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Biomedical subjects

L D Edwards

Publications and source records attributed to L D Edwards.

At least 37 records · Page 2Linked to original sources

Prevalence of intestinal helminths and protozoans in a rural population segment of the Dominican Republic.

There are few reports of parasitic disease prevalence in the Dominican Republic. The most recent study was that by Mackie et al. (1951). Examination of purged specimens from individuals employed by two sugar plantations demonstrated generally high prevalences of a number of helminths and protozoans. We report here the findings of a prevalence study using a population sample of 453 individuals. Ascaris lumbricoides, Trichuris trichiura, hookworm, Enterobius vermicularis, Giardia lamblia and Entamoeba coli were found.

Adolescent↗

Hemophilus aphrophilus endocarditis with a probable primary dental focus of infection.

A case of Hemophilus aphrophilus endocarditis in association with a prosthetic valve is reported in which the organism was isolated from dental plaque as well as blood. We emphasize the need for treating the primary source of the infection; in this case, periodontal disease. To the best of our knowledge, this is the first reported case of H aphrophilus endocarditis in which an oral primary focus has been demonstrated.

Aged↗

Comparative study of bacampicillin and ampicillin in the treatment of uncomplicated gonorrhoea.

Bacampicillin hydrochloride, a pro-drug ester of ampicillin trihydrate which is hydrolysed to ampicillin after absorption, was used in a randomised comparative study of ampicillin 3.5 g and bacampicillin 1.6g (each with probenecid 1 g) in the treatment of uncomplicated gonorrhoea. This dose of bacampicillin was selected because in serum it gives approximately the same peak concentration of ampicillin as 3.5 g of the present drug. Genital, pharyngeal, and anal cultures were performed at the initial visit and at follow up 5-9 days after treatment. There was no statistically significant difference in the microbiological or clinical response of patients with genital gonorrhoea who were treated with ampicilin and those treated with bacampicillin. At 5-9 days after treatment, 93% of the ampicillin-treated patients and 89% of the bacampicillin-treated patients had negative genital, pharyngeal, and anal culture results; furthermore, 87% and 89% respectively had no symptoms of infection. Fewer gastrointestinal side effects were noted in the patients treated with bacampicillin.

Adolescent↗

Treatment of twelve burn wound infections and eight other serious infections with cefazolin and tobramycin: in vitro and in vivo evaluation.

20 patients with serious infections were treated with cefazolin and tobramycin for 9--64 days. Minimal inhibitory concentration (MIC) values and minimal bactericidal concentration (MBC) values were determined for each of the 112 clinical bacterial isolates. The median cefazolin MIC/MBC was 1.56/12.5 micrograms/ml, and the median tobramycin MIC/MBC was 6.25/25.0 micrograms/ml for all organisms studied. Median cefazolin doses of 49.0 mg/kg/day gave median peak/trough serum levels of 43.0/11.0 micrograms/ml. Median tobramycin doses of 4.3 mg/kg/day gave median peak/trough serum levels of 5.0/1.4 micrograms/ml. Checkerboard studies revealed synergy with 65% of strains. Bacteriologic and clinical success was obtained in 17 of 20 patients.

Acute Kidney Injury↗

Cefazolin treatment of bacterial infections. In vitro and in vivo evaluation.

Cefazolin sodium was used to treat 20 serious bacterial infections in 19 patients, 11 of whom were infected by coagulase-positive Staphylococci. Clinical and bacteriologic success were initially obtained in 15 patients with 16 infections. 2 additional patients were cured after surgery for removal of foreign bodies and a second course of the antibiotic. 1 asplenic patient had bacteremia and died 5 days after initiating therapy with negative blood cultures and multiple abscesses. 1 patient with endocarditis relapsed 19 months after treatment with 6 weeks of cefazolin and prolonged oral antibiotics. Calculated median, trough, free drug levels were 1.5--15.3 times the minimum inhibitory concentration for 27 of 29 pathogens.

