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Biomedical subjects

F K Gould

Publications and source records attributed to F K Gould.

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

Treatment of Staphylococcus aureus endocarditis using moxifloxacin.

The conventional treatment of staphylococcal endocarditis requires in-patient administration, is inconvenient, and is potentially toxic. Increasing experience with well-absorbed, well-tolerated and highly active agents such as the new quinolones has prompted interest in their use as therapeutic alternatives for the treatment of such infections. We describe a case of staphylococcal endocarditis which failed to respond to conventional therapy, but where the addition of moxifloxacin, an 8-methoxyquinolone, was curative.

Adult↗
PubMed2001

Use of antibiotic locks to treat colonized central venous catheters.

Infections that result from bacterial colonization of central venous catheters are a significant problem in modern healthcare. The most effective means of eradication of such infections is the removal of colonized lines, but line removal carries drawbacks of its own and in many cases the balance of risks favours treatment in situ. Systemic antibiotics are usually administered but these frequently fail to achieve sterilization, and accordingly attention has turned to intraluminal therapy using antibiotic locks, in which 1-2 mL of a concentrated antibiotic solution is instilled to fill the lumen, left for a predetermined period, and removed. The evidence in favour of this technique is anecdotal and should not be allowed to influence any decision about line removal, but is sufficiently encouraging to justify the use of locks when in situ treatment is deemed acceptable. Indications, agents and appropriate administration regimes are discussed.

Aminoglycosides↗
PubMed2001

Infection control policies and practice in Pakistan.

OBJECTIVE: Infectious diseases in Pakistan are one of the main contributors to the burden of disease. The objectives of this article were to examine the various facets of the issue and suggest relatively inexpensive improvements. SETTINGS: The status of infections/infectious diseases both in hospitals and community were considered. METHODS: Studies on infectious diseases from Pakistan published in national and international journals were reviewed and compared with those from more advanced countries. Anecdotal observation and common experience provided bases for some of the points made. RESULTS: The article argues for some cost-effective and readily workable infection control measures in hospital and community. Government department and other organizations that can be mobilized to develop policies on the relevant issues have been identified. CONCLUSION: The article highlights the need for establishing surveillance system for infections and antibiotics on which to base further policies. As with some other development in the country, a culture of accountability in healthcare might provide sound basis for future developments.

Cross Infection↗
PubMed2000

Donor organ transmission of varicella zoster due to cardiac transplantation.

BACKGROUND: We report a case of donor-transmitted varicella zoster viral (VZV) infection in a cardiac transplant recipient. A 15-month-old girl developed primary VZV infection 12 days after cardiac transplantation. The donor suffered from varicella 2 weeks before death from pneumococcal meningitis. METHODS: Despite treatment of the seronegative recipient with intravenous acyclovir from the time of surgery, she developed symptoms of fever, a nonspecific macular rash, and small palatal vesicles. RESULTS: After rapid diagnostic confirmation by direct immunofluorescence on vesicular fluid, high-dose intravenous acyclovir was commenced. In addition, the cyclosporine dose was reduced by 25%. The child made a quick and uncomplicated recovery. CONCLUSIONS: Donor organ transmission of VZV has not, to our knowledge, been previously reported. It occurred despite treatment with acyclovir and resulted in an atypical cutaneous eruption. It responded to an increased dose of acyclovir and a reduced level of immunosuppression.

Acyclovir↗
PubMed2000

Evaluation of p-naphtholbenzein-beta-D-galactoside as a substrate for bacterial beta-galactosidase.

We describe the synthesis of a new substrate for the detection of beta-galactosidase and evaluate its performance in comparison with 5-bromo-4-chloro-3-indolyl-beta-D-galactopyranoside (X-Gal) and cyclohexenoesculetinbeta-D-galactoside (CHE-Gal). Of 206 Enterobacteriaceae strains able to hydrolyze X-Gal, 194 (94.2%) hydrolyzed CHE-Gal and 192 (93.2%) hydrolyzed p-naphtholbenzein-beta-D-galactoside (PNB-Gal). We conclude that PNB-Gal is an effective substrate for the detection of beta-galactosidase.

Chromogenic Compounds↗
PubMed2000

Heat disinfection of clinical waste: microbiological assessment and monitoring of effectiveness.

Simple, rapid and reproducible protocols are described for the microbiological assessment of clinical waste treatment processes, using Bacillus subtilis spore tests and end-product sampling. The use of these protocols to commission a new heat disinfection system (HDS), based on a hot oil-filled auger, and to monitor it over the first 21 months of operation is described. It is suggested that these protocols are suitable for assessment of other non-burn heat-treatment technologies.

Bacillus subtilis↗
PubMed1999

Prosthetic heart valve endocarditis caused by Bacillus circulans.

We report a case of prosthetic valve endocarditis due to Bacillus circulans in a 56-year-old woman. Pre-operative blood cultures were negative and the organism was only recovered on culture of the explanted mechanical valve. We discuss the reasons for the late clinical presentation of this case, 15 months post valve replacement, caused by an organism which is conventionally regarded as 'early' pathogen. The patient recovered well post surgery on a 6 week course of trimethoprim and ciprofloxacin.

Anti-Bacterial Agents↗
PubMed1999

Evaluation of tube coagulase and a fluorogenic substrate for rapid detection of methicillin-resistant Staphylococcus aureus from selective enrichment broth in an outbreak of EMRSA 15.

