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Biomedical subjects

J A Daly

Publications and source records attributed to J A Daly.

34 records · Page 2Linked to original sources

Early dynamics of O2 uptake and heart rate as affected by exercise work rate.

The kinetics of O2 uptake (Vo2) and heart rate (HR) in response to constant work rate exercise have been characterized as two phases, an immediate response as the result largely of abrupt hemodynamic changes and a slower response as the result of increases in both blood flow and arteriovenous O2 difference (avDo2). There are few data reported concerning Vo2 and HR during phase I or the relationship between their kinetics and work rate or intensity. Because phase I responses depend on abrupt cardiovascular adjustments, it was hypothesized that phase I increases in Vo2 and HR would be greater the more "fit" the subject and would be relatively independent of work rate. To test this, 10 normal subjects exercised from rest to each of five work rates ranging from unloaded cycling to 150 W. The phase I increases of Vo2, HR, and Vo2/HR had small but significant correlations with work rate but not with fitness. At very low work rates (unloaded cycling and 25 W), Vo2 and HR often exceeded their steady-state levels in phase I. There was therefore no phase II increase for Vo2 or HR at these work rates, the entire O2 requirement having been met by phase I circulatory adjustments. For all other work rates, mean response times for Vo2 and HR were related to fitness and were slower than those for Vo2/HR, suggesting that avDo2 reached a steady state before cardiac output did.

Adult↗

Sweat iron loss of male and female runners during exercise.

Male (n = 9) and female (n = 8) collegiate cross-country runners were studied during a training session to determine the amount of iron lost in the sweat. Sweat samples were collected from the arm using polyethylene bags. Total sweat loss was determined by weighing subjects before and after the runs. Average time of sweat collection was 42 min for males and 39 min for females. Sweat rate for the males (717.5 +/- 145.9 g/m2/h) was significantly greater than for the females (460.1 +/- 142.9 g/m2/h); however, the sweat rate per km was not significantly different. Females had a significantly greater sweat iron concentration (0.417 +/- 0.024 mg/l) than males (0.179 +/- 0.011 mg/l). Rate of sweat iron loss was not significantly different for females (0.276 +/- 0.140 mg/h) and males (0.21 +/- 0.13 mg/h). Sweat iron concentration was inversely related with sweat rate (r = -0.64). Our data suggest that although males lose more total sweat than females, the higher sweat iron concentration of females leads to similar rates of iron loss. For female runners, sweat iron loss coupled with a low dietary iron intake may result in a negative iron balance.

Adolescent↗

Evaluation of rapid, commercial latex techniques for serogrouping beta-hemolytic streptococci.

The clinical need to rapidly and correctly differentiate beta-hemolytic streptococci into Lancefield groups has prompted the development of commercially available rapid agglutination techniques. A modified Streptex (Wellcome Diagnostics, Research Triangle Park, N.C.) technique and the PathoDx latex Strep Grouping Kit (Diagnostic Products Corporation, Los Angeles, Calif.) technique were applied to 220 strains of beta-hemolytic streptococci that were serologically grouped by standard techniques. Agreements between standard and modified Streptex and PathoDx techniques were 99.1 and 100%, respectively. Modified Streptex produced a false-negative for one group G isolate and a weak-positive reaction for a group G reagent with a nongroupable isolate. Sixty-five strains representative of bacteria that may be found in the posterior pharynx in concentrations high enough to cause potential reactions with antigen detection reagents were tested with Streptex and PathoDx reagents. No cross-reactions were observed with any reagent tested when challenged with these 65 strains. When combined with colonial morphology and hemolytic reaction, both modified Streptex and PathoDx were rapid, specific tests for identifying streptococci, with PathoDx being slightly faster.

Agglutination Tests↗

Resurgence of acute rheumatic fever in the intermountain area of the United States.

We describe an outbreak of acute rheumatic fever that occurred in the intermountain area centered in Salt Lake City, Utah. Seventy-four children meeting the modified Jones criteria for the diagnosis of acute rheumatic fever were evaluated by the staff at Primary Children's Medical Center, Salt Lake City, from January 1985 through June 1986. This represents an eightfold increase over the average annual incidence at this hospital during the past decade. Carditis, a dominant feature of the outbreak, was confirmed by auscultation in 53 of the patients (72 percent). An additional 14 patients were found to have mitral regurgitation by Doppler ultrasound examination, raising the total incidence of carditis to 91 percent. The children were predominantly from white (96 percent) middle-class families with above-average incomes and with ready access to medical care. There was no apparent increase in the incidence of streptococcal disease or other explanation for the marked increase in acute rheumatic fever. However, mucoid M type 18 and M type 3 group A streptococcal strains were isolated from several siblings of the patients and from schoolchildren (chosen at random) in the area. We conclude that acute rheumatic fever remains an important health problem in the United States.

