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Biomedical subjects

M Cummings

Publications and source records attributed to M Cummings.

At least 73 records · Page 4Linked to original sources
PubMed1989

Ceftriaxone treatment of penicillinase-producing Neisseria gonorrhoeae infections in children.

The incidence of penicillinase-producing Neisseria gonorrhoeae (PPNG) among adults with gonorrhea in Brooklyn now exceeds 24%. Because children usually acquire their infection from adults, it follows that we have had a concomitant rise in PPNG among sexually abused children. The Centers for Disease Control now recommends ceftriaxone for the first line treatment of gonorrhea but there are no data as to its use in children for this indication. From May, 1987, through March, 1989, 33 children, 4 days to 10 years of age, were admitted to Kings County Hospital for 34 episodes of gonorrhea. Nine (26.5%) were caused by PPNG. Twenty-three were female; 10 were male. There were 17 isolates from the vagina, 3 from the urethra, 9 from the pharynx, 9 from the rectum and 6 from the eye. Eight children (all girls) had infections at greater than or equal to 1 site; 2 were infected at 3 sites. Twenty-eight children were sexually abused and 5 were neonates with ophthalmia (1 PPNG). All isolates were susceptible to ceftriaxone by disc diffusion testing. Agar dilution was performed for 18 isolates; minimal inhibitory concentrations to ceftriaxone were less than or equal to 0.06 mg/liter. The 5 PPNG isolates tested had minimal inhibitory concentrations to penicillin of 2 to 16 mg/liter and 3 isolates were resistant to tetracycline with minimal inhibitory concentrations of 32 mg/liter. Twenty-eight children were treated with a single dose of ceftriaxone, including the 5 neonates with ophthalmia; the dose was 125 mg if less than 45 kg or 250 mg if greater than 45 kg.(ABSTRACT TRUNCATED AT 250 WORDS)

Ceftriaxone↗
PubMed1989

Evaluation of difloxacin in the treatment of uncomplicated urethral gonorrhea in men.

Difloxacin is a new quinolone antimicrobial agent with in vitro activity against both Neisseria gonorrhoeae and Chlamydia trachomatis and a long (26-h) half-life. A single oral dose of 200 mg of difloxacin was used to treat 30 men with uncomplicated urethral gonorrhea in an open trial. Of the isolates of N. gonorrhoeae, three produced penicillinase and two were resistant to tetracycline. N. gonorrhoeae was eradicated from all 29 evaluable patients. The geometric mean MIC of difloxacin for 30 pretreatment N. gonorrhoeae isolates was 0.014 (range, less than or equal to 0.0039 to 0.03) microgram/ml. Four (13.3%) of the 30 subjects with gonococcal urethritis also had C. trachomatis recovered from their pretreatment cultures. Treatment with difloxacin was associated with the eradication of C. trachomatis from all four men. In addition, C. trachomatis was isolated from the posttreatment culture of only one man who had a negative culture before treatment. Nineteen patients (65.5%) reported adverse experiences, and 17 of them (58.6%) developed symptoms suggestive of central nervous system dysfunction. An oral dose of 200 mg of difloxacin is effective treatment for uncomplicated urethral gonorrhea and may also eliminate a coexisting infection with C. trachomatis. Side effects may limit the utility of this agent.

Adult↗
PubMed1987

Relationship of vaginal pH and Papanicolaou smear results to vaginal flora and pregnancy outcome.

Prematurity is a major cause of perinatal morbidity. Studies have implicated components of the vaginal flora in the etiology of some cases of preterm birth. Current scoring systems do not include factors which directly reflect the vaginal flora. Since Papanicolaou smears and the vaginal pH may be affected by the vaginal flora and are easy tests to perform, we studied their relationship to vaginal flora and pregnancy outcome. Among 231 patients, those with a vaginal pH greater than or equal to 4.4 were significantly more likely to carry Trichomonas vaginalis (P less than 0.03); Bacteroides species (P less than 0.01), and Mycoplasma hominis (P less than 0.001), and to have premature rupture of the membranes (P less than 0.01), and preterm rupture of the membranes (P less than 0.05). Patients with atypia reported on Papanicolaou smear more frequently carried M. hominis (P less than 0.01), and had premature rupture of the membranes (P less than 0.01). Although the high sensitivity and negative predictive value of those tests may make them useful additions to current scoring systems, their low specificity prevents them from being independent predictors of risk.

