Search PubMed⌕ Search

Biomedical subjects

G O Minns

Publications and source records attributed to G O Minns.

5 recordsLinked to original sources
PubMed2003

A network-informed approach to investigating a tuberculosis outbreak: implications for enhancing contact investigations.

BACKGROUND: To elucidate networks of Mycobacterium tuberculosis transmission, it may be appropriate to characterize the types of relationships among tuberculosis (TB) cases and their contacts (with and without latent TB infection) in addition to relying on traditional efforts to distinguish 'close' from 'casual' contacts. SETTING: A TB outbreak in a US low incidence state. OBJECTIVE: To evaluate whether social network analysis can provide insights into transmission settings that might otherwise go unrecognized by routine practices. DESIGN: All adult outbreak-associated cases (n = 19) and a convenience sample of their contacts with and without latent TB infection (LTBI) (n = 26) were re-interviewed in 2001 using a structured questionnaire. Network analysis software was used to create diagrams illustrating important persons within the outbreak network, as well as types of activities TB cases engaged in with their contacts. RESULTS: Drug use and drug sharing were more commonly reported among cases and their infected contacts than among contacts without LTBI. TB cases central to the outbreak network used crack cocaine, uncovering the need to focus control efforts on specific sites and persons involved in illicit drug use. CONCLUSION: Outbreaks occur even in areas with low TB incidence, frequently among groups whose drug use or other illegal activities complicate control efforts. TB programs should consider the use of network analysis as a supplement to routine contact investigations to identify unrecognized patterns of M. tuberculosis transmission.

Adolescent↗
PubMed1995

Rebound of plasma free phenytoin concentration following plasmapheresisin a patient with thrombotic thrombocytopenic purpura.

OBJECTIVE: To measure the total and free serum phenytoin concentrations and phenytoin clearance in a patient with thrombotic thrombocytopenic purpura undergoing plasmapheresis. CASE SUMMARY: A dose of phenytoin 400 mg i.v. was administered daily 2.5 hours after the completion of plasmapheresis. Intravenous samples were obtained to measure the free and total phenytoin concentrations on 4 consecutive days. These samples were obtained before, at the midpoint, upon completion, and 30, 60, and 120 minutes after completion of plasmapheresis. The samples were centrifuged and stored at 4 degrees C until analysis using the same fluorescence polarization immunoassay kit. The free phenytoin was separated by ultracentrifugation. DISCUSSION: Despite a decrease in total and free serum phenytoin concentrations measured during the procedure, a marked rebound in the free phenytoin concentration was noted 30 minutes after completion of the procedure. However, by 120 minutes after the procedure, the free phenytoin concentration had decreased to the preprocedure value. The total amount of phenytoin removed by the procedure was less than 5%. CONCLUSIONS: Despite the decrease in total and free serum phenytoin concentrations observed during plasmapheresis, patients undergoing plasmapheresis may not need supplemental phenytoin, as a rapid reequilibration of the therapeutically active free serum phenytoin occurs following the completion of the procedure. In addition, less than 5% of the total body phenytoin is removed. Second, if the patient experiences symptoms of phenytoin toxicity immediately after the procedure, a free serum phenytoin concentration may be obtained, as this concentration may reflect the reason for toxicity despite a decreased total phenytoin concentration.

Adolescent↗
PubMedDate not supplied

Postpartum myocardial infarction: association with primary coronary artery dissection.

CASE SUMMARY: A 36-year-old woman presented with an acute myocardial infarction 2 weeks after the birth of her first child. The patient had smoked two packs of cigarettes a day for 12 years and had been taking bromocriptine to suppress lactation. While in the emergency room, the patient went into ventricular fibrillation, but defibrillation successfully restored sinus rhythm. Coronary angiography revealed several atherosclerotic lesions. The patient refused to undergo coronary artery bypass grafting, and she was discharged receiving medical therapy. DISCUSSION: Forty-eight cases of postpartum myocardial infarction have previously been reported; the present case makes 49. In 41 cases a cardiac examination was performed, either on necroscopy or by angiography. Twenty-two (54%) of the 41 patients had occlusion related to primary coronary artery dissection, 11 (27%) had normal coronary arteries and presumed spasm, and only 6 (15%) had atherosclerosis-related coronary occlusion. The mortality rate was 39%, and surviving patients had significant cardiac limitation. CONCLUSION: Postpartum myocardial infarction and coronary occlusion, when they do occur, are frequently caused by primary coronary artery dissection. Immediate recognition of this association may significantly reduce morbidity and mortality for these patients.

Adult↗