Acute Disease↗

Evaluation of the Strep-A-Chek technique for presumptive identification of group A beta-hemolytic streptococci and group D enterococci.

Strep-A-Check (E-Y Laboratories, San Mateo, CA) is a 15-min chromogenic test for a species-specific aminopeptidase that could replace testing bacitracin susceptibility for presumptive identification of group A streptococci as well as 6.5% NaCl agar tolerance for presumptive identification of enterococcal streptococci, with a time savings of 24 hr. Recent clinical streptococcal isolates (n = 341), identified by conventional biochemical and serologic techniques, were used to evaluate the 15-min Strep-A-Chek test. Among the beta-hemolytic streptococci (176 group A, 43 group B, 8 group C, 9 group F, and 9 group G), Strep-A-Chek was 100% accurate. Among the non-beta-hemolytic streptococci, 100% of 52 group D enterococci, 100% of 30 viridans streptococci, and 100% of 14 group D nonenterococci were correctly identified by Strep-A-Chek. Strep-A-Chek is an extremely rapid and reliable test for presumptive identification of group A and enterococcal streptococci.

Aminopeptidases↗

Lack of correlation between streptococcal Fc receptors and symptomatic pharyngitis.

To determine whether bacterial Fc(gamma) surface receptors are associated with symptomatic streptococcal pharyngitis, throat cultures were obtained from 264 children (grouped according to symptoms of pharyngeal infection) and from 328 who were asymptomatic. Group A beta-hemolytic streptococci which were recovered were tested for the presence of Fc(gamma) surface receptors. There were no statistically significant differences in the incidence of Fc(gamma) surface receptors on strains from the various patient groups.

Carrier State↗

Haemophilus ducreyi.

Haemophilus ducreyi is the etiologic agent of chancroid, an infection which is endemic in tropical and subtropical areas of the world and which is becoming more prevalent in Europe and North America. Recently, several strains have demonstrated resistance to several antimicrobials by plasmid acquisition and cell envelope alteration making control of the spread of this organism a challenge. Equally challenging is the growth of this organism in the clinical microbiology laboratory because of its in vitro fastidious nature. Currently, the therapy of choice for Haemophilus ducreyi infection is trimethoprim sulfamethoxazole or erythromycin. Plasmid enumeration and restriction endonuclease fingerprinting in addition to outer membrane protein profiles may provide a basis for subtyping which would be useful in epidemiologic studies.

Animals↗

In vitro antibacterial activity of SK&F 88070 against aerobic gram-positive and gram-negative cocci and Haemophilus influenzae.

The inhibitory activity of SK&F 88070, a cephalosporin whose kinetic characteristics in animals suggest the possibility of once-daily doses, was determined against 345 clinical isolates, and results were compared with the activities of ceftizoxime, ceftriaxone, moxalactam, methicillin, and ampicillin. The spectrum of SK&F 88070 is similar to that of ceftizoxime.

Ampicillin↗

Evaluation of the Wayson variation of a methylene blue staining procedure for the detection of microorganisms in cerebrospinal fluid.

Meningitis of bacterial origin is a severe infection that must receive immediate attention and prompt treatment. We evaluated a basic fuchsin-methylene blue, ethyl alcohol-phenol staining procedure (Wayson stain) and compared it with the Gram stain procedure for evaluation of cerebrospinal fluid. All smears were prepared within 30 min of receiving the specimen and examined without knowledge of the results of the companion smear or culture. Of 546 specimens entered into the study, 84 were culture positive. Based on the culture results, the sensitivity and specificity of Wayson stain were 90 and 98%, respectively, compared with 73% sensitivity and 99% specificity by Gram stain. We observed that Wayson staining is a particularly sensitive method for screening clinical specimens that contain proteinaceous background material. The Wayson staining procedure is a simple and sensitive technique for early detection of meningitis.

Bacteriological Techniques↗

Differential primary plating medium for enhancement of pigment production by Pseudomonas aeruginosa.

A cost-effective and more rapid means of detection of Pseudomonas aeruginosa in cultures from clinical specimens would be very advantageous. We have developed a modified MacConkey agar (MMA), which enhances pigment production of P. aeruginosa and which, if pyocyanin pigment is present, provides a relatively rapid and very cost-effective identification. The MMA medium inhibits the gram-positive organisms, while lactose- and non-lactose-fermenting gram-negative rods are easily distinguishable from pigment-producing pseudomonads. Organisms that produce pyocyanin, pyoverdin, or pyorubin, or both pyocyanin and pyoverdin, are easily recognized on the medium. Pyocyanin production is clearly distinguishable from other Pseudomonas pigments on MMA. In a comparative study, MMA identified 97% of the P. aeruginosa strains 24 h earlier than routine laboratory biochemical methods. Highly mucoid strains which did not produce detectable pigments on standard biochemicals produced detectable pigments on the MMA within 48 h. This medium can provide a very practical, reliable, and cost-effective means for early characterization of P. aeruginosa.