Female↗
PubMed1987

Prophylactic effects of silver nitrate and erythromycin on Chlamydia psittaci conjunctivitis.

An animal model has been developed to study the effects of various prophylaxis agents on acquisition of chlamydial conjunctivitis. When Hartley strain newborn guinea pigs received ocular inoculations of Chlamydia psittaci followed by the instillation of various agents, 1% AgNO3 significantly lowered the risk of developing chlamydial conjunctivitis if it was administered within 15 min after the inoculation with C. psittaci. However, if the AgNO3 was administered at either 1 hr or 2 hr following inoculation, it did not have any prophylactic effect on the development of chlamydial conjunctivitis. Erythromycin ointment, 0.5%, was also found to prevent chlamydial conjunctivitis. The prophylactic effect was similar to placebo when the drug was given at 15 min; however, erythromycin ointment prophylaxis 1 hr or 2 hr after inoculation with C. psittaci was statistically superior to placebo.

Animals↗
PubMed1985

The effects of general anaesthesia on the asphyxiated foetal lamb in utero.

The effects of anaesthetic agents, per se, on the asphyxiated foetus are difficult to quantitate clinically. Anaesthesia is often necessary in foetal distress, however, to effect a rapid delivery. To investigate the effect of general anaesthetic agents commonly used for Caesarean section we administered these agents to 18 chronically prepared pregnant ewes with asphyxiated foetuses in utero. The foetuses were asphyxiated by partial occlusion of the umbilical cord until foetal arterial pH had decreased from 7.30 to a range of 7.08-7.13. The animals were divided into three groups: Group A which received no anaesthesia and thus served as a control, Group B which received thiopentone (3 mg . kg-1) intravenously followed by 50 per cent nitrous oxide and 0.5 per cent halothane in oxygen for 15 minutes, and Group C which received thiopentone (3 mg . kg-1) followed by one per cent halothane in oxygen for 15 minutes. Foetal cerebral, myocardial, and renal blood flows were measured by injection of radioactive microspheres after production of asphyxia and after 5 and 15 minutes of anaesthesia. General anaesthesia in both groups B and C abolished the hypertension and bradycardia produced by foetal asphyxia secondary to umbilical cord occlusion. There were no significant differences between Groups B and C in foetal pH, PCO2, or PO2. Two foetuses in the nitrous oxide group died after ten minutes of anesthesia, but the aetiology of the sudden demise is unclear. We conclude that general anaesthesia abolishes the foetal response to umbilical cord occlusion and does not improve foetal oxygenation or acid-base status.

Anesthesia, General↗
PubMed1985

Presence of Langerhans cells in the central corneas of normal human infants.

Nine normal adult and seven normal infant human corneas were studied for the presence of dendritic epithelial Langerhans cells in a masked fashion. Epithelial flatmounts were separated from the underlying corneal stroma using EDTA. The epithelial Langerhans cell densities were determined in the limbus as well as the peripheral, pericentral, and central corneal regions following staining with ATPase. Segments of the flatmounts were also studied by immunofluorescence to confirm that the dendritic cells contained class II histocompatibility antigens. The limbus, peripheral, and pericentral zones of adult and infant flatmounts contained similar densities of Langerhans cells. However, the central corneal Langerhans cell densities in infants were significantly elevated as compared with those in adults. These results suggest that Langerhans cells are a constant constituent of the human central corneal epithelium during late gestation and early infancy. They further suggest that perturbations of the corneal epithelium are not required for the presence of Langerhans cells in the corneal epithelium.

Aged↗
PubMed1985

Nonspecific vaginitis following sexual abuse in children.

