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Biomedical subjects

J M Miller

Publications and source records attributed to J M Miller.

At least 91 records · Page 5Linked to original sources
PubMed2000

Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital: a role for species and strain identification.

OBJECTIVES: To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI). SETTING: 400-bed community hospital. DESIGN: Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC). Retrospective review of medical records of 37 patients with multiple cultures positive for CNS. RESULTS: During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had > or =2 positive cultures. Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions. Species identification and strain clonality of CNS isolates from patients with > or =2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the > or =2 positive cultures, suggesting that CNS from these patients probably were contaminants. Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and > or =2 positive blood cultures. CONCLUSIONS: Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with > or =2 positive blood cultures.

Adolescent↗
PubMed2000

Outcomes in a referral cohort of patients with anxiety disorders.

This study describes 6- and 12-month outcomes in a referral cohort with anxiety disorders and identifies treatment and prognostic factors related to these outcomes. Patients were recruited at three general hospital clinics, two psychologist-run clinics, and one psychiatric hospital clinic. Outcomes included severity of symptoms, physical and mental health status, and subjective global change in problem severity. Of 254 patients eligible for follow-up, 165 (65.0%) completed a follow-up questionnaire. Methods of treatment included consultation with return to the primary care physician (38.2%); or continued treatment at the clinic, with medications (16.4%), psychotherapy (22.4%), or both (23.0%). Both severity of symptoms and mental health status improved but remained abnormal at follow-up. In multiple logistic regression, subjective global improvement was related to a diagnosis of panic disorder only, treatment with psychotherapy, and type of referral. Change over time in symptom severity was related to clinic type, and change over time in mental health was related to clinic type and duration of previous treatment.

Adult↗
PubMed2000

Measurement of refractive error in Native American preschoolers: validity and reproducibility of autorefraction.

PURPOSE: To examine (1) reproducibility of cycloplegic retinoscopy (C-RNS), cycloplegic autorefraction (C-Autoref), and noncycloplegic autorefraction (NC-Autoref), and (2) validity of C-Autoref and NC-Autoref compared with C-RNS in preschoolers with astigmatism. METHODS: Subjects were 36 Native American preschoolers. Three measurements of right eye refractive error were obtained with each of three methods: C-RNS (by three different retinoscopists), C-Autoref, and NC-Autoref (Nikon Retinomax K+). Vector methods (vector dioptric distance, VDD) were used in the analyses. RESULTS: Mean reproducibility was 0.41 D (SD = 0.18) for C-RNS, 0.25 D (SD = 0.17) for C-Autoref, and 0.37 D (SD = 0.21) for NC-Autoref. Mean agreement between C-Autoref and C-RNS ranged from 0.51 to 0.61 VDD (SD = 0.24 to 0.35), and ranged from 1.66 to 1.74 VDD (SD = 1.11 to 1.25) for agreement between NC-Autoref and C-RNS. Mean bias was -0.07 +0.21 x 149 and -1.33 +0.34 x 178 for C-Autoref and NC-Autoref, respectively. CONCLUSIONS: C-Autoref provided reliable and valid measurements of refractive error in young children. NC-Autoref measurements were reliable within subjects, but there was large variability in validity among subjects.

Arizona↗
PubMed2000

Inter-rater and intra-rater reliability in the interpretation of MTI Photoscreener photographs of Native American preschool children.

PURPOSE: To evaluate inter- and intra-rater reliability for the interpretation of MTI Photoscreener photographs taken in a population of Native American preschool children with a high prevalence of astigmatism. METHODS: Photographs of 369 children were rated by 11 nonexpert and 3 expert raters. Photographs for each child were scored as pass, refer, or retake. Nonexpert raters scored photos on two separate occasions, permitting analysis of intra-rater reliability. RESULTS: Analyses of pass/refer responses only: inter-rater reliability was moderate to substantial among nonexpert raters and substantial among expert raters. Intra-rater reliability among nonexperts was substantial. Analyses of all responses (pass, refer, and retake): inter-rater reliability for pass and refer scores was moderate among nonexperts and substantial among experts; for retake scores inter-rater reliability was slight for nonexperts and moderate for experts. Intra-rater reliability among nonexperts was substantial for pass and refer scores and moderate for retake scores. CONCLUSIONS: In this population with a high prevalence of astigmatism, whether MTI photoscreening results are interpretable is much more variable among and within raters than whether an interpretable photograph should be scored as pass or refer. The level of agreement among raters in the current study was influenced by the experience of the raters. In addition, nonexpert raters were more likely to deem a photograph uninterpretable than expert raters.

