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Biomedical subjects

L P Ormerod

Publications and source records attributed to L P Ormerod.

At least 19 recordsLinked to original sources
PubMed2002

Outcome of the treatment of culture negative tuberculosis (respiratory and non-respiratory): Blackburn 1996-2000.

OBJECTIVE: To determine the outcome of treating patients without culture confirmation of tuberculosis, with a regimen of two months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by four months of isoniazid and rifampicin (2HRZE/4HR) in a setting with a rate of isoniazid resistance of 7.5% in culture confirmed cases. SETTING: Tuberculosis patients treated in the Blackburn, Hyndburn and Ribble Valley districts of the UK between 1996 and 2000 inclusive. METHODS: Patients from a detailed prospective clinical and epidemiological data base for all tuberculosis patients were studied for the years 1996-2000. RESULTS: One hundred and fourteen cases, all but two of Indian subcontinent ethnic origin, without culture confirmation had received 2HRZE/4HR. Twenty had pulmonary, 55 other respiratory and 39 non-respiratory tuberculosis. There was no bacteriologically confirmed relapse, 1 case was retreated as a clinical relapse. CONCLUSION: The treatment of tuberculosis cases without culture confirmation with a regimen of 2HRZE/4HR gives highly acceptable results. The clinical relapse rate was 0.85% (1/114), and the cure rate 99.15%.

Antitubercular Agents↗
PubMed2002

Tuberculosis treatment outcome monitoring: Blackburn 1988-2000.

SETTING: All cases of tuberculosis in a high prevalence district (population 269,000) of England. OBJECTIVE: To analyse the tuberculosis programme outcome for confirmed pulmonary tuberculosis, and all other categories of cases for 1988-2000 inclusive. DESIGN: The outcome of all cases treated during the period 1988-2000 inclusive was assessed by agreed European outcome criteria, retrospectively for 1988-1998 and prospectively for 1999-2000. RESULTS: A total of 729 tuberculosis cases were notified, with 209 definite (culture-positive) pulmonary cases. Of the 205 definite pulmonary cases treated in life, 182 received self-administered treatment (SAT) and 23 directly observed treatment (DOT), with an 88% cure/completion rate and a 12% death rate. The relapse rate for SAT was 1/182 (0.5%) and 1/23 for DOT (4.3%). The cure/completion rate for all patients together was 94.3%, with a relapse rate of 0.8%. CONCLUSION: In this resource-rich setting, treatment largely by SAT, but carefully monitored, gives a very high cure/completion rate. Universal rather than selective DOT would make little additional impact on patient outcome. These outcomes are not likely to be reproducible, however, with SAT in a resource-poor setting.

Adult↗
PubMed2001

Can a nine-month regimen be used to treat isoniazid resistant tuberculosis diagnosed after standard treatment is started?

OBJECTIVES: National tuberculosis treatment guidelines suggest a regimen of 2RZE/10RE for the treatment of isoniazid resistant organisms. A retrospective clinical study of all patients treated for non-MDR-TB isoniazid-resistant organisms was undertaken. METHODS: A continuous database of the patients treated between 1978-1999 inclusive was examined to determine the regimens used and the outcome of treatment for such patients. RESULTS: Thirty-seven patients were identified. Eighteen had regimens of greater than 9 months, 19 had regimens of 9 months or less. No relapses occurred in those cases treated with a regimen of 2RZE/7RE during 12 months' minimum follow-up. CONCLUSIONS: A regimen of 2RZE/7RE may be possible for the treatment of isoniazid-resistant organisms if given either under close supervision or as a formally supervised regimen. Larger clinical studies or a controlled clinical trial are needed to confirm these initial findings.

Adult↗
PubMed2001

Are there still effects on Indian Subcontinent ethnic tuberculosis of return visits?: a longitudinal study 1978-97.

