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Biomedical subjects

M E Jones

Publications and source records attributed to M E Jones.

At least 91 records · Page 5Linked to original sources
PubMed1998

Risk of congenital inguinal hernia in siblings: a record linkage study.

Using data from the Oxford Record Linkage Study (ORLS), we conducted a case-control study to estimate the sex-specific risks of inguinal hernia in siblings of children with this condition. There were 1921 male and 347 female cases born during 1970-86 who were operated on for inguinal hernia at ages 0-5 years during 1970-87, with 12,886 male and 2534 female control subjects. The relative risk of inguinal hernia was 5.8 [95% confidence interval 4.0-8.4] for brothers of male cases and 4.3 [2.1-8.7] for brothers of female cases (both relative to brothers of control subjects). The relative risk was 3.7 [1.8-7.9] for sisters of male cases and 17.8 [6.9-46.3] for sisters of female cases (both relative to sisters of control subjects). The pattern of sex-dependent risks, particularly the large risk for sisters of female cases, suggests a multifactorial threshold model for the disease. Girls have much lower rates of inguinal hernia than boys, and if these rates are low because of a low susceptibility to disease due to the absence of a sex-related risk factor, then those girls who develop disease might have a potentially large contribution to susceptibility from genetic or intrauterine risk factors unrelated to sex.

Case-Control Studies↗
PubMed1998

Prenatal risk factors for cryptorchidism: a record linkage study.

Using data from the Oxford Record Linkage Study (ORLS), we conducted a case-control study to examine prenatal risk factors for cryptorchidism. We identified 1449 boys born during 1970-86 for whom there was a record of an orchidopexy during 1970-87. Up to eight controls were matched to each case on year of birth and hospital or place of delivery. For each boy and his mother we extracted abstracts of maternity and general hospital records from the ORLS. Low birthweight (trend P < 0.001), low social class (trend P < 0.001), breech presentation (relative risk 1.67; 95% confidence interval [CI] 1.16, 2.41), pre-eclampsia (1.17 [1.00, 1.37]), artificial feeding (1.22 [1.04, 1.45]) and episiotomy (1.13 [1.00, 1.27]) were identified as independent risk factors for cryptorchidism. Gestational age was not independently associated with cryptorchidism after adjusting for birthweight (P = 0.33), and this observation suggested that some cryptorchid boys may have suffered from intrauterine growth retardation. Low birthweight, breech presentation and pre-eclampsia may have in common poor placental function and impaired fetal growth, which may be causes of cryptorchidism.

Bottle Feeding↗
PubMed1998

Second trimester fetal abnormality scans: do women know the reasons why they are done?

A 10 point questionnaire was given to 239 women attending for second trimester fetal abnormality ultrasound scans to explore their level of knowledge about the nature, purpose and limitations of the procedure. Questions were included about the conditions which could or could not be diagnosed, and about the accuracy and sensitivity of the procedure. Demographic data was also recorded. Two hundred and thirty-five forms were correctly completed. The percentage of women returning correct answers ranged from 58.8% to 100% and response rate was correlated with years of full time education in some questions. The results suggest that patients perceive the scan as a chance to see their baby and that many do not fully appreciate either the purpose or the limitations of fetal anomaly scanning. This may complicate the post-test counselling required if an abnormality is detected.

Journal Article↗
PubMed1998

Pre-natal and early life risk factors for childhood onset diabetes mellitus: a record linkage study.

BACKGROUND: Using data from the Oxford Record Linkage Study (ORLS) we conducted a case-control study to examine pre-natal and early life risk factors for childhood and adolescent onset diabetes mellitus. METHODS: We identified 160 boys and 155 girls born 1965-1986 and admitted to hospital with a diagnosis of diabetes during 1965-1987 in the ORLS area. Up to eight controls were matched to each case on sex, year of birth and hospital or place of birth. We linked the hospital records for each child to all of that child's hospital records and to his or her mother's maternity record. RESULTS: There were no significant associations between subsequent diabetes and birthweight, gestational age, birthweight for gestational age, maternal age and parity. There were increased risks with not breastfeeding (relative risk [RR] = 1.33; 95% CI: 0.76-2.34), and with diabetes recorded in the mother during pregnancy (RR = 5.87; 95% CI : 0.90-38.3), but these were not statistically significant. There was a significantly raised risk with pre-eclampsia or eclampsia during pregnancy (RR = 1.48; 95% CI: 1.05-2.10). CONCLUSIONS: Pre-eclampsia may be the result of an immunogenetic incompatibility between mother and fetus, and this early immunological disturbance might be related to incidence of diabetes in later life.

Adolescent↗
PubMed1998

Relationship between ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin and moxifloxacin (BAY 12-8039) MICs and mutations in grlA, grlB, gyrA and gyrB in 116 unrelated clinical isolates of Staphylococcus aureus.