Culture Media↗

Gonococci with mutations to low-level penicillin resistance exhibit increased sensitivity to the oxygen-independent bactericidal activity of human polymorphonuclear leukocyte granule extracts.

Gonococci which cause disseminated gonococcal infection are nearly always highly penicillin sensitive, in contrast to many isolates causing uncomplicated gonorrhea. We questioned whether any of the known chromosomal mutations to low-level penicillin resistance might adversely affect virulence. The penA2 locus is known to result in low-level resistance to penicillins, whereas mtr-2 results in nonspecific resistance to a variety of antimicrobial agents. We found that the penA2 and mtr-2 mutations each markedly increased sensitivity of strain FA19 to oxygen-independent killing by human polymorphonuclear leukocyte mixed or isolated azurophilic granule extracts. The penA2 and mtr-2 mutations had no effect on sensitivity to serum antibody and complement. Isogenic opaque or transparent variants of several strains of Neisseria gonorrhoeae were equally resistant to human polymorphonuclear leukocyte mixed granule extract bactericidal systems. There were also no differences in susceptibility of piliated type 1 and nonpiliated type 4 variants to human polymorphonuclear leukocyte mixed granule extracts. Since the penA2 and mtr-2 loci are known to increase the degree of cross-linking of cell wall peptidoglycan, the structure of peptidoglycan apparently affects sensitivity to killing by one or more polymorphonuclear leukocyte azurophilic granule extract bactericidal systems. These observations might explain why gonococci with mutations similar to penA2 and mtr-2 are almost never isolated from patients with disseminated gonococcal infection.

Blood Bactericidal Activity↗

An investigation of allograft tolerance: Discordant reactivity to murine H-Y-incompatible lymphoid cell (PEC) and skin grafts.

The extremely sensitive peritoneal exudate cell (PEC) transfer technique has been applied to an investigation of the immune response of female mice which are "tolerant" of the male antigen. Females rendered tolerant of male skin grafts by multiparity, neonatal inoculation of male spleen cells, or multiple inoculations of adult females with male lymphoid cells displayed second-set reactivity to male PEC while continuing to tolerate H-Y-incompatible skin grafts. Furthermore, this discordant response to male PEC and skin was adoptively transferrable to normal females by spleen cells from multiparous donors. Females rendered tolerant by irradiation and reconstitution with male cells were unresponsive to both H-Y-incompatible skin and PEC grafts. A model is proposed using two male-specific antigens, the response to which is controlled by independent genes.

Age Factors↗

Antimicrobial susceptibility of clinical isolates of Haemophilus influenzae to ampicillin-sulbactam.

A total of 1092 clinical isolates of Haemophilus influenzae (306 type b; 786 non-type-b), from five medical centers were obtained during 1987 and 1988. Disk diffusion antimicrobial susceptibilities were obtained for all isolates, and broth microdilution susceptibilities were obtained for 502 isolates. Beta-lactamase was produced by 34.3% of type-b and 22.1% of non-type-b isolates, with some geographic variations. Using disk diffusion antimicrobial susceptibility testing, all isolates were susceptible to ampicillin-sulbactam, ceftriaxone, cefuroxime, and rifampin; two isolates were resistant to chloramphenicol. Whether tested using a fixed ratio of ampicillin to sulbactam of 2:1 or a fixed concentration of sulbactam, the ampicillin-sulbactam combination demonstrated good activity against clinical isolates of H. influenzae. Only 8 of the 1092 isolates did not produce beta-lactamase but demonstrated MICs of greater than or equal to 2 micrograms/ml for ampicillin.

Ampicillin↗

Risk of developing toxic shock syndrome associated with toxic shock syndrome toxin 1 following nongenital staphylococcal infection.

Few risk factors for nonmenstrual toxic shock syndrome (TSS) have been identified. This study sought to determine at what rate and under what circumstances nongenital toxigenic Staphylococcus aureus infections led to TSS. Clinical isolates of S. aureus were examined for the production of TSS toxin 1 (TSST-1), and available sera from infected patients were tested for antibody to this toxin. Twenty-six percent of 810 isolates produced TSST-1. Isolates from children were more likely to be positive for TSST-1 than were those from adults. None of 57 patients with TSST-1-positive staphylococcal infection and a TSST-1 antibody titer of greater than or equal to 1:100 developed TSS. Eight of 65 tested patients with TSST-1-positive isolates had antibody below the presumably protective level of 1:100. Two of these patients had definite TSS, three had probable or possible TSS, and three probably did not have TSS. In patients lacking protective antibody to TSST-1, the interval between acquisition and infection with staphylococci, the type and amount of toxins produced, the site of infection, and still-unclarified aspects of host susceptibility may all affect the rate and severity of TSS.

Adult↗