OBJECTIVE: To assess whether return visits to the Indian Subcontinent (ISC) are associated with increased risks of developing clinical tuberculosis. METHODS: Descriptive analysis of epidemiological records over a period of 1978-97 inclusive in Blackburn, Hyndburn and Ribble Valley for individuals of ISC ethnic origin notified with tuberculosis. Those cases diagnosed through local contact tracing exercises were excluded. RESULTS: Of 1032 eligible individuals notified with tuberculosis, 228 (22.1%) reported prior visits to the ISC. Of these 151 (66%) reported having visits within 3 years of that notification, including 60% of the United Kingdom (U.K.) born without prior exposure to the ISC. CONCLUSION: The clinical observations are consistent with the hypothesis that return visits to the ISC carry a risk of acquiring tuberculosis. This cannot be confirmed, however, without information about the return visits in the ISC population as a whole. A case-control study may be required to confirm the hypothesis.

Adult↗
PubMed2001

Tuberculosis at the end of the 20th century in England and Wales: results of a national survey in 1998.

BACKGROUND: A national survey of tuberculosis was conducted in England and Wales in 1998 to obtain detailed information on the occurrence of the disease and recent trends. This survey also piloted the methodology for enhanced tuberculosis surveillance in England and Wales and investigated the prevalence of HIV infection in adults with tuberculosis. METHODS: Clinical and demographic data for all cases diagnosed during 1998 were obtained, together with microbiological data where available. Annual incidence rates in the population were estimated by age, sex, ethnic group, and geographical region using denominators from the 1998 Labour Force Survey. Incidence rates in different subgroups of the population were compared with the rates observed in previous surveys. The tuberculosis survey database for 1998 was matched against the Communicable Disease Surveillance Centre HIV/AIDS database to estimate the prevalence of HIV co-infection in adult patients with tuberculosis. RESULTS: A total of 5658 patients with tuberculosis were included in the survey in England and Wales (94% of all formally notified cases during the same period), giving an annual rate of 10.93 per 100 000 population (95% CI 10.87 to 10.99). This represented an increase of 11% in the number of cases since the survey in 1993 and 21% since 1988. In many regions case numbers have remained little changed since 1988, but in London an increase of 71% was observed. The number of children with tuberculosis has decreased by 10% since 1993. Annual rates of tuberculosis per 100 000 population have continued to decline among the white population (4.38) and those from the Indian subcontinent, although the rate for the latter has remained high at 121 per 100 000. Annual rates per 100 000 have increased in all other ethnic groups, especially among those of black African (210) and Chinese (77.3) origin. Over 50% of all patients were born outside the UK. Recent entrants to the UK had higher rates of the disease than those who had been in the country for more than 5 years or who had been born in the UK. An estimated 3.3% of all adults with tuberculosis were co-infected with HIV. CONCLUSIONS: The epidemiology of tuberculosis continues to change in England and Wales and the annual number of cases is rising. More than one third of cases now occur in young adults and rates are particularly high in those recently arrived from high prevalence areas of the world. The geographical distribution is uneven with urban centres having the highest rates. The increase in the number of cases in London is particularly large. Tuberculosis in patients co-infected with HIV makes a small but important contribution to the overall increase, particularly in London. To be most effective and to make the most efficient use of resources, tuberculosis prevention and control measures must be based on accurate and timely information on the occurrence of disease. A new system of continuous enhanced tuberculosis surveillance was introduced in 1999, based on the methodology developed in this national survey.

AIDS-Related Opportunistic Infections↗
PubMed2001

Drug resistance trends in M. tuberculosis: Blackburn 1990-1999.

SETTING: Blackburn, United Kingdom. OBJECTIVE: To describe the drug resistance data for Mycobacterium tuberculosis in white and Indian Subcontinent (ISC) ethnic patients in a high prevalence district in the United Kingdom (UK) over a 10-year period. DESIGN: Data from a detailed prospective clinical and epidemiological database of all notified patients were examined for the years 1990-1999 inclusive. RESULTS: Primary isoniazid resistance was found in 17/229 (7.4%) of ISC and 3/67 (4.5%) of white isolates. There was no statistical difference in the rates of drug resistance in those of ISC ethnic origin, whether they were ISC or UK born and whether or not they had made return visits to the ISC. CONCLUSION: The rate of primary isoniazid resistance remains between 5-10% in ISC patients in Blackburn, showing no fall from previous surveys. The rate of drug resistance was not lower in those born in the UK, irrespective of whether return visits had been made to the ISC. These data will need to be further monitored.

