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Biomedical subjects

M E Jones

Publications and source records attributed to M E Jones.

At least 73 records · Page 4Linked to original sources
PubMed1999

Antimicrobial resistance among community-acquired pneumonia isolates in Europe: first results from the SENTRY antimicrobial surveillance program 1997. SENTRY Participants Group.

OBJECTIVE: The SENTRY antimicrobial surveillance program was established to monitor the occurrence and antimicrobial susceptibility of bacterial pathogens via an international network of sentinel hospitals. MATERIAL AND METHODS: Microorganisms were forwarded to the reference laboratory for testing against various antimicrobial agents using broth microdilution. Twenty European hospitals referred 286 Streptococcus pneumoniae, 309 Haemophilus influenzae, and 167 Moraxella catarrhalis isolates during the first 10 months of the study, starting in April 1997. RESULTS: Seven percent of the S. pneumoniae isolates were highly resistant to penicillin, and 21% showed intermediate resistance. The highly resistant pneumococcal isolates came from Coimbra, Barcelona, Athens, and London, whereas the intermediate penicillin-resistant isolates were received from all participating countries. The incidence of intermediate penicillin-resistant pneumococci was lowest in Lausanne, Freiburg and Duesseldorf, London, and Utrecht and highest in southern European countries. Fifty-five percent of the penicillin-resistant S. pneumoniae were also resistant to erythromycin, and 35% to clindamycin. Sparfloxacin, trovafloxacin, levofloxacin, and vancomycin were fully active against pneumococcal isolates. Haemophilus influenzae isolates were generally highly susceptible to most of the antibiotics tested, and 92% of the M. catarrhalis isolates were resistant to penicillin. Susceptibility to cephalosporins, ciprofloxacin, levofloxacin, and rifampicin was 100%. CONCLUSION: Penicillin may no longer be the first-choice drug for empirical treatment of pneumococcal infections. The newer fluoroquinolones may play a role in the empirical treatment of community-acquired pneumonia.

Anti-Bacterial Agents↗
PubMed1999

Standardized percentile curves of body mass index of Iranian children compared to the US population reference.

OBJECTIVE: To present standardized percentile curves of body mass index (BMI) for Iranian children, and compare these to the US population reference. SUBJECTS: 1599 boys and 1702 girls aged 2-18 y living in urban Tehran as a part of a random cluster sample survey of 1 in 1000 families throughout Iran. MEASUREMENTS: Heights (cm) and weights (kg) were collected by trained health staff. RESULTS: Standardized BMI reference curves for Iranian boys and girls were constructed. The curves are shown to fit the data well. The development pattern of BMI for boys and girls are compared. CONCLUSIONS: The major differences observed between Iranian and the US BMI charts underline the need for population-specific reference data. For children over six years the 5th and 95th percentiles of our data may be used provisionally as cut-off points for defining thinness and obesity for Iranian children and adolescents.

Adolescent↗
PubMed1999

Surgical treatment of locally recurrent malignant schwannoma of the lower leg.

This report describes a case of locally recurrent limb malignant schwannoma in a 74-year-old patient. The light microscopy and immunohistochemical findings are presented and current methods of surgical treatment reviewed. We describe treatment using wide local excision with frozen section control of the marginal nerves and present a 3-year follow-up.

Aged↗
PubMed1999

Resistance surveillance of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis isolated in the United States, 1997-1998.

A national antimicrobial resistance surveillance study was conducted from December 1997 to May 1998 to determine the prevalence of antimicrobial resistance in 6620 clinical isolates of Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis. In this centralized study, which involved 163 institutions located in 43 states, we determined MICs for representatives of five antimicrobial classes: beta-lactams (penicillin, co-amoxiclav, cefuroxime, ceftriaxone), macrolides (azithromycin, clarithromycin), co-trimoxazole, glycopeptides (vancomycin) and fluoroquinolones (levofloxacin). In most S. pneumoniae isolates, all antimicrobials were to be found active, but amongst penicillin-resistant isolates (MICs > or = 2 mg/L), resistance to other beta-lactams, macrolides and co-trimoxazole was common. For vancomycin and levofloxacin, however, activity was not associated with penicillin resistance. The prevalence of penicillin-nonsusceptible (intermediate and resistant) pneumococci was highest in the South Atlantic (44%) and East South Central (43%) regions and lowest in the Mid-Atlantic (28%) and New England (28%) regions. Resistance to beta-lactams, macrolides and co-trimoxazole was more commonly found amongst respiratory isolates than blood isolates and in strains from patients < or = 12 years old than from older patients. beta-lactamase, which was detected in 33% of H. influenzae and 92% of M. catarrhalis strains, did not affect the activity of the beta-lactams under study other than ampicillin. Certain agents, such as vancomycin and the fluoroquinolones, remain highly active, and well-designed surveillance systems that monitor MIC distributions would be needed to detect a potential for reduced susceptibility. In addition, surveillance programmes should be designed to collect information about associated resistance as well as differences in prevalence associated with region, specimen source and patient age.