Arizona↗
PubMed2000

Classification of Proteus vulgaris biogroup 3 with recognition of Proteus hauseri sp. nov., nom. rev. and unnamed Proteus genomospecies 4, 5 and 6.

Strains traditionally identified as Proteus vulgaris formed three biogroups. Biogroup 1, characterized by negative reactions for indole production, salicin fermentation and aesculin hydrolysis, is now known as Proteus penneri. Biogroup 2, characterized by positive reactions for indole, salicin and aesculin, was shown by DNA hybridization (hydroxyapatite method) to be a genetic species separate from biogroup 1 and from biogroup 3 which is positive for indole production and negative for salicin and aesculin. In this study, 52 strains were examined, of which 36 strains were Proteus vulgaris biogroup 3, which included the current type strain of the species P. vulgaris (ATCC 29905T), and compared to seven strains of Proteus vulgaris biogroup 2 and nine type strains of other species in the genera Proteus, Providencia and Morganella. By DNA hybridization, these 36 strains were separated into four distinct groups, designated as Proteus genomospecies 3, 4, 5 and 6. DNAs within each separate Proteus genomospecies were 74-99% related to each other in 60 degrees C hybridization reactions with < or = 4.5% divergence between related sequences. Proteus genomospecies 3 contained the former P. vulgaris type strain and one other strain and was negative in reactions for salicin fermentation, aesculin hydrolysis and deoxyribonuclease, unlike the reactions associated with strains considered as typical P. vulgaris which are positive in reactions for salicin, aesculin and DNase. Genomospecies 3 can be distinguished from Proteus genomospecies 4, 5 and 6 because it is negative for Jordan's tartrate. Proteus genomospecies 4, containing five strains, was differentiated from Proteus penneri, genomospecies 3 and 6 and most, but not all, strains of genomospecies 5, by its ability to ferment L-rhamnose. Proteus genomospecies 5 and 6, containing 18 and 11 strains, respectively, could not be separated from each other by traditional biochemical tests, by carbon source utilization tests or SDS-PAGE of whole-cell proteins. In an earlier publication, a request was made to the Judicial Commission that the former type strain of P. vulgaris (ATCC 13315) be replaced by P. vulgaris biogroup 2 strain ATCC 29905T, a strain considered more biochemically typical of P. vulgaris strains. This would have the effect of assigning the name P. vulgaris to P. vulgaris biogroup 2. Since this request has been acceded to, the name Proteus hauseri is herein proposed for Proteus vulgaris genomospecies 3. Its type strain is ATCC 700826T. Proteus genomospecies 4, 5 and 6 will remain unnamed until better phenotypic differentiation can be accomplished. All Proteus genomospecies were similar in their antimicrobial susceptibility patterns. Nineteen strains were isolated from urine, four from faeces, two from wounds, nine from other human sources and two from animals.

Anti-Bacterial Agents↗
PubMed2000

Atrial tachycardia masquerading as atrial flutter following ablation of the subeustachian isthmus.

We report a case of atrial tachycardia masquerading as atrial flutter in a man who had previously undergone catheter ablation for atrial flutter. The recurrent arrhythmia was electrocardiographically almost identical to the prior atrial flutter; at repeat electrophysiologic study, although bidirectional conduction block was observed in the tricuspid annulus-inferior vena caval isthmus, the atrial arrhythmia was readily initiated. Activation mapping suggested typical atrial flutter, but entrainment techniques demonstrated intra-atrial reentry not involving the ablated isthmus. This case illustrates the need to apply entrainment techniques even in cases of apparent "typical" atrial flutter to confirm that putative ablation targets are necessary for tachycardia perpetuation.