Antitubercular Agents↗
PubMed2000

Mammary tuberculosis: rare but still present in the United Kingdom.

Mammary tuberculosis (TB) is rare and usually affects women from the Indian sub-continent and Africa. It may be mistaken clinically for carcinoma or pyogenic abscess. Tuberculosis (particularly drug-resistant TB) is on the increase in areas of the UK with rising numbers of immigrants, some of whom may present with breast lesions of uncertain aetiology. Between 1978 and 1997 there were 436 cases of TB notified for Indian Sub-continent females aged 15-49 years in Blackburn, Hyndburn and Ribble Valley, Lancashire, UK. Ten cases were mammary TB (10/436 = 2.3%) which was clinically suspected in only three patients preoperatively, despite the area having large numbers of immigrants. Mammary TB should be included in the differential diagnosis of breast lesions in women from those ethnic groups at increased risk of TB. Pus and/or breast tissue samples should be subjected to TB culture and histological examination for both diagnosis of TB and determination of drug sensitivities.

Abscess↗
PubMed1999

Prevalence of asthma and 'probable' asthma in the Asian population in Blackburn, U.K.

Local research had shown increased asthma admission rates in the Asian ethnic group in Blackburn, U.K. Patients also reported that asthma seemed to develop some years after first arrival in the U.K. A community prevalence survey of respiratory symptoms and asthma was undertaken in three practices with no special asthma interest. The questionnaire was administered by a Health Visitor and language link worker. Of the Asian patients in the practices, 96.6% were studied. The age distribution was similar to that of the local 1991 census. Of the patients, 181/1783 (10.2%) had diagnosed asthma but positive responses to individual questions suggested underdiagnosis of asthma. Asthma prevalence was higher in males up to age 20 (14.6% vs. 8.2%), and aged over 50 (16.5% vs. 10.5%), but higher in females aged 20-49 (5.6% vs. 9.2%). There were no correlations with social class or Jarman index, and no effect of country of origin or duration in the U.K. by multivariate analysis. The prevalence of diagnosed asthma at ages 5-9 and 10-14 was higher than in previous studies. Diagnosed asthma prevalence rates fell in the 20-49 age band but rose again in the over-50s. In all age groups the prevalence of asthma is probably underestimated. Asthma prevalence was not related to social factors. The data show that those born in the U.K. are more likely to describe regular symptoms and to be on regular treatment, but that for those born abroad there was an increasing rate of symptoms and medication use with increasing duration in the country. These observations confirm patient views but are explained by the age/sex distribution of those born in the U.K. compared to immigrants.

Adolescent↗
PubMed1998

Is new immigrant screening for tuberculosis still worthwhile?

BACKGROUND: new immigrant screening in the 1980s showed that the official Port of Arrival (POA) system performed poorly, that there was a significant yield in terms of clinical tuberculosis, and that preventive measures (chemoprophylaxis and BCG) were appropriate in a substantial minority Data for the 1990s was sought for comparison. METHODS: prospective data on new immigrant screening for 1990-1994 inclusive in the Blackburn, Hyndburn and Ribble Valley local government areas were analysed, and compared with previous 1983-1988 data. RESULTS: of the 2242 new immigrants screened, 1333 were from Pakistan, 604 from India and 305 from the rest of the world. A total of 898 (40%) were found via the POA system, but 1344 (60%) were only identified by local links with the Family Health Services Authority (FHSA). Ten cases of active tuberculosis were found (0.45%), chemoprophylaxis was given to 19/465 (4.1%) of children aged 0-15 years, and BCG vaccination to 530/1705 (31%) of those aged under 30 years. CONCLUSIONS: between 1990-1994 the official POA system continued to perform poorly. The yield of new tuberculosis cases detected was lower than in the 1980s. Chemoprophylaxis at 4% and BCG vaccination at 31% showed that preventive health measures were appropriate for over one-third of new immigrants aged under 30.