Adolescent↗
PubMed1999

Predictors of birth outcome among Hispanic immigrant women.

Eliminating racial and ethnic disparities in health is a major goal of Healthy People 2010. Health care providers and institutions can address the specialized cultural expectations and needs of Hispanic Americans by assessing acculturation status of the population, an intervening variable in patient compliance, and health outcomes. This article reports on maternal acculturation status and the relationship to birth outcomes of 382 Hispanic pregnant women in the southwest United States. The majority of these women were Mexican-oriented and had healthy pregnancies and healthy birth outcomes. Findings support the hypothesis that traditional Mexican cultural practices serve protective functions for the childbearing woman.

Acculturation↗
PubMed1999

HIV and the returning expatriate.

Worldwide seroprevalence of the Human Immunodeficiency Virus (HIV) was estimated at 29.4 million at the end of 1996 with 75-85% of infections in adults transmitted through sexual intercourse, and by heterosexual intercourse in more then 70%. SubSaharan Africa is currently the area most heavily affected but over the past 5 years rapid spread of the virus has occurred in Asia. No developing country is free of HIV infection and HIV infection acquired abroad now accounts for most of heterosexually acquired HIV infection presenting in the (United Kingdom) UK, accounting for 25% of new HIV cases in the UK in the year to end March 1995 and 18% in the year to end March 1996, and at least 38% of new cases in Scotland in 1996.

Global Health↗
PubMed1999

Comparative activities of clinafloxacin, grepafloxacin, levofloxacin, moxifloxacin, ofloxacin, sparfloxacin, and trovafloxacin and nonquinolones linozelid, quinupristin-dalfopristin, gentamicin, and vancomycin against clinical isolates of ciprofloxacin-resistant and -susceptible Staphylococcus aureus strains.

The activities of eight fluoroquinolones and linezolid, quinupristin-dalfopristin (Synercid), gentamicin, and vancomycin were tested against 96 ciprofloxacin-susceptible and 205 ciprofloxacin-resistant Staphylococcus aureus strains. Overall, clinafloxacin, followed by moxifloxacin and trovafloxacin, was the most active quinolone tested. For all isolates, linezolid and quinupristin-dalfopristin showed activities that were at least comparable to vancomycin, with no cross-resistance to any other test compound.

Anti-Bacterial Agents↗
PubMed1999

Many class I integrons comprise distinct stable structures occurring in different species of Enterobacteriaceae isolated from widespread geographic regions in Europe.

Three sizes of inserted regions of DNA (800, 1,000, and 1,500 bp) were shown to be common among class I integrons in unrelated clinical isolates of Enterobacteriaceae from different European hospitals. Sequencing showed that 800-bp inserted regions comprised identical sequences including aacA4, that 1,000-bp inserted regions included aadA, and that 1,500-bp inserted regions included dfrI and aadA1, irrespective of host species and geographic origin. In addition promoter sequences were mostly identical for each size class. These data suggest that inserted gene cassettes and promoter regions of integrons are conserved and stable, with resistance genes transferred more often as part of the entire integron structure than as individual gene cassettes.

Base Sequence↗
PubMed1999

Emergence and spread in French hospitals of methicillin-resistant Staphylococcus aureus with increasing susceptibility to gentamicin and other antibiotics.

Oxacillin (methicillin) resistance in methicillin-resistant Staphylococcus aureus (MRSA) is associated with an increased incidence of resistance to other antibiotics, which has increased since it was first reported in 1969. In 1992 a new phenotype of MRSA arose in France; this was characterized by a heterogeneous expression of resistance to oxacillin and susceptibility to various antibiotics, including gentamicin but also tetracycline, minocycline, lincomycin, pristinamycin, co-trimoxazole, rifampin, and fusidic acid. In French hospitals a longitudinal nationwide surveillance of antibiotic resistance in S. aureus has allowed for the detection of changes in antibiotic susceptibility profiles. Seven French clinical laboratories (six from the mainland and one from the West Indies) reported the results of susceptibility testing of 57,347 S. aureus strains isolated in their institutes between 1992 and 1998. Over a 7-year period the incidence of isolation of gentamicin-susceptible MRSA (GS-MRSA) strains has steadily increased to represent, in 1998, 46.8 to 94.4% of the MRSA strains, irrespective of the overall incidence of MRSA. Two predominant types recognized by pulsed-field gel electrophoresis (PFGE) accounted for the majority of the GS-MRSA in different mainland hospitals, both differing from the predominant type observed in the French West Indies. Some GS-MRSA and gentamicin-resistant MRSA (GR-MRSA) strains had closely related PFGE profiles, and hybridization studies confirmed the lack in GS-MRSA of the aac6'-aph2" gene, which confers resistance to all aminoglycosides, with conservation of the ant4' gene, which confers resistance to kanamycin, tobramycin, and amikacin. Thus, it is likely that certain GS-MRSA strains could have emerged from GR-MRSA strains by excision or deletion of the aac6'-aph2" gene.