We investigated the use of tube coagulase and a fluorescent substrate, N-t-BOC-val-pro-arg-7-amido-4-methylcoumarin for the rapid detection of MRSA in selective broth enrichment cultures during an outbreak. These methods were compared with direct plating of swabs and plating a selective broth enrichment culture using 200 screening swabs collected from forty patients during the investigation of an outbreak of E-MRSA 15. Overall 66 swabs were positive for MRSA following subculture of broth enrichment culture. Direct plating detected 25 (38%) positives, tube coagulase 37 (56%), and fluorescent substrate 49 (74%) respectively, although nine of the 49 turned out to be false reactions. When detection from individual patients was analyzed, selective broth subculture identified 28 patients colonized with MRSA. Direct plating detected only 12 (43%) of these patients. The tube coagulase and fluorescence methods detected MRSA in 17 (60%) and 19 (68%) patients respectively. The tube coagulase method was found to be 100% specific for MRSA suggesting its use as a rapid method for the detection of MRSA from selective enrichment broth.

Bacteriological Techniques↗
PubMed1999

Significance of Epstein-Barr virus status and post-transplant lymphoproliferative disease in pediatric thoracic transplantation.

Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disease (PTLD) is a serious complication of organ and bone marrow transplantation. The importance of EBV matching between recipient and donor remains unclear. Between October 1987 and December 1997, 64 pediatric cardio-pulmonary transplants were performed at this center (58 hearts, two heart/lungs, four sequential single lungs). The EBV viral capsid antigen (VCA) immunoglobulin G (IgG) status of both donor and recipient was determined at the time of transplant. Of 56 patients from whom paired sera was available for analysis, 27 (50%) were recipient and donor EBV IgG positive, four (7%) were recipient EBV IgG positive and donor EBV IgG negative, and 12 (20%) were recipient EBV IgG negative and donor EBV IgG negative. The remaining 13 (23%) patients were EBV IgG negative but received organs from EBV IgG-positive donors. The EBV immunoglobulin M (IgM) status was determined from 6 weeks post-transplant in the 11 mismatches who survived for longer than 28 d. Seven became EBV IgM positive, two remained EBV IgM negative; the status of the remaining two remains unknown. The EBV IgM status was also determined retrospectively in patients who were EBV IgG negative pretransplant and received organs from EBV IgG-negative donors. Nine became EBV IgM positive; the rest remained negative. PTLD was diagnosed in two of 56 patients from whom paired sera was available; one was donor and recipient EBV IgG negative; the other was donor and recipient EBV IgG positive. No cases of PTLD were diagnosed in the remaining eight patients from whom paired sera was not available. Our experience suggests that PTLD does not occur with any greater frequency in the 'mismatch' group, and does not justify EBV matching in pediatric thoracic transplantation where there is a higher proportion of EBV-negative recipients than in adults.

Adolescent↗
PubMed1999

Prevention of nosocomial infection in solid organ transplantation.

Despite improvements in survival rates, infection remains an important cause of morbidity and mortality following solid organ transplantation. Prevention of infection and, failing this, prompt diagnosis and treatment remain the cornerstones of management. During the peri-operative admission, when the level of immunosuppression is at its height, nosocomial infection accounts for the majority of infective morbidity. Although the measures taken to prevent nosocomial infection may vary, centres undertaking such procedures must ensure that strategies are in place to protect patients. The importance of basic infection control measures cannot be over-emphasised. In addition, appropriate prophylactic agents, rapid diagnostic techniques and the early institution of appropriate therapy are essential. As developments in this field advance, the epidemiology of infection will continue to change, demanding an ongoing assessment of preventative, diagnostic and therapeutic strategies.

Cross Infection↗
PubMed1999

Very large (CAG)(n) DNA repeat expansions in the sperm of two spinocerebellar ataxia type 7 males.

Genetic anticipation, i.e. increasing disease severity and decreasing age of onset from one generation to the next, is observed in a number of diseases, including myotonic dystrophy type 1, Huntington's disease and several of the spinocerebellar ataxias. All of these disorders are associated with the expansion of a trinucleotide repeat and array length is positively correlated with disease severity and inversely correlated with the age of onset. The expanded repeat is highly unstable and continues to expand from one generation to the next, providing a molecular explanation for anticipation. Spinocerebellar ataxia type 7 (SCA7) is one of the latest additions to the list of triplet repeat diseases and is distinct from the other SCAs in that it is accompanied by retinal degeneration. Pedigree analyses have previously revealed that the SCA7 repeat is highly unstable and liable to expand, in particular when transmitted by a male. Surprisingly, though, an under-representation of male transmission has also been reported. We now demonstrate directly by single molecule analyses that the expanded repeat is extraordinarily unstable in the male germline and biased toward massive increases. Nearly all of the mutant sperm of two SCA7 males contain alleles that are so large that most of the affected offspring would at best have a severe infantile form of the disease. Indeed, the gross under-representation of such very large expanded alleles in patients suggests that a significant proportion of such alleles might be associated with embryonic lethality or dysfunctional sperm.

Alleles↗
PubMed1999

Glycopeptide tolerance in bacteria causing endocarditis.

Glycopeptides have been recommended as therapy for endocarditis. MICs and MBCs of vancomycin and teicoplanin were compared for 100 isolates from patients with proven bacterial endocarditis. MICs were generally lower for teicoplanin and tolerance to both agents was common. Almost all isolates of enterococci were tolerant to both glycopeptides. Among the streptococci, 78% were tolerant to teicoplanin and 57% to vancomycin. Similar findings were demonstrated for staphylococci. Although isolates appear sensitive to glycopeptides, bactericidal activity cannot always be predicted. If a glycopeptide is indicated for treatment of endocarditis, combination therapy with a suitable aminoglycoside should be considered unless MBC testing can be performed.

Anti-Bacterial Agents↗