Adolescent↗
PubMed1998

How frequently do endobronchial secondaries occur in an unselected series?

Isolated endobronchial secondaries are reported usually as single cases or in series from either specialist surgical or cancer units. The latter two are selected populations and are not a good guide to the true frequency of occurrence of such isolated endobronchial secondaries. The incidence of such endobronchial secondaries in a 15 yr prospective series is reported. Results of all fibre-optic bronchoscopies carried out in the Blackburn, Hyndburn and Ribble Valley districts from 1981 to 1995 together with histology were recorded prospectively throughout the period. These had been audited yearly throughout, the data were collated, and the individual records of cases of endobronchial secondaries examined. A total of 3353 bronchoscopies were carried out in the years 1981-1995 inclusive. Of these, 1391 had visible endobronchial abnormalities, from which 1059 had positive endobronchial histology. Sixteen of the 1059 (1.5%) were with endobronchial secondaries. Over the same period eight bronchial carcinoids (none biopsied, but later surgically resected) were encountered. Isolated endobronchial secondaries made up a higher proportion of endobronchial histology than expected at 1.5% and were twice as frequently found as bronchial carcinoids. The possibility of endobronchial secondaries should always be considered in those with a history of previous carcinomas at other sites.

Adult↗
PubMed1998

Rifampicin and isoniazid prophylactic chemotherapy for tuberculosis.

Prophylaxis of tuberculosis in children with four month (n = 53) and three month regimens (n = 213) of rifampicin and isoniazid from 1987 to 1996 were tolerated without any toxicity. The reduction in the proportion of paediatric tuberculosis, which was seen after the introduction of chemoprophylaxis with longer regimens in 1981, was maintained with the shorter duration regimens. Altered immigration patterns and a fall in the proportion of infectious tuberculosis, as defined by sputum culture positivity, have been excluded as factors in the reduced paediatric proportion of tuberculosis. The data show such regimens have little toxicity and provide indirect evidence that three months chemoprophylaxis may be as effective as longer regimens.

Antibiotics, Antitubercular↗
PubMed1998

Geographical distribution of tuberculosis notifications in national surveys of England and Wales in 1988 and 1993: report of the Public Health Laboratory Service/British Thoracic Society/Department of Health Collaborative Group.

BACKGROUND: The geographical distribution of tuberculosis in England and Wales and changes since 1983 were examined using data from the 1988 and 1993 national surveys of tuberculosis notifications. METHODS: Notification rates for England and Wales in 1988 and 1993 were calculated for geographical areas using Office for National Statistics (ONS) mid year population estimates. Those for the standard regions and the Greater London boroughs were calculated for the main ethnic groups. Those for the counties and local authorities were calculated for all ethnic groups combined. These were compared using data from the 1983 national survey as a baseline. RESULTS: Wide regional variations in notification rates persist with Greater London having the highest rates. Rates in the ethnic group from the Indian subcontinent (ISC) were high in all regions, whilst those of the white ethnic group varied fourfold. Twenty seven of the 33 London boroughs showed increased rates in 1993 compared with 1988. In general, those local authority areas with high rates had high proportions of notifications in individuals of ISC ethnic origin, emphasising the continuing important contribution of ethnic minority groups to local tuberculosis rates. The number of local authority areas with notification rates four times the national average increased, but the number of areas with low or zero rates increased even more. CONCLUSIONS: The distribution of tuberculosis in England and Wales continues to vary markedly by geographical area. The distribution is becoming increasingly polarised with a growth in the number of areas with very high rates of notifications and a greater increase in the number of areas with very few notifications. Patients from ethnic minorities continued to contribute a substantial and increasing proportion of all reported tuberculosis cases in most regions in 1988 and 1993. These findings have important implications for the provision of tuberculosis services in England and Wales.

Demography↗