Aged↗
PubMed2000

Unusual features of intermediate septal bypass tracts.

INTRODUCTION: Intermediate septal (IS) AV bypass tracts, located along the tricuspid annulus between the His bundle and coronary sinus os, lie in close proximity to the AV node. Surgical or catheter ablation of IS bypass tracts incurs increased risk for development of complete heart block. We report additional unusual features of some IS bypass tracts that distinguish them from typical bypass tracts in other anatomic regions. METHODS AND RESULTS: We analyzed a consecutive series of 150 patients with a history of Wolff-Parkinson-White syndrome and supraventricular tachycardia who underwent ablation of bypass tracts. We studied the incidence and characteristics of AV conduction of IS bypass tracts compared with bypass tracts in other locations. Of the 150 patients in the study, 21 had an IS bypass tract (all had anterograde AV conduction). Ten (48%) of these 21 IS bypass tracts demonstrated anterograde decremental properties with atrial pacing versus 3 (2%) of 129 non-IS bypass tracts (P < 0.001). During ablation, a change in delta wave morphology before total loss of conduction in the IS bypass tract also occurred in 3 (14%) of 21 IS bypass tracts versus 0 of 129 non-IS bypass tracts (P = 0.0004). During ablation, a change in P wave to delta wave interval occurred in 4 (19%) of 21 IS bypass tracts versus 0 of 129 non-IS bypass tracts (P < 0.0001). One IS patient exhibited retrograde Wenckebach block in the bypass tract, and two IS patients showed loss of retrograde bypass tract conduction after ablation attempts that first changed the delta wave morphology. No non-IS patient had these features (P < 0.0001 for each comparison). CONCLUSION: Some IS bypass tracts have unusual properties that distinguish them from bypass tracts in other locations, perhaps due to the presence of multiple ventricular insertions of the bypass tract. It is possible that some cases represent true "nodoventricular" pathways.

Adolescent↗
PubMed2000

Classification, identification, and clinical significance of Proteus, Providencia, and Morganella.

This review presents the current taxonomy of the genera Proteus, Providencia, and Morganella, along with the current methods for the identification of each species within the three genera, incorporating both conventional biochemical and commercial methods. While all of these organisms are ubiquitous in the environment, individual case reports and nosocomial outbreak reports that demonstrate their ability to cause major infectious disease problems are presented. Lastly, anticipated antimicrobial susceptibility patterns are reviewed. Many of these organisms are easily controlled, but the advent of newer and more powerful antimicrobial agents has led to some problems of which laboratorians need to be aware.

Anti-Bacterial Agents↗
PubMed2000

Evaluation of the MicroScan rapid neg ID3 panel for identification of Enterobacteriaceae and some common gram-negative nonfermenters.

The MicroScan Rapid Neg ID3 panel (Dade Behring, Inc., West Sacramento, Calif.) is designed for the identification of gram-negative bacilli. We evaluated its ability to accurately identify Enterobacteriaceae that are routinely encountered in a clinical laboratory and glucose nonfermenting gram-negative bacilli. Using 511 stock cultures that were maintained at -70 degrees C and passaged three times before use, we inoculated panels according to the manufacturer's instructions and processed them in a Walk/Away instrument using version 22.01 software. The time to identification was 2 h and 30 min. All panel identifications were compared to reference identifications previously determined by conventional tube biochemicals. At the end of the initial 2.5-h incubation period, 405 (79.3%) identifications were correct. An additional 49 (9.6%) isolates were correctly identified after required additional off-line biochemical tests were performed. Thus, at 24 h, 88.8% of the 511 strains tested were correctly identified. Twenty-two (4.3%) were identified to the genus level only. Twenty-six (5.1%) strains were misidentified. Because the system is based on fluorogenics, there are no conventional tests readily available with which to compare possibly incorrect reactions. Of the 28 Salmonella strains that were tested, 5 were incorrectly reported. The 21 remaining errors were scattered among the genera tested. Testing on nine strains gave a result of "no identification" (very rare biotype). The Rapid Neg ID3 panel in this study approached 89% accuracy for the identification of gram-negative organisms encountered in the hospital laboratory.