Cross Infection↗
PubMed1999

Two-point, timesaving method for measurement of gastric emptying with diagnostic accuracy comparable to that of the conventional method.

Solid-phase gastric emptying is linear. Therefore, the authors calculated gastric-emptying half-time, the time for half of the ingested solids or liquids to leave the stomach, with the conventional multiple-point method and the proposed two-point method (at 0 and 120 minutes) in retrospective and prospective studies of 50 patients each. The results showed excellent correlation. Results with the two-point method were comparable to those with the multiple-point method, and the two-point method substantially reduced technologist and camera times.

Adult↗
PubMed1999

Clinical outcome of cephalothin versus vancomycin therapy in the treatment of coagulase-negative staphylococcal septicemia in neonates: relation to methicillin resistance and mec A gene carriage of blood isolates.

OBJECTIVE: Coagulase-negative staphylococci (CONS) are the most common causative agents in neonatal nosocomial septicemia. Because of widespread methicillin resistance among CONS, empiric therapy with vancomycin is recommended as the primary antibiotic regimen for these infections. In our unit, empiric treatment of nosocomially acquired septicemia consists of cephalothin and gentamicin, which are adjusted subsequently according to the determined bacterial susceptibility profile. Vancomycin is initiated only when the patient has been treated recently with cephalothin or when intravascular lines or endotracheal tube are colonized with oxacillin/cephalothin-resistant CONS strains. The aim of the present study was to evaluate the efficacy of our antibiotic regimen for CONS septicemia, in relation to methicillin-resistance and the carriage of mec A gene, encoding methicillin resistance, among CONS blood isolates from our unit. METHODS: Clinical symptoms of septicemia, clinical outcome, and laboratory parameters of septicemia (C-reactive protein) were studied retrospectively in 66 patients with CONS septicemia. The diagnosis of septicemia was made by the attending neonatologist and was defined by clinical symptoms of septicemia in the presence of a positive finding of a blood culture test, which was performed using a defined protocol. All CONS blood isolates were included to determine mec A gene carriage. RESULTS: In the 66 patients, three treatment categories were distinguished: treatment with cephalothin (25 patients, 38%); with vancomycin (15 patients, 23%); and primary treatment with cephalothin, switched subsequently to vancomycin (26 patients, 39%). It was found that 92% of all CONS blood isolates (61/66) were mec A-positive. Concordance of mec A gene carriage with methicillin/oxacillin resistance was found in 56 of 66 isolates (85%); 10 of 61 (16%) isolates that were mec A-positive were determined as oxacillin-susceptible. Although 22 of the 25 blood isolates of the cephalothin-treated patients were mec A-positive, clinical recovery was uneventful. In the 26 patients in whom antibiotic therapy was switched from cephalothin to vancomycin, two strains were cephalothin-susceptible and 8 patients already had recovered clinically before the switch, which was based solely on susceptibility test results. CONCLUSIONS: Cephalothin was found to be clinically efficacious in the treatment of neonatal CONS septicemia, despite a steadily increasing mec A gene carriage of CONS blood isolates in our neonatal intensive care unit and a corresponding high methicillin/oxacillin resistance. Hence, cephalothin remained the antibiotic of first choice in the treatment of CONS septicemia in our unit, with vancomycin selected exclusively for cases not responding to initial cephalothin treatment, or for patients developing CONS septicemia during or after recent cephalothin treatment. By applying this approach in our unit, we were able to reduce vancomycin use from 62% in 1994 to 1995 to 21% in 1997. This shows that such a policy may result in an important reduction of vancomycin use, which may aid in postponing the threatening emergence of vancomycin resistance among Gram-positive cocci.

Anti-Bacterial Agents↗
PubMed1999

The prevalence of aminoglycoside resistance and corresponding resistance genes in clinical isolates of staphylococci from 19 European hospitals.

