Penicillin-resistant pneumococcal meningitis.
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Biomedical subjects
Publications and source records attributed to G M Scott.
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1. OBJECTIVE--To evaluate the status of clinical development of zidovudine and new drugs for the treatment of Human Immunodeficiency Virus (HIV) infections. 2. METHOD--A critical review of the clinical trial reports and assessment of the design and methodology of the therapeutic trials. Evaluation of the drugs being tested and of the specific difficulties in testing drugs in AIDS. 3. CONCLUSIONS--Drugs are being tested in a unique climate of public opinion characterised by (1) fast track criteria for regulatory approval (2) parallel track (compassionate release) of new drugs before adequate determination of safety and efficacy (3) resistance to the use of placebos in controlled trials.
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Eighteen patients with recently diagnosed pulmonary tuberculosis were studied for factors which could predict, at the outset, reactions to treatment. Abnormally low corticosteroid responses to tetracosactrin were seen in some but not all of the patients who deteriorated while on treatment. Those who deteriorated transiently or died had pre-treatment C-reactive protein (CRP) concentrations above 20 mg/l, which then persisted. As previously observed, those who responded unfavourably were older, had extensive disease and presented with hypoalbuminaemia and hyponatraemia.
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The performance of the Axicare human milk pasteurizer was evaluated under different load conditions. The design criteria for pasteurisation specified that milk should be held at 63 degrees C for 30 min. The holding time at this temperature was insufficient if bottles of milk frozen at -20 degrees C were placed into the machine as directed, after the water-bath preheating phase. However, if the machine was loaded with frozen bottles before the whole cycle was commenced, adequate thawing and warming to holding temperature was achieved in sufficient time for satisfactory pasteurization. The pasteurizer gave consistent and adequate temperature and time conditions. The seals on three types of bottles tested tended to leak during the pasteurization cycle but no method of avoiding this problem was established.
Thirty hospitalized patients with newly diagnosed tuberculosis were studied prospectively with a range of in vitro and in vivo tests of immune function. Responses were compared with those of healthy controls matched for age, sex, ethnic group and diet. A series of metabolic and immunologic abnormalities was found, including evidence of undernutrition, anaemia, neutrophil leucocytosis, monocytosis, lymphopenia, hyperglobulinaemia and raised erythrocyte sedimentation rate. Some patients had accelerated, others diminished, cutaneous tuberculin hypersensitivity, and some had diminished mononuclear cell proliferative and lymphokine responses to tuberculin (purified protein derivative, PPD). The patients were not uniform in their responsiveness, but could be arranged within a spectrum which showed a relationship to crude bacillary excretion and response to treatment. 27% of patients were characterized by hypersensitivity, with normal in vitro cellular responses and skin tests to PPD, scanty bacillary excretion and rapid bacteriologic sputum conversion to negative cultures with treatment. In contrast, 30% of patients were relatively anergic with negative skin tests, reduced or absent in vitro cellular reactivity to PPD, moderate or heavy bacillary excretion and later (greater than 4 weeks) bacteriologic sputum conversion. The remainder of the patients fell between these two groups. There were no correlations between cellular immunity on the one hand, and radiological extent of disease, levels of serum immunoglobulins, peripheral white cell counts or ESR on the other. In those patients followed throughout treatment, all the abnormalities with the exceptions of arm muscle circumference and serum albumin, reverted to the normal ranges established in the control group.
An outbreak of epidemic methicillin-resistant Staphylococcus aureus occurred on a rehabilitation geriatric ward. Intensive screening of patients and staff revealed an unusually high carriage rate in the nursing staff (38%), thought to be related to a ward cat which was heavily colonized from the environment. Infection control measures and removal of the cat led to rapid resolution of the outbreak.
An 8-year-old boy developed acute herpes simplex virus stomatitis followed by transient facial palsy. The possible relationship between this virus and Bell's palsy is discussed.
Streptococcus pyogenes is a potential cause of serious infections in plastic surgery and burns units. We report an outbreak of this organism in one such unit, which was successfully managed by closing the ward, and treating infected patients with a new antibiotic, teicoplanin.
