A total of four cytomegalovirus (CMV) isolates were obtained from two CMV seronegative patients, each of whom received a lung transplant from the same seropositive donor. CMV was isolated from Patient 1 from two bronchial alveolar lavage (BAL) specimens, one obtained during treatment with ganciclovir (GCV) and a second during later treatment with foscarnet. Both of these isolates are sensitive to GCV and foscarnet. CMV was isolated from Patient 2 from a blood and a BAL specimen obtained during treatment with GCV. Both of these isolates are resistant to GCV and show reduced GCV phosphorylation. Patient 1 is still alive 33 months posttransplant. Patient 2 died 6 1/2 months posttransplant. Although the four strains differ with respect to GCV susceptibility and phosphorylation, their DNA restriction fragment hybridization patterns and UL97 kinase gene sequences indicate that they are closely related. The restriction fragment hybridization patterns are identical among the strains, while these patterns differ markedly from those of unrelated strains. The DNA sequences of the UL97 genes of the strains from Patient 2 differ by only one nucleotide from those of Patient 1. The same comparison with unrelated strains shows a minimum of 12 nucleotide differences. The nucleotide change in the strains from Patient 2 produces an amino acid substitution of serine for leucine at residue 595, a substitution that was previously shown to transfer GCV resistance. Both patients, therefore, were apparently infected with the same donor strain, but during the course of GCV prophylaxis and treatment, a GCV-resistant mutant strain was selected in Patient 2.

Base Sequence↗

PubMed1996

Penetration of the atrialventricular septum by spread of infection from aortic valve endocarditis: early diagnosis by transesophageal echocardiography and implications for surgical management.

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Anatomy, Artistic↗

PubMed1996

Analysis of trends in antimicrobial resistance patterns among clinical isolates of Bacteroides fragilis group species from 1990 to 1994.

Antimicrobial resistance, including plasmid-mediated resistance, among Bacteroides fragilis group species is well documented. A 5-year (1990-1994) prospective, eight-center survey of 3,177 clinical isolates of Bacteroides species was undertaken to review trends in resistance, using the breakpoints for full and intermediate susceptibility established by the National Committee for Clinical Laboratory Standards. No documented resistance to either metronidazole or chloramphenicol was found in this survey. Among B. fragilis isolates virtually no resistance was seen to imipenem, meropenem, ampicillin/sulbactam, piperacillin/tazobactam, or ticarcillin/clavulanate. Significant increases in resistance among B. fragilis isolates to cefotetan, ceftizoxime, and clindamycin (p < .01) were noted. Resistance to cefoxitin remained unchanged. Among the non-fragilis species of the B. fragilis group, there was virtually no resistance to imipenem, meropenem, chloramphenicol, or metronidazole. The three beta-lactamase inhibitors had increasing levels of resistance, although 95%-98% of strains were susceptible (p < .05). There was a significant decline in cefoxitin, cefmetazole, and clindamycin activity over time against these strains (p <.01). There was a significant (P < .001) increase in geometric mean minimum inhibitory concentration for most drugs and species tested from 1990 to 1994. Clusters in the eight institutions could not account for this rise in resistance. This survey demonstrates that rates of resistance of B. fragilis and non-fragilis species of B. fragilis group are increasing.

Bacteroides↗

PubMed1995

Medical students' first-person narratives of a patients story of AIDS.

Fourth year U.S. medical students' first-person narratives of a patient's experience of AIDS are analyzed using a conceptual framework that builds on the interactive model of narrative critique. Relational and affective convergence and, conversely, relational and affective dissonance, reveal imaginative reconstructions of emotional and interactional themes depicted in the patient's original story. Attention is focused on representations of isolation, contamination, shame and fear. Elements of indeterminacy and openness in the patient's description of his experience with AIDS provided students with opportunities to create an imagined response to HIV infection in their own narratives. The narratives describe social interaction that is tainted and constrained by the presence of infection and its associated stigma. The emotional content of the student narratives portrays an affective landscape that resonates. elaborates and, in some cases, distorts the feelings expressed in the patient's story. The narratives call attention to the way in which individual meanings are externalized, objectified and projected onto a socially and morally salient 'other'. Using the first-person narrative approach in the seminar on AIDS proved to be an effective method of sensitizing students to the experience of living with HIV infection. The challenge for medical educators lies in creating opportunities for students to develop increased empathy toward individuals with AIDS.

Acquired Immunodeficiency Syndrome↗

PubMed1994

A study of factors affecting dental expenditures in Quebec: 1962-1991.

The issue of dental manpower planning has received considerable attention in Quebec in recent years. Quebec dentists agree that there is a need for detailed information regarding the impact of economic factors on the supply of and demand for dental care in the province. This study examines the impact of economic factors on dental care expenditures in Quebec between 1962 and 1991. The functional form of the econometric model used by the authors is similar to the one used in a study of the growth of the U.S. dental sector between 1950 and 1989. The dependent variable is per capita dental expenditure, and the three independent variables are: dentist/population ratio, per capita personal disposable income; and percentage of the population with dental insurance coverage. All data come from secondary sources. The findings indicate that per capita dental expenditure has grown substantially in Quebec over the past three decades, with the rate of growth slowing dramatically during the 1980s. Dental insurance coverage, the number of dentists in the community and the disposable income of the population all have a positive impact on dental expenditure in Quebec. However, it is clear that the incomes of Quebec dentists may decrease in the future if: no restrictions are placed on the number of new dental graduates entering the profession; dental insurance programs are curtailed; or dental disease levels continue to fall.

Dentistry↗