 8 cm shaft length with a matching 26-gauge pencil point spinal needle. The study included 150 consecutive combined spinal/epidural anaesthetics for lower segment Caesarean section. Eighty-eight percent of the cases fulfilled the criteria as technically perfect, i.e. cerebrospinal fluid obtained at the first attempt after identifying the epidural space. There were two cases of significant postdural puncture headache requiring blood patch due to puncture by the 26-gauge spinal needle giving an incidence of 1.3%. This compares favourably with previously reported rates in obstetric patients.
Anesthesia, Epidural↗
The diagnosis of small bowel bacterial overgrowth in elderly patients.
OBJECTIVE: To examine the frequency of small bowel bacterial overgrowth in elderly subjects. DESIGN: Prospective observational study. SETTING: Department of Health Care of the Elderly in a university teaching hospital. PATIENTS: Thirteen elderly control subjects having undergone normal gastroscopy with normal hematology and anthropometry; 39 consecutive referrals of elderly patients with clinical or biochemical evidence of malnutrition. MAIN OUTCOME MEASURES: Duodenal bacterial counts and the 14C-glycocholate, hydrogen, and 14C-xylose breath tests. RESULTS: Five of the 13 control subjects and 21 of 39 patients with malnutrition had high duodenal bacterial counts (greater than 10(5) organisms/mL), whereas only seven patients were judged to have clinically significant bacterial overgrowth. The 14C-xylose breath test showed a high specificity (89%) but a low sensitivity (30%) when compared with the results of duodenal culture. The hydrogen breath tests and the 14C-glycocholate test showed a similar picture of moderately high specificity and low sensitivity (77% and 20%, respectively, for the hydrogen breath test, 76% and 33%, respectively, for the 14C-glycocholate test). CONCLUSIONS: A positive xylose breath test was the best predictor of high duodenal bacterial counts. However, since many elderly subjects have high duodenal bacterial counts, the overdiagnosis of bacterial overgrowth syndrome will result if duodenal culture is relied upon exclusively.
Aged↗
A 26-gauge pencil-point needle for combined-epidural anaesthesia for caesarean section.
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Anesthesia, Epidural↗
Non-Hodgkin's lymphoma and Hodgkin's lymphoma in the same patient.
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Aged↗