Bacterial Typing Techniques↗
PubMed2000

Evaluation of the oxyrase OxyPlate anaerobe incubation system.

The Oxyrase OxyPlate anaerobe incubation system was evaluated for its ability to support the growth of clinically significant anaerobic bacteria previously identified by the Anaerobe Reference Laboratory at the Centers for Disease Control and Prevention. The results were compared with those obtained with conventional anaerobe blood agar plates incubated in an anaerobe chamber. We tested 251 anaerobic bacterial strains. Plates were read at 24, 48, and 72 h; growth was scored by a numerical coding system that combines the degree of growth and the colony size. Organisms (number of strains tested) used in this study were Actinomyces (32), Anaerobiospirillum (8), Bacteroides (39), Campylobacter (8), Clostridium (96), Fusobacterium (12), Leptotrichia (8), Mobiluncus (8), Peptostreptococcus (16), and Propionibacterium (24). At 24 h, 101 (40.2%) of the 251 strains tested showed better growth with the anaerobe chamber than with the OxyPlate system, 10 (4.1%) showed better growth with the OxyPlate system, and the remaining 140 (55. 8%) showed equal growth with both systems. At 48 h, 173 (68.9%) showed equal growth with both systems, while 78 (31.1%) showed better growth with the anaerobe chamber. At 72 h, 176 (70.1%) showed equal growth with both systems, while 75 (29.9%) showed better growth with the anaerobe chamber. The OxyPlate system performed well for the most commonly isolated anaerobes but was inadequate for some strains. These results indicate that the Oxyrase OxyPlate system was effective in creating an anaerobic atmosphere and supporting the growth of anaerobic bacteria within 72 h. OxyPlates would be a useful addition to the clinical microbiology laboratory lacking resources for traditional anaerobic culturing techniques.

Agar↗
PubMed2000

Incidence and identification of Klebsiella planticola in clinical isolates with emphasis on newborns.

Studies conducted in France and Germany suggest that up to 19% of clinically identified Klebsiella sp. are actually Klebsiella planticola, an environmental species that has been attributed to two cases of septicemia, with a rare isolate of Klebsiella terrigena (0. 4%) being identified. A 1-year survey of newborns on a neonatal ward, also conducted in Germany, reported that 72% of Klebsiella sp. were Klebsiella oxytoca and 8.7% were K. planticola. The tests necessary to identify these species are not found in most clinical identification schemes or in the database matrices of most commercial identification products. To determine the incidence of unrecognized K. planticola among the Klebsiella sp. isolates in our collection, we used the battery of seven supplemental tests amended from the work of Monnet and Freney to test 352 stock isolates and 84 fresh clinical isolates from four local hospitals. After testing 436 strains of Klebsiella, only one strain was identified as a possible K. planticola and none was identified as K. terrigena. We tested an additional 43 stock strains of K. oxytoca isolated from newborns by using eight biochemical tests and found one additional strain of K. planticola. The occurrence of K. planticola in our collection is far less frequent than that observed in other countries.

Bacterial Typing Techniques↗
PubMed2000

Preclinical diagnosis of scrapie by immunohistochemistry of third eyelid lymphoid tissue.