Aminoglycosides still play an important role in antistaphylococcal therapies, although emerging resistance amongst staphylococci is widespread. To further our understanding of the prevalence of aminoglycoside resistance in Europe, we tested 699 and 249 consecutive unrelated clinical isolates of Staphylococcus aureus and coagulase-negative staphylococci (CNS), respectively, from the SENTRY Antimicrobial Surveillance Program, for susceptibility to gentamicin, tobramycin, kanamycin and streptomycin, and examined the relationship between susceptibility to these antimicrobials and susceptibility to methicillin. Three hundred and sixty-three staphylococcal isolates demonstrated resistance to at least one of the aminoglycosides tested; all of these isolates were screened for the presence of aac(6')-Ie + aph(2"), ant(4')-Ia and aph(3')-IIIa, the genes encoding the most clinically relevant aminoglycoside-modifying enzymes. S. aureus isolates derived from hospital-acquired pneumonia tended to be more resistant to aminoglycosides and methicillin than isolates from blood or wound infections. In S. aureus, resistance to aminoglycosides was closely associated with methicillin resistance. Susceptibility of S. aureus to gentamicin has decreased by 9% from previous European studies to a current level of 77%, while susceptibility of CNS, currently at 67%, has increased by 21%. Geographical variation occurred, correlating with methicillin resistance, although intra-country variation was considerable. aac(6')-Ie + aph(2"), ant(4')-Ia and aph(3')-IIIa were found throughout Europe in 68%, 48% and 14% respectively of staphylococci resistant to at least one aminoglycoside. aph(3')-IIIa was considerably more common in methicillin-susceptible S. aureus and CNS isolates; the reverse was true for the other two resistance genes. The prevalence of ant(4')-Ia and aph(3')-IIIa genes in aminoglycoside-resistant staphylococci was significantly greater than that reported in previous European studies.

Acetyltransferases↗
PubMed1998

Bias in the standardized mortality ratio when using general population rates to estimate expected number of deaths.

Cohort studies often compare the observed number of cases arising in a group under investigation with the number expected to occur on the basis of general population rates. The general population is taken to represent unexposed persons, but it is almost inevitably biased in that it comprises all types of people including exposed ones. To identify circumstances when this bias matters, the authors modeled its effect in relation to the size of the observed standardized mortality ratio (SMR) and the prevalence of exposed individuals in the general population. The authors found that bias may be a major problem, causing substantial underestimation of the true relative risk, when either the prevalence of exposure in the general population or the SMR are large. The bias can cause an apparent trend in SMRs with age when none exists. It also places a limit on the maximum size of the observed SMR, no matter how large the true relative risk. A table is provided showing the extent of bias in different circumstances. Cohort studies of people with common diseases or exposures, or that find large SMRs, when using general population expectations, need to consider the extent of bias from this source.

Adolescent↗
PubMed1998

Clinical and molecular pathology of aggressive Schneiderian papilloma involving the temporal bone.

BACKGROUND: Inverting papilloma is a benign but locally aggressive sinonasal tumor that rarely involves the middle ear or temporal bone. METHODS: A report of a case and the molecular pathology of the tumor is presented. RESULTS: A 35-year-old woman with a history of recurrent inverting papilloma of the left paranasal sinuses was found to have evidence of extension through the eustachian tube and extensive involvement of the temporal bone. Surgical management resulted in the patient being disease-free at 14 months. Molecular pathology studies of the resected tumor suggest an association with human papillomavirus. CONCLUSIONS: Direct extension of the sinonasal tumor through the eustachian tube may represent the pathologic mechanism involved in the development of inverting papilloma involving the middle ear and temporal bone.

Adult↗
PubMed1998

Detection of staphylococcal genes directly from cerebrospinal and peritoneal fluid samples using a multiplex polymerase chain reaction.

A multiplex polymerase chain reaction (PCR) that can simultaneously detect eubacterial isolates and the methicillin-susceptibility of staphylococcal isolates from cerebrospinal and peritoneal fluid samples was compared to conventional microbiological methods. Using conventional methods, bacteria were isolated from 8% (29/350) of the cerebrospinal fluid samples and from 5% (3/60) of the peritoneal fluid samples. All isolates except two Staphylococcus epidermidis isolates were also detected using the multiplex PCR. Coagulase-negative staphylococci and Staphylococcus aureus were correctly identified using both methods. The multiplex PCR can rapidly and simultaneously detect eubacteria, and the methicillin susceptibility of staphylococci from samples containing > or = 10(2) cfu/ml of bacteria.

Ascitic Fluid↗