Nonspecific vaginitis, one of the most common causes of vaginitis in adults, is a polymicrobial infection in which vaginal anaerobes act synergistically with Gardnerella vaginalis. The diagnosis is made by examination of the vaginal secretions for clue cells, the development of a fishy odor after the addition of 10% KOH to vaginal secretions, and a vaginal pH greater than 4.5. To determine whether nonspecific vaginitis occurs in sexually abused children, we obtained vaginal washes from 31 abused and 23 nonabused children, 21/2 to 13 years of age. A child was considered to have definite nonspecific vaginitis if her wash contained both clue cells and odor; she was considered to have possible nonspecific vaginitis if her wash contained either clue cells or odor. We did not use vaginal pH as a diagnostic criterion because the normal range has not been standardized in prepubertal girls. Possible nonspecific vaginitis (odor only) was found in only 1/23 (4%) of nonabused children. This girl was asymptomatic and findings from her examination were normal. Only one of the 31 abused children had possible nonspecific vaginitis (odor) detected at the initial examination, less than 48 hours after the episode of abuse, whereas 4/31 (13%) developed definite, and 4/31 (13%) possible nonspecific vaginitis at the follow-up visit more than seven days after the episode of abuse or rape. Five of these eight girls developed either a new vaginal discharge or dysuria; three were treated with metronidazole with resolution of their symptoms and reversion of the vaginal wash to normal.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Risk factors for prematurity and premature rupture of membranes: a prospective study of the vaginal flora in pregnancy.

Prematurity remains a major cause of perinatal mortality in the United States. Some research has indicated that infectious agents play a role in either initiating preterm labor, causing premature rupture of the membranes, or preventing tocolysis. This study attempted to determine if the presence of various vaginal pathogens in early pregnancy was associated with the subsequent development of premature rupture of membranes or preterm labor. We found that among 233 evaluable patients those with Trichomonas vaginalis were significantly more likely to have premature rupture of the membranes (p less than 0.03), and those with Bacteroides sp. were more likely to be delivered of their infants before 37 weeks (p less than 0.03) and to have infants weighing less than 2500 gm (p less than 0.05). Those with Ureaplasma urealyticum more frequently began preterm labor (p less than 0.05). Preterm premature rupture of the membranes was found significantly more often among patients with Bacteroides sp. Stepwise multiple logistic regression analysis indicated that those associations were not related to the number of previous abortions, deliveries, or preterm deliveries or to maternal age. We conclude that microbiologic screening in early pregnancy may aid in the assessment of patient risk for preterm delivery.

Adolescent↗
PubMed1982

Susceptibility of dermatiaceous fungi to amphotericin B, miconazole, ketoconazole, flucytosine and rifampin alone and in combination.

The dematiaceous fungi comprise a group of organisms that are deeply pigmented and found in soil or on decaying organic material, such as wood. The majority of infections with these fungi presumably results from traumatic inoculation. Although various forms of infection have been appreciated for some time, none of the presently available antifungal drugs have been shown to have predictable activity against these organisms. We report on the activity in vitro of various antifungal agents alone and in combination against various dematiaceous fungi.

Amphotericin B↗
PubMed1981

Susceptibility of multiply antibiotic-resistant pneumococci to the new beta-lactam drugs and rosaramicin.

Eight new beta-lactam antibiotics and rosaramicin were tested for their activity against penicillin-susceptible and multiply resistant pneumococci. All of the beta-lactam drugs were 50- to 150-fold less active against the drug-resistant pneumococci when compared with their activity against penicillin-susceptible pneumococci. Rosaramicin activity was similar to that of erythromycin.

Anti-Bacterial Agents↗
PubMed1981

Vancomycin and rifampin therapy for Staphylococcus epidermidis meningitis associated with CSF shunts: report of three cases.

Three patients with Staphylococcus epidermis meningitis associated with cerebrospinal fluid (CSF) shunt devices were treated with a combination of intravenous vancomycin and oral rifampin. Two of the isolates were methicillin-resistant. All patients had a favorable clinical response. Time-kill curves showed that the addition of rifampin to vancomycin resulted in enhanced bactericidal activity against all isolates when compared to either antibiotic alone. This finding suggests that the combination of oral rifampin and intravenous vancomycin may be useful in the treatment of methicillin-resistant and recalcitrant methicillin-sensitive S. epidermis meningitis associated with CSF shunts. In vitro susceptibility testing should be performed.

Aged↗