Ovine scrapie is a member of the transmissible spongiform encephalopathies (TSEs), a heterogeneous family of fatal neurologic disorders characterized by deposition of an abnormal isoform (prion protein [PrP] PrP-Sc) of a cellular sialoglycoprotein in neural tissue. PrP-Sc is detectable in some lymphoid tissues of infected sheep months or years before development of clinical disease. Detection of PrP-Sc in these tissues is the basis for live-animal testing. In this study, we characterize the performance of a preclinical diagnostic test for ovine scrapie based on a monoclonal antibody (MAb)-based immunohistochemistry assay of nictitating membrane ("third eyelid")-associated lymphoid tissue. The results of third eyelid immunohistochemistry assay agreed with the scrapie status of the sheep for 41 of 42 clinical suspects with confirmed scrapie and 174 of 175 sheep without scrapie. Third eyelid sampling agreed with the scrapie status for 36 of 41 clinically normal sheep positive for PrP-Sc immunostaining of brain tissue, including 27 sheep with positive biopsy specimens that progressed to clinical disease with confirmed scrapie 3 to 20 months after biopsy. The assay used MAb F89/160.1.5, which binds to residues 142 to 145 of ovine PrP. This antibody can be used in combination with MAb F99/97. 6.1, which binds to residues 220 to 225. One or both MAbs in this cocktail recognize PrP sequences conserved in most mammalian species in which natural TSEs have been reported. Immunohistochemistry assay of routinely formalin-fixed lymphoid tissues with a cocktail of pan-specific MAbs is a practical, readily standardized live-animal and preclinical test for ovine scrapie.

Animals↗
PubMed2000

Antenatal marijuana use is unrelated to sexually transmitted infections during pregnancy.

OBJECTIVE: This study evaluated the relationship between marijuana use and sexually transmitted diseases in pregnant women. METHODS: A retrospective review of clinic records over a 12-1/2 month period identified all women entering prenatal care. Eighty-six women using no illicit substance other than marijuana were compared to 441 drug-free women. The prevalence of gonorrhea, chlamydia, syphilis, human immunodeficiency virus, hepatitis B surface antigen, human papilloma virus, and herpes was ascertained. RESULTS: No significant differences were found in the prevalence of any single sexually transmitted disease between pregnant women who used marijuana and drug-free pregnant women. When the presence of one or more sexually transmitted disease was considered, again no difference was found. CONCLUSION: Marijuana use was not associated with sexually transmitted disease in pregnant women.

Adult↗
PubMed2000

Objective quantification of plaque using digital image analysis.

Dental plaque is the precursor to many oral diseases (e.g. gingivitis, periodontitis, caries) and thus its removal and control are an important aspect of oral hygiene. Many of the oral care products available today remove or inhibit the growth of dental plaque. Historically, the antiplaque efficacy of products was measured in blinded clinical trials where the amount of plaque on teeth is assessed via subjective visual grading with predefined scales such as the Turesky index. The ability of the examiner to consistently apply the index over time and the sensitivity of the scales often leads to large, expensive clinical trials. The present invention is an automatic measurement of plaque coverage on the facial surfaces of teeth using a digital image analysis technique. Dental plaque disclosed with fluorescein is digitally imaged under long-wave ultraviolet light. Ultraviolet illumination of fluorescein-disclosed plaque produces an image where the pixels of the image can be categorically classified based on color into one of five classes: teeth; plaque; gingiva; plaque on gingiva, or lip retractors. The amount of plaque on teeth can be determined by summation of the number of plaque pixels. The percent coverage is calculated from the number of plaque pixels and teeth pixels in the image. The digital image analysis of plaque allows facial plaque levels to be precisely measured (RSD = 3.77%). In application, the digital image analysis of plaque is capable of measuring highly significant plaque growth inhibition of a stannous fluoride dentifrice with as few as 10 subjects in a cross-over design.

Analysis of Variance↗
PubMed2000

Immunohistochemical diagnosis of chronic wasting disease in preclinically affected elk from a captive herd.

An immunohistochemical (IHC) method was used to test brain tissues from 17 elk in a captive herd in which chronic wasting disease (CWD) had previously occurred. The IHC technique detects the protease-resistant prion protein (PrP-res), which is considered a disease-specific marker for transmissible spongiform encephalopathies (TSE), regardless of the species affected. Of the 17 elk tested, 10 were positive by IHC. Only 2 of these 10 animals had shown clinical signs and histologic lesions of CWD, and an additional animal had histologic lesions only. The most consistently IHC-positive tissue was medulla oblongata, especially the obex. These results show that the PrP-res IHC test on brain tissue, specifically medulla oblongata at the obex, should be considered an essential component of any surveillance study intended to determine the incidence of CWD in captive or free-ranging cervids.

Animals↗