Specimens from a total of 162 patients were studied prospectively using a rapid nucleic acid synthesis inhibition assay and a plaque-reduction assay to detect interferon levels in serum and cerebrospinal fluid. The specificity, consistency, and diagnostic applications of the rapid assay were evaluated by intensively investigating each patient for possible viral illness. Forty-one percent of patients with proven acute virus infections (excluding those with acute hepatitis and infectious mononucleosis) had unequivocal detectable interferon in serum or cerebrospinal fluid, compared with only two patients with bacterial infections (7%) who had equivocal interferon in the serum. Retrospective analysis showed the test to have high specificity for virus infections, but in patients with clinical syndromes of uncertain aetiology the test was not a particularly sensitive indicator of the presence of subsequently detected virus. The presence of interferon was not related to the time during the illness at which the sample was taken, nor to the numbers of lymphocytes in the cerebrospinal fluid, nor to the patients' general symptoms.
Under double-blind conditions, groups of volunteers (68 in total) were allocated at random to take intranasal solutions of placebo or one of three doses of highly purified leucocyte interferon by intranasal spray twice a day for 28 days. The highest dose would have been expected to protect against experimental colds. Treatment was discontinued because of upper respiratory symptoms as often in each of the interferon groups as in the placebo group. However, it was possible to distinguish clinically between "colds" on placebo and low-dose interferon and "reactions to treatment" on high-dose interferon. The features of the reactions to treatment were a protracted build-up of local symptoms and minor epistaxis. None of the volunteers on the high-dose interferon were thought to have a definite cold, but viruses were isolated from four out of six volunteers on low-dose interferon who had definite colds. Previous experiments had also shown this dose to be insufficient to protect against experimental rhinovirus challenge. The dose of interferon that appeared to protect against virus infection caused significant unwanted effects. It is essential to find interferon preparations with less inflammatory activity before interferon can be considered for use as a long-term prophylactic against the common cold.
Natural killer (NK) cell activity was studied in 27 patients with active tuberculosis and 27 healthy controls matched for age, sex, ethnic origin and diet. Spontaneous and interferon (IFN)-augmented NK cytotoxicity against K562 target cells were measured, using a 4-hour 51Cr-release assay. There were no differences between the patients and their matched controls in mean spontaneous and IFN-augmented cytotoxicity before and during antituberculosis chemotherapy. However, one malnourished alcoholic patient with extensive non-reactive multibacillary disease had depressed NK cell activity which was not significantly enhanced by in vitro pretreatment with leucocyte IFN. We conclude that the NK system is not of prime importance in host defence against human tuberculosis, although advanced disease may be associated with deficient NK activity, as part of generalized anergy.
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Production of interferon (IFN)-alpha and -gamma by peripheral blood mononuclear cells (PBMC) were studied in 28 patients with active tuberculosis and 28 healthy control subjects matched for age, sex, ethnic origin and diet. No significant differences were found between patients and matched controls in mean titres of IFN-alpha induced by Newcastle disease virus, IFN-gamma induced by staphylococcal enterotoxin A with tetrahydrophorbyl acetate, and IFN-gamma induced by purified protein derivative (PPD). However, a subset of nine out of 25 tuberculosis patients tested produced low titres (less than 100 u/ml) of IFN-gamma in response to PBMC stimulation with PPD. In comparison to other patients, this group was characterized by lower IFN-alpha and IFN-gamma responses to virus and mitogens respectively, relative anergy to tuberculin skin testing, depressed in vitro PBMC proliferative responses to PPD, and neutrophil leucocytosis. In all nine patients effective chemotherapy restored cutaneous reactivity, PBMC proliferative responses, neutrophil counts and IFN-alpha responses to virus by 6 months, and also IFN-gamma responses to PPD in one patient re-tested.
Eleven male patients with genital warts were given injections of fibroblast interferon (300 u) and placebo into the bases of two similar warts. The changes in size of the treated warts compared with that of the controls suggested that interferon did inhibit the growth of the warts. The dose given was probably insufficient for a dramatic effect. In one patient, however, a wart on the penile shaft was injected with interferon and did disappear within two weeks whereas an untreated meatal wart increased in size.