The in-vitro activities of five fluoroquinolones were tested against 70 ciprofloxacin-resistant and 46 ciprofloxacin-susceptible unrelated isolates of Staphylococcus aureus. All 116 S. aureus isolates were studied for the presence of mutations in the grl and gyr loci. The order of efficacy of the fluoroquinolones tested, from least to most active, was: ciprofloxacin, ofloxacin, levofloxacin, sparfloxacin and moxifloxacin (BAY 12-8039), in response to all characterized mutations in grlA, grlB, gyrA and gyrB. Moxifloxacin was active against most S. aureus isolates tested (MIC90 = 1 mg/L for ciprofloxacin-resistant isolates) and was less influenced by known mutations.

Anti-Infective Agents↗
PubMed1998

The prevalence of low- and high-level mupirocin resistance in staphylococci from 19 European hospitals.

The topical agent mupirocin plays a crucial role in strategies designed to control outbreaks of methicillin-resistant Staphylococcus aureus. The extent of high- or low-level mupirocin resistance amongst S. aureus from European hospitals is not known. Six hundred and ninety-nine S. aureus and 249 coagulase-negative staphylococci (CNS) derived from blood, hospital-acquired pneumonia or skin and soft tissue infections from 19 European hospitals were tested for susceptibility to mupirocin and oxacillin. Methicillin sensitivity was found in 72% and 32% of S. aureus and CNS, respectively. High-level mupirocin resistance was detected in 1.6% of S. aureus and 5.6% of CNS isolates, while low-level mupirocin resistance was detected in 2.3% of S. aureus and 7.2% of CNS isolates. Amongst S. aureus, methicillin-resistant isolates were twice as likely to have high- or low-level mupirocin resistance. This difference was less pronounced in CNS. No relationship was found between the site of infection and prevalence of mupirocin resistance. High- and low-level mupirocin resistance was detected amongst staphylococci from 10 and 16 of the hospitals studied, respectively. To maintain the relatively low prevalence of mupirocin resistance in Europe amongst both S. aureus and CNS, the prudent use of mupirocin restricted to defined infection control strategies should be emphasized.

Anti-Bacterial Agents↗
PubMed1998

Class I integrons in Gram-negative isolates from different European hospitals and association with decreased susceptibility to multiple antibiotic compounds.

Class I integrons are associated with carriage of genes encoding resistance to antibiotics. Expression of inserted resistance genes within these structures can be poor and, as such, the clinical relevance in terms of the effect of integron carriage on susceptibility has not been investigated. Of 163 unrelated Gram-negative isolates randomly selected from the intensive care and surgical units of 14 different hospitals in nine European countries, 43.0% (70/163) of isolates were shown to be integron-positive, with inserted gene cassettes of various sizes. Integrons were detected in isolates from all hospitals with no particular geographical variations. Integron-positive isolates were statistically more likely to be resistant to aminoglycoside, quinolone and beta8-lactam compounds, including third-generation cephalosporins and monobactams, than integron-negative isolates. Integron-positive isolates were also more likely to be multi-resistant than integron-negative isolates. This association implicates integrons in multi-drug resistance either directly through carriage of specific resistance genes, or indirectly by virtue of linkage to other resistance determinants such as extended-spectrum beta-lactamase genes. As such their widespread presence is a cause for concern. There was no association between the presence of integrons and susceptibility to cefepime, amikacin and the carbapenems, to which at least 97% of isolates were fully susceptible.

Anti-Bacterial Agents↗
PubMed1998

The effect of reserpine, an inhibitor of multidrug efflux pumps, on the in-vitro activities of ciprofloxacin, sparfloxacin and moxifloxacin against clinical isolates of Staphylococcus aureus.

In Staphylococcus aureus, in addition to mutations in the grl and gyr gene loci, multidrug efflux pumps like NorA contribute to decreased fluoroquinolone susceptibility. Efflux pumps can be inhibited by the plant alkaloid reserpine, which, at 20 mg/L, reduced sparfloxacin, moxifloxacin and ciprofloxacin IC50s and MICs by up to four-fold in 11, 21 and 48 of the 102 unrelated clinical isolates tested, respectively. The effect was less pronounced with the hydrophobic drugs sparfloxacin and moxifloxacin than with the hydrophilic drug ciprofloxacin and was stable in all 25 clonally related isolates tested.

Anti-Infective Agents↗
PubMed1998

Where does culture fit in outcomes management?

The authors describe the concept of cultural competence and ways in which culture, a structure of care variable, is important to the delivery of culturally competent care. The role of culture in outcomes assessment and management is explored. The culture of the patient, the health care professional, and the organization is examined as it influences the potential to deliver culturally competent care. Strategies for developing a culturally competent work force are proposed with examples from ongoing projects in a large metroplex in the southwestern part of the United States.

Cultural Characteristics↗
PubMed1998

Typing of methicillin-resistant Staphylococcus aureus isolates from Düsseldorf by six genotypic methods.