Adult↗

Endocarditis on a Björk-Shiley mitral prosthesis due to Neisseria meningitidis.

To our knowledge, there has been reported only one previous case of prosthetic valve endocarditis due to Neisseria meningitidis. In describing a second fatal case, we emphasize the difficulty of clinical diagnosis due to lack of characteristic high fever, murmur, skin rash, or splenomegaly. This lack of findings plus the chronic, intermittent course suggest a rare occurrence of endocarditis complicating chronic meningococcemia with an acute exacerbation, leading to rapid decompensation and death.

Acute Disease↗

A comparative study of 48 host valve and 24 prosthetic valve endocarditis cases.

Forty-eight cases of host valve endocarditis and 24 cases of prosthetic valve endocarditis occurring during a concurrent period of time were analyzed to assess differences between the two groups. The over-all incidence of prosthetic valve endocarditis during this 40 month period was 4.4%. The symptoms and signs in both groups were similar, except that PVE patients had more frequent occurrences of changing heart murmurs and splenic and cerebral emboli. Spleen scans may be helpful in the diagnosis of selected cases of culture-negative prosthetic valve endocarditis. There was no significant difference between the two groups for the various infecting microorganisms. However, the culture-negative prosthetic valve group had a mortality rate of 77.7% compared to 46.2% for the host valve group. In the HVE patients the oral cavity or urinary tract was the probable source of infection in 50.0% of the patients. In about one third of HVE cases, there was strong evidence that the infection was related to a therapeutic procedure, whereas nearly half of the PVE patients had clinical evidence of an extracardiac infection at the time of open-heart surgery. We emphasize the need for good pre- and postoperative surveillance to eliminate possible predisposing infections and appropriate antibiotic prophylaxis in all patients with valvular disease at times of risk. The survival rate in patients with prosthetic valve endocarditis was highest in those patients who received "appropriate" antibiotics and, if significant congestive heart failure was present, surgical intervention was necessary.

Adolescent↗

The epidemiology of 2056 remote site infections and 1966 surgical wound infections occurring in 1865 patients: a four year study of 40,923 operations at Rush-Presbyterian-St. Luke's Hospital, Chicago.

Over a 4-year period 40,923 operations and 44,716 surgical admissions were monitored for both community and hospital onset infections. One thousand eight hundred sixty-five patients had 1966 surgical wound infections and 2056 remote infections including 1652 hospital onset and 404 community onset infections. One thousand one hudnred forty-four patients with multiple infections averaged 40 days in the hospital contrasted with 24 days for 721 patients with a single wound infection. The total excess cost of hospitalization for these patients was $951,150. A statistically significant reduction occurred for urinary tract infections, lower respiratory infections and clean and contaminated surgical wound infections. It is suggested that these are all inter-related and a significant reduction in surgical wound infections can be achieved through control of infections at remote sites, particularly those associated with medical devices. The coagulase positive staphylococcus is still the most important single bacterial species in the primary etiology of surgical wound infections. When the gastrointestinal tract is entered or "supra" infecting organisms appear, gram negative bacteria and mixed gram negative and gram positive infections are dominant. Reduction in remote site infections occurring in surgical patients is necessary to reduce the incidence of surgical wound infections, suggest preventive and control measures, and document the effectiveness of such measures.

Adolescent↗

Infections in splenectomized patients. A study of 131 patients.

A retrospective study on infections was done on 131 patients (predominately adults) undergoing splenectomy with a median follow-up to 11 months. 43 patients died, and 23 of them were infected. Three succumbed primarily from their infection; in 9 the infection was a contributing factor; and 11 died primarily from their underlying disease with an associated infection. 64 patients had lymphoreticular malignancies, 53 had a nonmalignant condition and 14 had carcinomas. Infection rates were 42%, 42%, and 21% respectively. Bacteremia rates (all in adults) were were 5%, 4%, and 7% respectively. Over four-fifths of the infections were hospital acquired. 12 of 14 community onset infections occurred in patients with lymphoreticular malignancies.

Bacterial Infections↗