Nosocomial infections caused by methicillin-resistant Staphylococcus aureus (MRSA) represent an increasing problem in hospitals. Quick and reliable typing methods are required to obtain information about the relatedness of MRSA isolates and to allow faster implementation of appropriate infection control measures. This investigation describes the distribution of MRSA isolates from 11 hospitals in the Düsseldorf region of Germany, and the ability of six different genotypic typing techniques -- pulsed-field gel electrophoresis (PFGE), random amplification of polymorphic DNA (RAPD), 16S-23S rDNA spacer amplification, protein A-gene PCR, PCR characterisation of the hypervariable region (HVR) adjacent to mecA, and coagulase gene-PCR -- to detect different unrelated types. Of 7814 S. aureus isolates tested, 489 (6.3%) were MRSA, of which 183 were selected for subsequent molecular analyses on the basis of being the first MRSA isolated from colonised or infected patients. Larger hospitals had a higher incidence of MRSA and a greater variability in genotypes than smaller hospitals. All methods confirmed the presence of two main clonal types. The ability of techniques to detect different unrelated types was found to be as follows: PFGE, 28 types; 16S-23S rDNA spacer-amplification, 10 types; RAPD, nine types; protein A-gene PCR, five types; HVR-PCR, five types; and coa gene-PCR, two types. Combination of PFGE and one other PCR-based method (spacer-amplification, RAPD or protein-A gene PCR) provided the best resolution of types and allowed the identification of subtypes. Similar molecular types were identified with international MRSA isolates. Although PCR-based techniques have the advantage of rapid performance and easy handling, their discriminatory capacity is inferior compared to the more labour intensive PFGE.

Bacterial Typing Techniques↗
PubMed1998

Reduction in cytokine release from human monocytes by modifications in cell wall structure of Staphylococcus aureus induced by subinhibitory concentrations of oxacillin.

Whole bacterial cells of Staphylococcus aureus as well as purified staphylococcal peptidoglycan (PG) have been demonstrated to stimulate human monocytes to release cytokines. Hypothesising that the phenomenon of changes induced by beta-lactam antibiotics in cell-wall composition may alter the immunological properties of the intact cell wall as well as of purified cell-wall components, this study assessed whether cytokine release by human monocytes is altered if cells from strains grown in the presence or absence of sub-minimal inhibitory concentrations of oxacillin are used as stimuli. Whole bacterial cells and isolated PG from these strains, grown in the presence of oxacillin, showed a significantly reduced stimulation of tumour necrosis factor-alpha, interleukin (IL)-1beta and IL-6 release by human monocytes in a concentration-dependent fashion. The serum-induced potentiation of cytokine production by human monocytes in response to PG with modified cross-linking was also reduced. These observations may have particular relevance for staphylococcal infections, in which clinically achievable beta-lactam concentrations do not suppress staphylococcal growth yet may alter and possibly enhance virulence.

Anti-Bacterial Agents↗
PubMed1998

Characterization of grlA, grlB, gyrA, and gyrB mutations in 116 unrelated isolates of Staphylococcus aureus and effects of mutations on ciprofloxacin MIC.

One hundred sixteen unrelated clinical isolates of Staphylococcus aureus (70 ciprofloxacin resistant and 46 ciprofloxacin susceptible) from eight countries were studied for the presence of mutations in the grlA, grlB, gyrA, and gyrB gene loci. Two mutations within grlA (located at codons 80 and 84) and two mutations within gyrA (located at codons 84 and 88) were clearly associated with ciprofloxacin resistance, although other mutations detected within the four genes studied may also contribute to decreased susceptibility.

Anti-Infective Agents↗
PubMed1998

PCR-ELISA for the early diagnosis of invasive pulmonary aspergillus infection in neutropenic patients.

AIM: To evaluate a newly developed aspergillus mitochondrial gene PCR-ELISA assay for the early diagnosis of invasive pulmonary aspergillosis (IPA) in neutropenic patients. METHODS: The aspergillus mitochondrial gene was chosen for the amplification target for use with a solution hybridisation assay with colorimetric end stage detection in microtitre plate format (PCR-ELISA). The study group comprised neutropenic patients undergoing febrile episodes not responding to standard antibacterial antibiotics. Patients underwent computed tomography and bronchoscopy. Bronchoalveolar lavage (BAL) fluids were examined by culture and PCR. RESULTS: The aspergillus mitochondrial gene PCR-ELISA was both sensitive (100%) and specific (100%) for IPA in neutropenic patients. All 12 patients with definite or probable IPA had PCR positive BAL fluids. None of the patients with undiagnosed or confirmed infections of other aetiologies were mitochondrial PCR positive. Speciation based upon amplicon size difference was possible. CONCLUSIONS: Aspergillus mitochondrial DNA PCR-ELISA on BAL fluid is useful in the early diagnosis of IPA in neutropenic patients alone or, potentially, as an indication for thoracic computed tomography.

Adolescent↗